At about the same time, a friend who teaches at an associates degree in nursing program told me about her need to revise an assignment that had previously been called 'the well elder paper.' In that assignment, the first year/first semester nursing students were charged with interviewing an older adult who was not in an acute or long-term care setting.
My friend and her colleagues had decided to modify the assignment, to make it possible for the students to conduct the interview in the clinical setting to which they had been assigned. Some students have been assigned to acute care hospitals, while others have been assigned to rehabilitation and long-term care facilities, for their first clinical rotations of the program.
It has fallen on my friend to draft the details of the assignment, and the due date loomed near. I offered to help, and she gratefully accepted.
Since nursing education is my area of concentration in the online program at Ol' Saint Joe's, I figured I'd get a head start on some future assignment in one upcoming course or another. This is what I came up with.
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Assignment
Interview and assess an older adult who has been assigned to you, paying primary attention to their functional health status; and to how their current functional health status affects their perceived quality of life, ability for self care, and subjective independence. Focus on their activities of daily living and instrumental activities of daily living. Consider how their current acute illness or injury, if applicable, has affected their functional status; identify the prognosis and plan for recovery and rehabilitation, if applicable; and identify the presence or absence of support from family, friends, community, and other resources. Finally, conduct a physical assessment of your patient's feet, and identify any actual or possible relationships between this specific aspect of your physical assessment and the patient's overall level of independence and functional health status.
Reporting requirements
- Minimum 3 pages, maximum 5 pages, typed, single-spaced, no title/cover page
- Due date: Month/date
- Health assessment, primary data
- Functional health status, functional health assessment
- Aging, the older adult
- Quality of life
- Self-care, independence
- Activities of daily living (ADL's)
- Instrumental activities of daily living (IADL's)
- Lawton and Brody IADL Scale
I tried to think what could be accomplished in this visit. She was in good condition for her age, but she faced everything from advancing arthritis and incontinence to what might be metastatic colon cancer. It seemed to me that, with just a forty-minute visit, Bludau needed to triage by zeroing in on either the most potentially life-threatening problem (the possible metastasis) or the problem that bothered her the most (the back pain). But this was evidently not what he thought. He asked almost nothing about either issue. Instead, he spent much of the exam looking at her feet.- - - - -
“Is that really necessary?” she asked, when he instructed her to take off her shoes and socks.
“Yes,” he said. After she’d left, he told me, “You must always examine the feet.” He described a bow-tied gentleman who seemed dapper and fit, until his feet revealed the truth: he couldn’t bend down to reach them, and they turned out not to have been cleaned in weeks, suggesting neglect and real danger.
Gavrilles had difficulty taking her shoes off, and, after watching her struggle a bit, Bludau leaned in to help. When he got her socks off, he took her feet in his hands, one at a time. He inspected them inch by inch—the soles, the toes, the web spaces. Then he helped her get her socks and shoes back on and gave her and her daughter his assessment.
from “The Way We Age Now” by Atul Gawande
Required reading, tools, and resources
Craven and Hirnle (their selected text for nursing fundamentals)
- Chapter 25 “Health Assessment of Human Functions”
- p. 378, table 25-1 “Comparison of Functional Health, Head to Toe, and Body Systems Frameworks”
- pp. 381-388, “Obtaining Subjective Data: the Interview”
- pp. 409-411, “Lifespan Considerations – Adult and Older Adult”
- Chapter 19 “The Older Adult”
- Chapter 33 “Self-Care and Hygiene”
- p. 710, Table 33-1 “Levels of Self-Care”
- p. 711, Table 33-2 “Index of Independence in Activities of Daily Living”
- p. 720, Table 33-5 “Common Foot Problems”
- Lawton and Brody, Instrumental Activities of Daily Living Scale
- available here (pdf) - Graf, “The Lawton Instrumental Activities of Daily Living (IADL) Scale” in Annals of Long-Term Care, ISSN: 1524-7929 Volume: 15 Publication Date: Jul 01 2007 Issue Number: 7
- available here - Gawande, “The Way We Age Now” in The New Yorker April 30, 2007
- available here - Boston Partnership for Older Adults (BPOA)
- Functional Assessment Tool for Primary Care Physicians
