Running head: ASSESSMENT OF AN OLDER ADULT 1

PRNU 112 Assignment: Assessment of an Older Adult

Courtney Banks

Vancouver Island University

ASSESSMENT OF AN OLDER ADULT 2

Introduction

The World Health Organization defines the social determinants of health as

“conditions in which people are born, grow, live, work and age.” They are health promoting

factors that influence health status. This includes our basic needs for survival such as food and

housing, as well as our psychosocial needs such as support networks. In this assignment, I will

be interviewing an older adult and recognizing which of the Determinants of health they are most

supported by, and which they are most challenged by. I will also be documenting my findings

from the interview and comparing the health patterns of this senior to Gordon’s Functional

Health Patterns, which identifies the ‘norms’ for healthy aging.

Part B Selecting and Identifying a Senior Client

The older adult I have chosen to interview for this assignment is a seventy-one-

year-old female. This woman is a type II Diabetic and has chronic Arthritis but other than that is

over all quite healthy, as she is still a very active individual. She lives in a home in Nanaimo

with one of her three sons, she also has eleven grandchildren and is the primary caregiver to two

of those children.

As said in the Eliopoulous text on page sixty-five, as you age your reaction and response

time becomes slower. As well as ability to focus, and the transmission of information to the brain

is altered. Keeping these things in mind during my conversation to creative effective professional

communication I plan to allow adequate time for her to process and respond to the questions I

will be asking her. I will also be asking open ended questions, which is a strategy that

encourages more than just a yes or no answer and also encourages free verbalization. My client

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is in Erik Erikson’s Integrity versus Despair stage of adulthood which is explained as, “the last

stage of human development, which begins at about 60 years of age. Older Adults continue to

look forward but now also look back and begin to reflect on their life” (Taylor 2015 p 429).

Part D Post Interview Investigation

Appendix 1-3, Gordon’s Functional Health Patterns, explains the normal and expected

patterns of health in older adults. In my interview with my client I used Appendix 1-2, Gordon’s

Health Pattern Assessment Questions to assess my clients over all heath patterns. I then

compared them to see what differed from the expected ‘norms’.

Health Perception/ Health Management

This health pattern includes general health patterns and maintenance. Some patterns I

found in my interview that differed from the expected norms are, she does not have annual

doctor visits, she has a recent history of a fall and her general health is effected by chronic

diseases, which include Diabetes and Arthritis.

Nutritional-Metabolic Pattern

Nutrition and metabolic pattern includes daily food and fluid intake and healing patterns.

My client maintains the expected balanced diet and does not have trouble swallowing or

chewing. However, a few things that differ from the norms are she has Diabetes so she has to be

extremely careful with certain foods, such as sugars. Due to her Diabetes her wounds do not heal

quickly or completely. Another thing that differs from the expected norms is her fluid intake, it is

recommended to have 1.6- 2.5L/day and my client told me she usually only has a cup or two.

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Elimination Pattern

Adequate fluid intake is needed to lower risk of bladder infections or constipation. My

client shared with me that she only drinks one or two cups of water in a day which could put her

at risk for these things.

Activity-Exercise Pattern

My client explained to me that she has chronic painful Arthritis that can sometimes make

her activity level difficult. She finds things such as stairs or steep hills to be very strenuous

activities because of this pain.

Sleep-Rest Pattern

Although it is considered normal for older adults to have trouble sleeping and require naps

during the day, I found that my client does not have trouble going to sleep and does not need

more rest throughout the day.

Cognitive-Perceptual Pattern

My client falls into a few of the norms of this category, which include sensory

impairment such as decreased vision or hearing, and chronic pain which is caused by her

Arthritis. Another norm in this category is decreased or changes in memory, which is not

something that relates to my client. When I asked her she explained that she does not feel like

her memory or her ability to learn new things has been altered over the years.

Self- Perception-Self-Concept Pattern

This category is about how someone views themselves, feelings of accomplishment and

possible regrets or wishes. My client expressed that she feels happy with who she is.

Role Relationship Pattern

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I did not find anything under this category that differed from the expected norms during

my interview. As the primary care giver of two of her grandchildren, my client has a very strong

role in her family. She has a very strong network of friends and family.

Sexuality- Reproductive Pattern

Something I noticed that differed from the norms in my client is that she does not have an

intimate partner. She explained to me that she has been separated from her husband for ten years

and did not have a significant other in her life.

Coping- Stress- Tolerance Pattern

This is a very important category because of how common depression is in the elderly. I found

that my client does not have a good way of relieving stress or someone to talk to in times of

stress. She explained to me that she doesn’t like to bother people with her problems.

Value Belief Pattern

It is very common for peoples spiritual beliefs to increase with age. My client does not

differ from any of the norms in this category because she explained to me that she has just

recently begun attending church every Sunday.

I will now be identifying specific priority health patterns from Gordon’s Framework, that

stood out to me from my interview and matching them to the relevant Health Determinant. The

problem that stood out to me most after interviewing my client was her coping and stress

tolerance. She told me she does not have anyone to talk to about her stress because she would

feel like a burden to them. This falls under the Individual Health Practices and Coping skills

health determinant. Taking into consideration that she does not want to talk to other people about

her problems, the community resource I found would me most helpful for me to suggest to her

was Stretch and Relax Yoga for seniors in Nanaimo. This is class for seniors that focuses of

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relaxation, and could be an effective way for my client to relieve stress without having to feel

bad about seeking a friend for help to relieve stress (City of Nanaimo).

Another health problem I have identified in my client is that she does not have sufficient

financial funds, she lives with her son because she cannot afford her own home and she

explained to me that she does not feel financially stable. This is a common problem for many

older adults who do not have an old age pension. This ties in with the Income and Social Status

health determinant. Luckily there are many financial assistant programs in BC for older adults,

one of the ones I looked into is called Income Assistance, this would be a good suggestion for

my client because it is simply displayed online about how to apply and how to receive, and it

would just require her visiting the Government of BC website.

Something else that stood out to me is that my client is still raising two children, she

explained to me that she is happy to do it because she loves her Grandchildren, but does get very

tired sometimes. This relates to the Social Support Networks determinant of health, because

raising children requires support. I think having any extra support would be beneficial for my

client, I was able to find a toll-free phone line for Grandparents raising Grandchildren in the BC

Seniors Guide. This phone line is for Grandparents to call at any time to receive any type of

support or resources to provide them with the help they need while raising children.

Along with raising children, my client is still working almost every day as a babysitter so

that she has enough money to care for her Grandchildren. This is another important priority heath

problem. She explained to me that she enjoys working but because if her Arthritis she feels she

won’t be able to much longer. This is related to the Employment and Working Conditions health

determinant. I previously mentioned that there are many financial assistance opportunities for

low income seniors, and I was able to find another one in the BC seniors guide that would

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benefit my client called Senior’s Supplement. This “is a monthly payment to low-income

seniors” (BC Senior’s Guide p 105).

The last priority problem I identified while interviewing my client was her management

of her chronic Arthritis pain, which I would consider one of the most important problems

because it is affecting her daily life. During the interview when I asked my client about her pain

and how she manages it she told me that she usually takes a Tylenol, but that she does not feel

like it really helps her. When I suggested she go to the doctor or the hospital to get something

prescribed, she told me she doesn’t know if she has enough medical coverage and would not be

able to afford it if she didn’t. She was not properly educated on her health care plan and it is

affecting how she manages her pain which relates to the Health Services health determinant. The

best suggestion I found that I could give my client would be a link to the BC Government

website. The have information on this site about health plans and insurance coverage. Managing

pain is so important because “untreated pain in older adults can result in disrupted sleep patterns,

altered social activities, and a decline in their ability to complete the routine activities of daily

living” (Taylor 2015 p 1166).

Part E Reflections

The health determinant my client is most supported is Social Environments. Along with

children and grandchildren living with her, she has a strong group of friends and a social network

at church, which she attends every Sunday. It is very common for senior’s social network to

decrease with age and can even result in social isolation, which is not the case with my client.

Health Services is the determinant my client is most challenged by because her chronic

pain alters her life on a daily basis. This pain prevents her from doing things, as well as making

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everyday activities strenuous, such as walking up stairs. As I mentioned previously, chronic pain

can eventually result in a variety of physical challenges.

Conclusion

In completing this assignment, I have gained insight on the importance of assessing all of

an individual’s health patterns, and a better understanding of what is considered normal

development of older adults. Along with this, I discovered how relevant the Determinants of

Health are when assessing health and how they relate to Gordon’s Health Patterns.

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References

BC Seniors Guide. (n.d.). Retrieved from

http://www2gov.bc.ca/assets/gov/people/seniors/about-seniorsbc/guide/bc-seniors-guide-11th-

edition.pdf

Eliopoulos, C. (2014). Gerontological Nursing. Philadelphia. 2014.

Income Assistance – Province of British Columbia. (n.d.). Retrieved from

http://www2.gov.bc.ca/gov/content/family-social-supports/income-assistance

Lillis, C & Lynn, P & Taylor, C. (2015). Fundamentals of Nursing. Dickinson, S.

Philadelphia. McAllister, L.

Rec 60+ Parks and Recreation. (n.d.). Retrieved from

https://www.nanaimo.ca/assets/Departments/Parks-Rec-Culture/Leisure-Guide/

AG_HCSeniors.pdf.

WHO What are social determinants of health? (n.d). Retrieved from

http://www.who.int/social_determinants/sdh_definition/en/

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Part C Appendix 1-2: Gordon’s Functional Health Patterns Assessment Questions

Health Perception/Health Management: Describes the client’s perceived pattern of health

and well-being and how health is managed

1. How is your general health? Aside from diabetes and arthritis, good.

2. Any significant illness in the past 3 years? No.

3. Any significant accidents? Fell down and fractured foot.

4. What do you to keep healthy? Eat properly, exercise occasionally.

5. What resources do you access to keep healthy? Gym membership, Swimming at the pool.

6. What are your patterns of compliance/non-compliance to health practices?

7. Any safety issues? No.

8. Any allergies? No.

Nutrition/ Metabolic: Describes the client’s pattern of food and fluid consumption

relative to metabolic need and pattern indicators of local nutrient supply

1. Describe your typical daily food and fluid intake. 1 or 2 cups of water. 6-7 small meals.

2. Any significant weight or height gain or loss in the past year? No.

3. Any difficulties with eating, chewing or swallowing? No.

4. Any diet restrictions? Diabetic, so avoids carbs and sugars.

5. Any skin problems-dryness, itching, lesions? No.

6. How quickly do you heal from an injury? Slowly, due to Diabetes.

7. Any food allergies? No.

Elimination: Describes patterns of excretory function (bowel, bladder, and skin)

1. Describe the frequency and characteristics of your stool. Once a day, formed.

2. Describe the frequency and characteristics of your urine. Pale yellow, 8 times a day.

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3. Do you have any problems with perspiration? No.

Activity/Exercise: Describes patterns of exercise, activity, leisure, and recreation

1. Describe a typical day and week of activity. Gym once a week, swimming once a week.

2. Do you have sufficient energy to complete your regular activities? Not always.

3. What is the most strenuous activity that you do? Stairs because of Arthritis pain.

4. Are you able to complete your ADLs without difficulty? Most days.

5. Are you still working? Babysitting 5 days a week.

Sleep Rest: Describes patterns of sleep, rest, and relaxation

1. How many hours of sleep do you get each night? 7 hours.

2. Do you feel rested in the morning? Yes.

3. Do you have any sleep rituals? No.

4. Do you require anything to help you sleep? No.

5. Do you take any sleep or rest breaks during the day? No.

Cognitive Perceptual: Describes sensory – perceptual and cognitive patterns

1. Describe the acuity of all your senses and the need for any aids. Hearing aids, glasses.

2. Have you noticed any changes in your memory or your ability to retain information? No.

3. Have you noticed any changes in your ability to learn new things? No.

4. Can you describe the process you used to make a significant decision?

5. Do you have any acute or chronic pain, if so, how do you manage it? Arthritis. Takes Tylenol.

Self-Perception/ Self Concept: Describes the client’s self-concept pattern and perceptions

of self

1. How would you describe yourself? Happy, busy.

2. Have you experienced any changes in how you feel about yourself? No.

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3. Have you experienced any changes in the things that you can do? No.

4. What role does hope play in your life? Faith (religion).

5. Are there specific things that frequently make you angry, sad, or depressed? She feels

underappreciated by her son, who’s children she is raising.

Role Relationships: Describes the client’s pattern of role engagements and relationships

1. Can you describe your immediate family structure? Children, Grandchildren.

2. Who would you identify as the significant people in your life? Children, Grandchildren.

3. How do you perceive your role in the family? Raising grandchildren still.

4. Who consists of your social network? Friends.

5. How would define or describe your social community? Friends and people at church.

6. Do you feel you have sufficient financial resources? No, lives with son who pays for most

things.

Sexuality/Reproductive: Describes the client’s patterns of satisfaction and dissatisfaction

with sexual pattern; describes reproductive pattern

1. When did you complete menopause? (women) 65.

2. What things are important to you in defining your sexuality?

3. Are you satisfied with the level of intimacy in your life at this time?

Coping/Stress Tolerance: Describes the client’s general coping pattern and the

effectiveness of the pattern in terms of stress tolerance

1. Have there been any significant changes in your life in the past year? Ex husband died this

year.

2. What are the stressors in your life? Still raising children.

3. How do you manage your stress? Tries not to worry about things she can’t change.

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4. Who do you turn to at times of stress? No one, she said she doesn’t want to bother others with

her problems.

5. Who or what is most helpful in managing your stress?

Values/Beliefs: Describes patterns of values, beliefs (including spiritual), and goals that

guide the client’s choices or decisions

1. Can you identify any important values and beliefs that impact how you maintain a sense of

health and wellbeing?

2. Does religion play a role in your life? Christianity/Faith.

3. Do you feel that you are spiritual person? (describe) Yes, she has faith in God and goes to

church every Sunday.

4. Do you have any specific plans for the future? Traveling. She wants to take her grandchildren

to Disneyland.

Appendix 1-3: Gordon’s Functional Health Patterns

Health Maintenance Pattern

General health during past year

Doctor check-up annually & prn

Dental check-up q 6 month or annually and prn

Immunization and vaccination annually and prn

see - http://www.phac-aspc.gc.ca/im/is-cv/index-eng.php#b

Safety (grab bars for bath tub, no throw rugs)

Interacts with social supports (family, friends, volunteers, community)

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Ht, Wt BMI see link to Health Canada below for BMI information (scroll to question

#2) http://www.hc-sc.gc.ca/fn-an/nutrition/weights-poids/guide-ldadult/qa-qr-pub-

eng.php

Older adults 65 years and older the 'normal' BMI range may begin slightly above BMI

18.5 and extend into the 'overweight' range. (Health Canada. Canadian Guidelines for

Body Weight Classification in Adults. Ottawa: Minister of Public Works and

Government Services Canada; 2003.) Retrieved Jan. 12, 2010, from above web site.

Nutritional-Metabolic Pattern

Eats balanced nutritious diet see Canada Food Guide (link below) recommendations

http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/order-commander/index-eng.php

Calories ~ 1600- 1800 (women), ~ 2400 (men)

Smaller protein intake with meals

Increased fibre intake with meals (fruit, vegetables, whole grains)

Absorption of iron, calcium and vitamin B12 is reduced.

Increase calcium intake in food &/or supplement(1500 mg/day)

Increase vitamin D supplement (min 800 IU/day)

Decrease phosphorous intake (to prevent calcium excretion) avoid cola drinks, processed

foods and red meats

Decrease intake of caffeine and alcohol to decrease further excretion of calcium

Frequent smaller meals and snacks

Maintains adequate fluid intake ~ 1.6 – 2.5 L/day

* Note: many older adults have reduced appetite

Elimination Pattern

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Reduced bladder capacity

Intermittent stress incontinence

Possible urgency incontinence

Possible nocturia

Adequate fluid intake needed to reduce risk of bladder infections and urinary

incontinence related to UTI

Potential for constipation increased with reduced fluid and fibre intake

Voiding every 2 – 3 hours while awake

Avoid bladder irritating substances i.e. caffeinated, carbonated and acidic beverages

Avoid concentrated urine which causes urgency with increase water intake

Activity-Exercise Pattern

Level of activity will match and carry over from level of activity in middle age

Exercise within natural capabilities

Muscle size decreased along with a reduction in strength, endurance and flexibility

Activity is enjoyed as tolerated. May require rest periods.

Activity is imperative to retain present function and prevent further physical decline

Activity is assessed on an individual basis

Assess current

May use assistive devices to mobilize (cane, walker, scooter)

Level of Activity –

Level of Function – explain

Self care level – independent, intermittent assistance, regular assistance,

Respiratory- rate, rhythm, breath sounds – does respiratory status impede activity

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Gas exchange/skin colour

Cardiac, circulation – pulse, notice any swelling in extremities

Tissue Perfusion – cap refill

Sleep-Rest Pattern

Requires ~ 5-7 hours

May wake frequently results in fragmented sleep, decreased time in stage 4 (REM)

May need more rest

May sleep for shorter periods of time

May have problems getting to sleep

May retire to bed earlier and be awake earlier

May or may not require naps during the day

Cognitive-Perceptual Pattern

Sensory impairment i.e. decreased vision/hearing

May use glasses or hearing aids other assistive devices

Pain (new, acute or chronic)

Decreased or changes in memory

Eye check-up annually (ophthalmologist)

Self-Perception-Self-Concept Pattern

Views self as healthy or self identifies areas of health concerns or problems

Sees self as involved in life and participating at level of capability

May have some regrets or ‘wishes’ but overall enjoys life

Erikson stage – integrity versus despair

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Feels fulfilled, like contributed or accomplished something, otherwise may feel

unfulfilled

Resources and supports used (friends, family, community)

Role Relationship Pattern

Relationship with family and friends

Roles fulfilled in connections with others

Volunteer, advisor, child care giver, mentor, working, wife, sister, brother, father,

grandparent, friend, lover

Connected with family and or community

Isolated by choice or feeling lonely – difference

Sexuality- Reproductive Pattern

Feeling about topic of sex and sexuality

Children/grandchildren/great-grandchildren

Friends

Lovers

Intimate friendships or partnerships

When menstruation stopped

Hysterectomy (with or without oophorectomy)

Prostate problems? (TURP)

Breast self exam, Testicular self exam

(Orchidectomy?)

Coping-Stress-Tolerance Pattern

General status of emotions, upbeat, calm, pleasant, sad, depressed

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Early use of resources may result in better coping (friends, family, social resources,

community contacts)

Stress relieving strategies used in past

Stress relieving strategies used presently

Depression in the elderly is widespread, often goes undiagnosed and untreated

Suicide rates increase with age

Value Belief Pattern

Spiritual values and beliefs may increase as one ages

Trusting that there is a Divine Order may be comforting

Religion and spirituality are personal and vary

Kohlberg – II Conventional (Law and Order), III Post-conventional (Social Contract

Legalistic Orientation) or (universal ethical principle orientation)