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THE OLDER ADULT: A

GLOBAL AND NZ PERSPECTIVE

Ida Shepherd

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LEARNING OUTCOMES• Discuss the international & national population growth

statistics of the older adult• Review & discuss NZ ageing research literature • Discuss what positive ageing is• Discuss the NZPAS and its significance • Identify the goals/objectives of the NZPAS and the HOPS• Identify the 3 types of ageing• Identify & describe the physiological changes with

ageing• Discuss the psychosocial changes of ageing and the

associated characteristics• Describe cognitive & memory changes in the OA & how

to keep brain healthy• Identify and describe several areas of assessment

criteria in detail

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AGING AND SELF REFLECTION... Nurses have differing views: OA’s are too much trouble OA’s are not usually a priority on the

ward OA’s take up too much time when we

could be looking after others OA’s require specialised care OA’s need time OA’s are a pleasure to look after OA’s regardless of age or illness are of

equal concern for all nurses

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YOUR VIEWS???1.How would you like to see older people treated?

What are some of the positive and negative experiences you’ve had with OA?

2.What do you think of your parents or grandparents? How would you like them to be treated?

3.Draw yourself at 80 years.

4.What concerns do you have about your old age? How would you like to be treated by nursing staff and others in the health discipline when your are 80 and in the hospital or ARC?

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DEMOGRAPHICS Fastest growing population group

Deaths and life expectancy Statistics on deaths record the number of deaths

registered in New Zealand each year. Life expectancy is an indicator of how long a person can expect to live on average given prevailing mortality rates

The following highlights are based on deaths registered in New Zealand:

There were 30,082 deaths registered in New Zealand in the year ended December 2011, comprising 14,823 male and 15,259 female deaths.

The median age at death in 2011 was 77.5 years for males and 83.2 years for females.

Life expectancy at birth was 82.2 years for females and 78.0 years for males, based on deaths in 2005–07 (from New Zealand life tables 2005–07).

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NOTE: THE PERCENTILES AND SHADING IN GRAPHS INDICATE THE CHANCE THAT ACTUAL RESULTS WILL FALL WITHIN THIS RANGE. BY 2036, WE EXPECT THAT BETWEEN 21 AND 24 PERCENT OF NEW ZEALANDERS WILL BE AGED 65+, COMPARED WITH 14 PERCENT IN 2012 (FIGURE 2). BY 2061, WE EXPECT THAT BETWEEN 22 AND 30 PERCENT OF THE POPULATION WILL BE AGED 65+. 

NOTE: THE PERCENTILES AND SHADING IN GRAPHS INDICATE THE CHANCE THAT ACTUAL RESULTS WILL FALL WITHIN THIS RANGE. BY 2036, WE EXPECT THAT BETWEEN 21 AND 24 PERCENT OF NEW ZEALANDERS WILL BE AGED 65+, COMPARED WITH 14 PERCENT IN 2012 (FIGURE 2). BY 2061, WE EXPECT THAT BETWEEN 22 AND 30 PERCENT OF THE POPULATION WILL BE AGED 65+. 

New Zealand’s population is ageing New Zealand is experiencing a significant change in the structure of its population. The number of people aged 65 and over (65+) has doubled since 1980, and is likely to double again by 2036 (Figure 1). The largest growth will occur between 2011 and 2036, as the baby boomers (those born from 1946 to 1965) move into the 65+ age group. 

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Note: The percentiles and shading in graphs indicate the chance that actual results will fall within this range.

By 2036, we expect that between 21 and 24 percent of New Zealanders will be aged 65+, compared with 14 percent in 2012 (Figure 2). By 2061, we expect that between 22 and 30 percent of the population will be aged 65+. 

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Within the 65+ age group, we expect the number of people aged 85 and over (85+) to increase significantly. By 2061, about one in four people aged 65+ will be 85+, compared with one in eight in 2012

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Like many other countries, New Zealand's population is ageing. This means more people, and a higher proportion of the population, will be in the older ages. An ageing population will dampen population growth, but there will be more households, partly because of the trend to fewer people in each household. This will be driven by more one-person and couple-only households.

The demographic projections were published by Statistics NZ between 2010 and 2012.

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GLOBAL POPULATION AGING MAPS Go to the following website to view

maps showing the proportion of population aged 60 or over in 2014 and 2050 and demonstrate the speed at which populations are ageing. http://www.helpage.org/global-agewatch/population-ageing-data/population-ageing-map/

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INCREASING DEMAND FOR COMMUNAL DWELLINGS Population ageing also contributes to the projected large increases in the number of people living in more communal, non-private dwellings (including retirement homes).

The number of people aged 80+ living in non-private dwellings is projected to roughly double between 2006 and 2031, from 23,000 to 43,000 – even allowing for increases in life expectancy and improved well-being, which would allow older people to live independently for longer.

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HOUSING HAS TO CATER TO OLDER PEOPLE’S NEEDS Because of increases in life expectancy and

improved well-being, there is likely to be a continued emphasis on ‘ageing in place’ – living in the community, with some level of independence, rather than in residential care.

As a result, one might expect strong demand for safe, warm, and affordable housing. Increasing numbers of older people, many of whom will be women on their own, will require housing which is secure and easily maintained, with access to public transport, health, and other services.

http://www.stats.govt.nz/browse_for_stats/population/estimates_and_projections/ageing-population-property-market.aspx#ageing

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ADULT RESIDENTIAL CARE (ARC) Features to assist older people include

smart assistive technology and modifications to help mobility, and range from video-entry phones and handrails to accessible driveways, ramps, and street-level entrances. Some of these are easier than others to retrofit to existing dwellings.

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ARC CLOSURES What factors do you believe have

contributed to the number of closures? Funding is one What does this mean for the future? Where do the OA’s go? From anecdotal evidence, many rest

homes included closing respite beds. What does this mean for caregivers? What happens if caregivers desperately

need a break and can’t get it? May lead to illness and OA abuse

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DEMOGRAPHIC FACTS OF AGING IN NEW ZEALAND At the 2001 Census there were 400 people aged 100

and over. In 2051, there are projected to be over 12,000 people

aged 100 and over (assuming an increase in life expectancy at birth of about six years between 1996, the base year for the projections, and 2051).

This ageing of the population will significantly change demand for health and disability support services in New Zealand

Consider: the complex interplay of changes in population age structure, health status, technological advances and social expectations in driving demand for, and the cost of, health and disability support services.

Increasing ethnic diversity amongst older New Zealanders

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Population ageing: Significant increases are projected for older Mäori, Pacific and Asian peoples.

The Mäori population is projected to grow to almost 1 million by 2051. By then Mäori aged 65 or more will make up approximately 10 percent of older people.The largest proportions of older Mäori will still be in the 65–74 age group, but

increasing numbers will be living to older ages. Pacific peoples will also increase as a proportion

of people aged 65 and over (from 1.6% in 2001, to 2.3% by 2016 and 4.4% by 2051).

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At the 2001 Census approximately 248,000 people affiliated with an Asian ethnic group. Of those, 3.3 percent were aged 65 and over

By 2016, 7.3 percent of the Asian community will be aged 65 and over, 2.2 percent will be 75 and over and 0.5 percent will be 85 and overhttps://www.health.govt.nz/system/files/documents/publications/stat_report_9.09pdf

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• Older people in New Zealand are fairly evenly distributed across the socioeconomic deprivation quintiles (NZDep2001). The distribution of older Māori is skewed toward the high deprivation end of the scale.

• Older Māori (female and male) aged 50+ years were more likely than their non-Māori counterparts to have no access to telecommunications or motor vehicles, not own their home and live in a crowded home.

SOCIOECONOMIC DETERMINANTS OF HEALTH

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HEALTH SERVICE UTILISATION People aged 65+ years, both males and females, were

significantly more likely to report that they had seen a GP in the past 12 months than were those in the age group of 50–64 years.

For all age groups, getting a routine check-up or health advice was significantly more common than any other reason for visiting a GP in the last 12 months.

Of those people who had visited a GP in the last 12 months, significantly more people among the older age groups had received 15+ prescriptions than had those aged 50–64 years.

Compared with younger age groups, older people were significantly more likely to report that they had used a public hospital or been admitted to one as a patient in the last 12 months, but were significantly less likely to report that they had seen a dentist or dental therapist, or an alternative health care provider.

Ministry of Health. 2011. Tatau Kura Tangata: Health of Older Maori Chart Book 2011. Wellington: Ministry of Health. (p. 13).

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HEALTH OF OLDER MAORICompared to other

ethnicities in NZ, Maori were found to:

Consume less than the recommended number of servings of vegetables and fruit per day.

Report doing physical activity. Be more likely to be overweight or obese Smoke Have a shorter life expectancy and healthy

life expectancy years Have higher hospitalisation and mortality

rates for all types of cardiovascular disease Have higher rates for almost all types of

cancer, except colorectal cancer Have higher hospitalisation and mortality

rates for chronic obstructive pulmonary disease

Have higher prevalence of doctor-diagnosed diabetes (over two-and-a-half times higher in Māori males aged 50–64 years than in their non-Maori counterparts)

Have higher rates for renal failure and lower limb amputation with concurrent diabetes

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Maori have been recognized in the Health of Older people Strategy (HOPS) because of the special relationship between Maori and the Crown and the government’s commitment to recognizing the Treaty of Waitangi and understanding of the holistic view of health held by many Maori in NZ.

Three key principles have been noted:• Partnership in service delivery• Participation at all levels of the health sector• Protection and improvement of Maori health

status and safeguarding Maori cultural concepts, values, and practices.

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RESIDENTIAL CARE Majority of OA NZ’ers live in their own homes until they die (Ageing

in Place strategy) By 2026, between 12,000 and 20,000 extra residents will require aged

residential care. Sector bed numbers need to increase by 78% to 110% by 2026 to

accommodate the projected increase in extra residents and to replace aging facilities.

Financial returns currently being generated for subsidised aged residential care operations are insufficient to support building new capacity and replacing aging stock. Approximately half of current stock is now over 20 years old.

Workforce demand is expected to increase between 50% and 75% (on an FTE basis) by 2026 –(trebling of the workforce). – pay? (AGED RESIDENTIAL CARE SERVICE REVIEW, 2010).

Right now, there are 690 ARC facilities in the country (on the decline) with 34. 247 beds running at a 92.5% occupancy. Facilities in NZ being used are from between 1910-2010.

Majority of ARC are privately owned (for profit – 76%) and 24% are not-for-profit. (Facility operated: Ind. 47%; Group 53%). Mixed service facilities are growing though (RH/HOSP/DEMENTIA/PSYCHOGERI)

A number of facilities run “swing beds” meaning that they have no formal delegation but are a RH/Hosp bed that skew bed numbers at the gov’t level. (Martin Taylor, NZACA Conference, 2013).

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HEALTH OF OLDER PEOPLE IN RESIDENTIAL CARE Older people in residential care (RC) were more likely to be

physically sedentary than their counterparts in private dwellings (PD).

Older adults are going in later in life, sicker and not staying long. Since 1988, the total population of the ‘oldest old’ in Auckland

increased by 112% The proportion of Maori residents is small and has changed very

little in the last 20 years The proportion of Pacific Island and Asian aged care residents has

increased The mean length of stay at the time of the census has decreased

for all residents in the last twenty years The proportion of residents with a length of stay less than 3

months at the time of the census has increased (11% to 13%) From 1998 to 2008, private hospital level residents with a length

of stay less than 3 months at the time of the census has increased (12% to15%).age of residents has increased from 83 to 86 years

(Boyd et al, 2009, Changes in Aged Care Residents’ Characteristics and Dependency in Auckland 1988 to 2008: Findings from OPAL 10/9/8 Older Persons’ Ability Level Census).

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EMPLOYMENT/JOB PROSPECTSResearch the following key terms:

aged care + nursing + jobs

Use Google and see what you find. Go into the assorted websites and view and

count up how many positions are available.

In 2013 – there were almost 400 RN positions around the country that were available in ARC.

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40 percent of the current workforce is aged over 50 and 5000 nurses are aged over 60. “New graduates are needed to take the place of the high number of nurses expected to retire in the next five to ten years.(NZNZ Press Release, Scoop Health News, November 2, 2010)

According to Lorraine Ritchie (NZNO):

-We are losing our home grown nurses in ARC and IQN who come to NZ are younger, here for a short time then leave.

-There are more unregistered care givers (URCG) (caregivers, HCA’s and nursing assistants) than registered (RN’s/EN’s)

-No mandatory code of conduct or set of national standards for URCG (NZACA conference, 2013).

-Remember that auditing drives compliance NOT quality of care. Part of that auditing is care planning & how effectively is that NCP being used?

-Care models (of which NZNO was part of promoting in NZ) - does ratios of 5:1 mean good care? Abuse of residents rife in the media.

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MODELS OF CARE Current bio-medical model outdated,

impractical, expensive, unfeeling, & impersonal – baby boomers want to be unique and treated like a person (not saying that those present in ARC do not)

Current models Eden Alternative (Dr William Thomas) Humanitas (Prof Hans Becker) The Abbeyfield Concept Selwyn Model (NZ)

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REALITIES Older people are living better, as well as

longer, with less disability.

Currently, most older people live on an income of under $20,000 per year.

A growing number of older people are doing paid work, either full or part-time.

Older people contribute through unpaid work and donate more of their time than younger age groups.

Age Concern (1999). Ageing is Living, p. 4.

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DISTINCTIVE FEATURES OF OLDER WORKERS' EMPLOYMENT Demographic profile Compared with employed people of all ages, older workers were

proportionately more likely to be: male rather than female (57 percent and 43 percent,

respectively) of European only ethnicity (89 percent) either New Zealand born (79 percent) or well established

migrants to New Zealand (18 percent) living in a rural area or a secondary/minor urban area (18

percent and 13 percent, respectively) less qualified - around one-quarter had no qualifications (24

percent) living as part of couple without adult or dependent children (59

percent) or living on their own (16 percent) married or partnered (77 percent) and living with an employed

spouse or partner (58 percent) self-employed rather than working as an employee (30 percent

and 70 percent, respectively).http://www.dol.govt.nz/publications/research/working-patterns/working-patterns_09.asp

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NZ’S HEALTH SPENDING Similar to other OECD countries NZ’s share of Gross Domestic Product (GDP) has risen above the OECD average. Govt health expenditures are defined to

include both acute and long term care (Bryant et al, 2004)

2010/2011 financial health spending in NZ = $13.1 billion

2010 - approx 5% GDP spent on health expenditure

By 2020 = 6.8% By 2040 = 8.2%

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Ageing is a development issue. Healthy older persons are a resource for their families, their communities and the economy.“

WHO Brasilia declaration on healthy ageing, 1996.

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CHANGING THE WAY HEALTHCARE IS DELIVERED TO THE OLDER ADULT… Current models of health care remain

heavily focused on episodic, often medicalised, service delivery and acute care.

Chronic and complex problems cannot be resolved through acute medical interventions, although they often play a part in the overall management of care. Contemporary public health models suggest a shift to secondary prevention, early intervention and ongoing management and support in primary and community care setting.

Consider: Aging in place Strategy Nay & Garratt, 2009

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Primary and community care have a obligation and commitment to keeping people well and providing them with the interventions, care and support that they need to maintain their life. A melding of primary and community care will require significant reorganisation and investment. They need to be strongly focused on providing comprehensive, integrated and coordinated care for individuals and their families. Nay & Garratt, 2009

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POSITIVE AGEING-AGE CONCERN, NEW ZEALAND-HE MANAAKITANGA KAUMATUA, AOTEAROA

What is Positive Ageing?

health financial security independence self-fulfilment personal safety security physical

environments.

Positive ageing includes physical, intellectual, emotional and spiritual wellbeing as well as the ability to be involved in social activities and the community. It involves feeling satisfied and having a sense of personal control over your life.Therefore…positive ageing means being free to contribute and participate in society whatever your age, as much as you wish to, with the respect and support of your family and community.

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THE NEW ZEALAND POSITIVE AGEING STRATEGY (2001) In 1999 the United Nations proclaimed

it The International Year of Older Persons & identified 5 principles that are key for enhancing the life of the older person. These are:

• Independence• Participation• Care• Self-fulfilment• Dignity

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THE NEW ZEALAND POSITIVE AGEING STRATEGY (2001) New Zealand took the lead and in 2001

developed the NZPAS in order to promote these principles.

It is a founding international document in which aims to promote the value of older people and affirms their importance the wider cultural context of New Zealand society.

All NZ government agencies have identified ways in their departments of how to contribute to the PAS action plan, thereby creating a society where the older adult is valued and are afforded the dignity in their senior years.

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GOALS OF THE NZPAS:1. Secure an adequate income for older

people.

2. Equitable, timely, affordable and accessible health services for older people

3. Affordable and appropriate housing options for older people.

4. Affordable and accessible transport options for older people.

5. Making older people feel safe and secure an can “age in place”.

6. Provide a range of culturally appropriate services allows choices for older people.

7. Making sure older people living in rural communities are not disadvantaged when accessing services.

8. Working toward an environment where people of all ages have positive attitudes to ageing and older people.

9. Elimination of ageism and the promotion of flexible work options.

10. Increasing opportunities for personal growth and community participation

1. Income

2. Health

3. Housing

4. Transport

5. Ageing in place

6. Cultural diversity

7. Rural

8. Attitudes

9. Employment

10.Opportunities

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YOU CAN SEE THE STRATEGY IN ACTION BY LOOKING AT THE 2007-2010 REPORT & PLAN:http://www.osc.govt.nz/documents/publications/nz-positive-ageing-strategy-2007-2010-highlights.pdf

Preparing for Positive Ageing:"The best way to ensure you are physically and mentally active in your older age is to start early by making it a part of everyday living." -Age Concern, 2006

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INFLUENCES ON POSITIVE AGEING1. Personal factors2. Interpersonal factors3. Social & cultural experiences4. Lifestyle & health5. Income6. Housing & living arrangements7. Home support services8. Rehabilitation & injury prevention services9. Community resources10. Transport11. Local & central government policies & services12. Rural issues13. Gender issues Read Module Two “Influences on positive ageing” pp. 26-28 in

Ageing is Living: An education and training resource to prepare for positive ageing, Rev. ed., 2005, Age Concern.

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HEALTH OF OLDER PEOPLE STRATEGY (HOPS) -2002Follows in the footsteps of the NZPAS.Overview:

Health and disability support programmes for older people tend to be planned, funded and provided in a piecemeal fashion resulting in service gaps and overlaps and overlaps in some areas and inconsistent access criteria.

The primary aim of the strategy is to develop an integrated approach to health and disability support services that is responsive to older people’s varied and changing needs. The integrated continuum of care, means that an older person is able to access needed services at the right time, in the right place and from the right provider.There are 8 objectives, but the key elements of this strategy are:

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THE INTEGRATED CONTINUUM OF CARE FROM THE HOPS The following eight objectives identify areas where

change is essential if the vision is to be achieved.

1. Older people, their families and whanau are able to make well-informed choices about options for healthy living, health care and/or disability support needs.

2. Policy and service planning will support quality health and disability support programmes integrated around the needs of older people.

3. Funding and service delivery will promote timely access to quality integrated health and disability support services for older people, family, whanau and carers.

4. The health and disability support needs of older Maori and their whanau will be met by appropriate, integrated health care and disability support services

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THE INTEGRATED CONTINUUM OF CARE FROM THE HOPS (CONT’D)

5. Population-based health initiatives and programmes will promote health and wellbeing in older age.

6. Older people will have timely access to primary and community health services that proactively improve and maintain their health and functioning.

7. Admission to general hospital services will be integrated with any community-based care and support that an older person requires.

8. Older people with high and complex health and disability support needs will have access to flexible, timely and co-ordinated services and living options that take account of family and whanau carer needs.

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RURAL OLDER ADULTSHOMELESS OLDER ADULTS

What happens to those who choose to remain in a rural home?

What can contribute to OA’s becoming homeless?

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HOMELESS ADULTS Choice: Shelters generally cannot provide safety

protection Personal belongings: Travel light – own little Pets: Are socially excluded so would rather share

food and companionship with a dog Health hazards: Have difficulty in accessing

medical care, so... Poor diet = increased risk of infection

Control in a shelter: told what to do – show up late, miss out

Shelters -Night time only- kicked out in a.m. rain or shine

Addictions: some have drug &/or ETOH addiction or maybe coming off

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NORMAL CHANGES WITH AGING

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DISCUSS THE FOLLOWING:

Primary aging

Secondary aging

Functional aging

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PHYSICAL CHANGES IN AGING General survey – Physical appearance-age, sexual

development, LOC, skin colour, facial features

Body structure-stature, nutrition, symmetry, position, posture, body build and contour, physical deformities

Mobility- Gait, ROM Behaviour- Facial expression, mood and

affect, speech, dress, personal hygiene

Refer to: Lewis (2015) & Jarvis Physical examination and Health assessment (2012)

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REVIEW AGE-RELATED CHANGES AND ASSOCIATED CLINICAL MANIFESTATIONS

3rd (2012) & 4th(2015) eds 6th ed and pocket companion (2012)

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GERONTOLOGICAL DIFFERENCES IN ASSESSMENT

CHAPTER5-PP 68-73 LEWIS 3RD ED

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Review all the systems: Cardiovascular Respiratory Integumentary Urinary Reproductive Gastrointestinal Musculoskeletal Neurological Visual Auditory Immune Refer to Lewis’s Med/Surg 3rd ed (2012)

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PART 2Changes in

aging:

Biological & Psychosocial

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THEORIES OF AGEING:

Biological Theories address the anatomic and physiologic

changes occurring with age. Psycho-Social Theories explain the thought processes and

behaviors of aging persons.

Psychological changes can be influenced by a number of factors

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BIOLOGICAL REF LEWIS (2011) PP. 67-69

Stochastic vs Non-stochastic theories.

Stochastic theories propose that ageing is due to chance; due to genetic damage.

Non-stochastic theories propose that ageing occurs due to no-chance; gene regulated and therefore influence molecules and cells.

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PSYCHOSOCIAL DEVELOPMENT AGEING THEORIES & PERSPECTIVES

1. Disengagement Theory

2. Activity Theory

3. Continuity Theory

4. Person-Environment Fit Theory

5. Lifecourse Perspective

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PSYCHOSOCIAL DEVELOPMENTS Retirement from workforce may offer new

options for use of time. People need to cope with personal losses

and impending death (Erikson) Relationships with family and close friends

can provide important support. Search for meaning in life assumes central

importance.

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ADULT DEVELOPMENTAL STAGE THEORIESBROWN & EDWARDS (2009), P. 65-66.

Erikson Psychosocial Conflict:

Integrity versus despair

Major Question: "Did I live a meaningful life?"

Basic Virtue: Wisdom

Important Event(s): Reflecting back on life

Peck Havinghurst Levinson

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DISTINGUISHING FEATURES OF LIFE EVENTS OF THE OA: They usually involve losses, rather than

gains. They are likely to occur close together, with

less time available to adjust to each event. They are longer lasting and often become

chronic problems. They are inevitable, evoking a feeling of

powerlessness.

From: Miller, 2004, p. 140.

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JUST LIKE THERE ARE INFLUENCES ON (+) AGEING, THERE ARE RISK FACTORS THAT CAN AFFECT PSYCHOSOCIAL FUNCTIONING…

Poor physical health Impaired functional abilities Poor social supports Lack of economic resources An immature developmental level The occurrence of unanticipated events The occurrence of several daily hassles at the same

time The occurrence of several major life events in a short

period of time High social status and high feelings of self-efficacy in

situation that cannot be changed Having a rigid set or narrow range of coping skills People who cannot realistically appraise a situation

From: Miller, 2004, p. 148.

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INTERRELATEDNESS AMONG THE LIFE EVENTS OF OLDER ADULTHOOD

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BRAIN HEALTH!!!

Hedden & Gabrieli

(2004) recommend:

Stay intellectually engaged

Maintain cardiovascular physical activity

Minimize chronic stressors

Maintain a brain-healthy diet

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PART 3

Assessment & Chronicity

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CONSIDER: Barthel assessment ADL’s IADL’s 3 D’s

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ASSESSMENT AREAS PERTAINING TO THE OLDER ADULT

→ physical → psychosocial → spiritual → functional → sexual (if sexually

active with multiple partners)

→ psychological → financial → nutritional → biochemical

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FUNCTIONAL INDEPENDENCE MEASURE

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MEDICATION ASSESSMENT Medicines are important therapeutic tools for living well in later life,

but there are also risks that increase with age. At least 94% of older adults >65 take medications.

Older adults use more medicines than other age groups, and are at increased risk of serious adverse drug events for a number of reasons.* The prevalence of drug use increases even more for those >75.

In addition, most older adults live with at least one chronic condition, take multiple medicines, have more than one prescribing healthcare provider and use at least one pharmacy. Ageing interferes with pharmacokinetics & pharmacodynamics .

Studies show important gaps in patient-provider communication about medicines, which can contribute to improper medicine use.(Felix’s story)

Older age must be taken into account when recommending specific medicines and initial dose.

Strengthening efforts to educate older adults and their caregivers about medicine use and encouraging them to be active partners in their healthcare is essential to guard against medicine use related problems.

QUESTION: What can we do as nurses in assessing the meds our patients use?

From: Fact Sheet: Medicine Use and Older Adults (2010) http://www.mustforseniors.org/

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What questions would you ask when assessing the patient’s medication management?

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MINI MENTAL STATUS EXAM ORFOLSTEIN TEST The mini-mental state examination

(MMSE) or Folstein test is a brief 30-point questionnaire test that is used to assess cognition.

It is commonly used in medicine to screen for dementia.

In the time span of about 10 minutes, it samples various functions, including arithmetic, memory and orientation.

It was introduced by Folstein et al in 1975,[1] and is widely used with small modifications.

Practice this exam with colleagues, family, friends

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General Practitioner cognitive screening tool (Patient Examination) Informant Interview

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SIGNIFICANCE OF CLOCK DRAWING DURING ASSESSMENT Representative illustration of common

types of clock-drawing errors.

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GERIATRIC DEPRESSION SCALE

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Geriatric Depression Scale

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