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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
ASSESSMENT OF AN OLDER ADULT 3
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.
ASSESSMENT OF AN OLDER ADULT 4
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
ASSESSMENT OF AN OLDER ADULT 5
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
ASSESSMENT OF AN OLDER ADULT 6
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
ASSESSMENT OF AN OLDER ADULT 7
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
ASSESSMENT OF AN OLDER ADULT 8
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.
ASSESSMENT OF AN OLDER ADULT 9
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/
ASSESSMENT OF AN OLDER ADULT 10
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.
ASSESSMENT OF AN OLDER ADULT 11
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.
ASSESSMENT OF AN OLDER ADULT 12
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.
ASSESSMENT OF AN OLDER ADULT 13
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)
ASSESSMENT OF AN OLDER ADULT 14
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
ASSESSMENT OF AN OLDER ADULT 15
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
ASSESSMENT OF AN OLDER ADULT 16
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
ASSESSMENT OF AN OLDER ADULT 17
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
ASSESSMENT OF AN OLDER ADULT 18
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)