MIDTERM

EXAM

NCM 114 RLE:

BSN 3RD YEAR 1ST SEMESTER MIDTERM 2023
WEEK 7 -11
Bachelor of Science in Nursing
INSTRUCTOR: RI Z Z A FR A N C I S C O RN , MA N

Midterm Topics: INSTRUMENTAL ACTIVITIES OF DAILY LIVING

 Fuctional Assessment
 Fuctional Assessment tool for older - Are the basic daily activities needed to live
adult independently in the community – shopping, food
 Katz indez of independence in Activities of preparation, cooking, using the telephone, doing
Daily Living laundry, housekeeping, managing medications,
managing finances, maintaining a home and
property, performing duties of employment or
FUNCTIONAL ASSESSMENT OF OLDER ADULTS volunteer work, and traveling (driving or using public
or private transportation systems).
 Functional status can change within an individual
from time to time, depending on the factors such as
PSYCHOLOGICAL FUCTION
control of symptoms, progression of the disease, and
- is assessed by measuring cognitive mental and
mood
 Involves determining an individual’s level of affective functions independently
independence in performing ADLs and instrumental SOCIAL FUNCTIONING
activities of daily living (IADLs) -includes social interactions and resources, subjective
 Explores the skills the patient possesses to meet well-being and coping, and person-environment fit.
basic requirements such as eating, washing, dressing,
toileting, and moving. Characteristics of functional decline in older persons
 examines the skills beyond the basics that enable the
individual to function independently in the community, The incidence of chronic conditions increases with age
such as the ability to prepare meals, shop, safely use (arthritis, hypertension, heart disease, hearing
medications, clean, etc. impairment, orthopedic impairment, and cataract)
 Persons can be totally independent, partially
independent, or dependent in their ability to perform A. Persons over 65 years of age use approximately one-
these activities third of available physician resources, and one-
 Katz Index of Independence in Activities of Daily fourth of total medications prescribed, and they
Living constitute more than two-fifths of acute hospital
admissions.
FUCTIONAL ASSESSMENT TOOL B. In 2002, there were an estimated 35.6 million (12.3%)
people age 65 or older, and it was estimated that
FUCTIONAL ASSESSMENT 2% of the population was age 85 and older. By
2030, there will be about 71.5 million older persons.
- is a comprehensive evaluation of the physical and The 85+ population will increase from 4.6 million in
2002 to 9.6 million in 2030 and 19 million by 2050.
cognitive abilities required to maintain
C. Functional decline, as measured in Activities of Daily
independence. Assessment tools provide objective
Living (ADLs) and Instrumental Activities of Daily
measures of physical health, activities of daily living
Living (IADLs), is more prevalent with age (20% of
(ADLs), instrumental activities of daily living (IADLs),
older persons over 65 years require assistance with
and psychological and social functioning. In a
ADLs; 45% of older persons over 85 years require
narrower sense, function can be defined as “the
assistance with ADLs).
ability to function in the arena of everyday living”.
ACTIVITIES OF DAILY LIVING (ADL) Comorbid conditions that might impact negatively on the
functional status of an older adult.
- Are the basic daily activities of bathing, dressing,
toileting, continence, transfer / mobility, grooming, A. Acute illness
and feeding. The Katz ADL Index has been the B. Alteration in nutrition and / or hydration
most reliable and easy to use. It gathers information C. Chronic illness
by observation on bathing, dressing, toileting, eating, D. Delirium
transferring, continence, and grooming. E. Dementia
F. Economics
G. Environment
H. Medications
NICOR, THEA KAYE NATHALIE BSN3C
I. Psychiatric comorbidities, especially LAWTON INSTRUEMENTAL ACTIVITIES OF DAILY LIVING
depression  has been useful in rehabilitation settings to
J. Psychological / social stressors. monitor improvements over time. IADLs are
those activities whose accomplishment is
A variety of instruments and methods are available for necessary for continued independent residence
conducting functional assessment on the older adult: Katz
in the community. The independent activities of
Activities of Daily Living index (ADL), the Barthel
Instrumental Activities of Daily Living index (IADL), daily living are more sensitive for subtle
PULSES Profile, SPICES, and the Older American functional deficiencies than the ADLs. It
Resources and Services (OARS) assessment. differentiates among task performances
including the amount of help and amount of time
KATZ ADL needed to accomplish each task.

 The Katz ADL Index has established reliability

and is easy to use. It was first developed in 1963
by Dr. Sidney Katz, who wanted to find a way to
measure function and how it changed over time
in older people who had progressive chronic
illnesses. It has been modified and simplified
and different approaches to scoring were used
from categorical scoring (yes/no), to point
scaling (independent, some assistance, or
dependent). There were no formal reliability and
validity reports in the literature; however, it is
used extensively to assess functional
capabilities of older adults at home and in the
clinical setting. The Katz inventory is useful in
creating a common language about a patient’s
function for all care givers involved, evaluating
older adults according to levels of independence.
A number of adapted versions are in use
today.

NICOR, THEA KAYE NATHALIE BSN3C

PULSE PROFILE asked to rise from a chair, stand still momentarily,
then walk toward the wall and turn around, walk
This instrument measures general functional back to the chair, turn around and sit down. Undue
performance in mobility and self-care, medical slowness, hesitancy, abnormal movements,
status, and psychosocial factors. The acronym is staggering, and stumbling are considered
useful for remembering the components:
abnormal and indicate that the patient is at risk of
P = Physical Condition
falling. Other investigators have categorized this
U = Upper Limb Function
test by time requirement (<20 seconds; 20 – 39
L = Lower Limb Function
seconds; >40 seconds). Physical performance
S = Sensory Components
tests have some advantages over self-report
E = Excretory Functions
measures such as the ADLs and IADLs) including
S = Support Factor
better reproducibility, greater sensitivity to change
SPICES and ability to predict pre- clinical impairment.
is an acronym for the common syndromes of the
older adult requiring nursing intervention:
- S is for Sleep Disorders;
- P is for Problems with eating or feeding;
- I is for Incontinence;
- C is for Confusion;
- E is for Evidence of Falls; and
- S is for Skin Breakdown.
Developed by Terry Fulmer, PhD, RN, FAAN, at New
York University, Division of Nursing, SPICES is an
appropriate instrument for obtaining the information
necessary to prevent health alterations. Psychometric
testing has not been done. The instrument has been
used extensively to assess and prevent most frequent
health problems of older adults at the following
healthcare facilities: Yale University Medical Center,
and the New York University Medical Center Scoring:
If the syndrome screens positive, refer to evidence-
based practice protoco

E. The Older American Resources and Services

(OARS) assessment for physical function is similar
in scope of measurement to the Katz scale,
including bathing, dressing, grooming, and
continence. However, unlike the Katz instrument,
OARS relies on self report, therefore, this tool may
be less valid than observations of performance.

F. Timed “Get-Up and Go” Test measures the

ability to walk. This is a simple, validated, and
practical assessment of balance function, yielding
information on independence in ambulation
with efficiency and ease of use.. Subjects are

NICOR, THEA KAYE NATHALIE BSN3C

CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER MIDTERM 2022

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