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The paper is about Gerontologic Nursing- Brief history of the client; including the medical history, social history

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Gerontologic Nursing

Introduction

The term geriatric assessment being a diagnostic process, often include both evaluation as well as management. The scope of comprehensive geriatric assessment mainly include multidisciplinary approach which aims to identify, the underlined limitations related to physiology, psychology, and functions in older person. The overall objective of the assessment is to achieve accurate health information based on which a coordinated plan to maximize the health with aging can be developed. Well, it should be noted that the geriatric problems are often distinct from those categories which are organ based diseases or have multifactorial causes. The key elements included within the scope of evaluation the cognitive, social, environmental, physical, and spiritual components which have the effect to modulate the older adult’s health (Kalsi, Babic-Illman, Ross, 2015). 

Scope of the present report

In the present report, the focus is on the details of geriatric assessment. For a clear overview, a case study of an adult (Mr. Charles) from the local community is selected. The information thus presented in this report are based on health information obtained with the help of the family members, the community nurse, and the healthcare professionals who are in close contact with Charles. 

The framework for conducting the assessment

The comprehensive geriatric assessment (CGA) is mainly relies on the team consisting of nurse, social work, clinician, and other professionals including the nutritional list, psychologist, optician, podiatrist, pharmacist, dentist, and occupational therapist. According to Evans et al (Evans, Sayers, Mitnitski, 2014), in recent time the team performing CGA program is also referred as virtual. This means that the team member will include the professionals according to the requirement and the assessment information. Furthermore, the recommendation and careful considerations prescribed by one professional must be open to another professional during their evaluation (Ward, & Reuben, 2016). In this way the extensive assessment and careful consideration of health improvement can be performed for elderly person. The rendered care by the CGA team can be described as following:

1. Gathering data based on assessment and intercommunication among the professionals. 

2. Discussion of the patient health related information. This include patient as well as caregiver with the CGA team member. 

3. Development of specific treatment plan with patient and/ or with caregiver, according to the requirement. 

4. Implementation of the treatment plan. 

5. Monitoring and assessment of the plan. Discussion among the team members and implementation of change in the plan, if required. 

6. Record of patient information. 

The assessment model for an individual mainly based on the age, the health conditions, and the factors affecting the health. Based on the information collected from Mr. Charlie, it was revealed that the CGA process, first comprises of a tool which include questionnaires (Ramani, Furmedge, & Reddy, 2014). The importance of the questionnaire is to obtain critical information the professionals required, as well as is the time saving method to gain more information. In particular these are focused on the criteria such as:

• The ability to perform self-task and the requirement of assistance in the routine activity

• The history of fall 

• Any occurrence of pain or discomfort 

• Difficulties in visual, hearing and Cognitive abilities

• The social environment Including the family members, friends, and community members

According to the family members, it was revealed that the majority of evaluation was focused on the assessment of processes such as related to, the functional capacities, the risk of fall, cognition related abilities, polypharmacy associated with routine life, the social support system the financial issues, and any preferences related to the care framework (Corre, Greillier, Le Caër, 2016). 

Importantly, in addition to this components, it is also important identify the factors which are related to the social or psychological routines. These mainly includes the nutritional orientation, the sexual function, living situation, the social context, and the spirituality. Since, the health of adult is not only based on the physiological conditions, but are also affected with the social, economic, and psychological means; and hence the assessment of these issues are also vital. Note that, the key objective of all these assessment is to develop a framework with which the health management and orientation two words healthy life can be achieved. 

Individual focus

The most important aspect for duration of good health is to develop a plan to meet the requirement of functional status of the elderly individual. In this case analysis, the functional status was mainly described which three levels, the basic activities including the routines of daily life. The instrumental activities and the advanced activities of the routine life (Partridge, Harari, Martin, 2014). 

For example, the tasks such as dressing, batting, going to toilet, grooming, transferring of material from one place to another, feeding and maintaining the continents are considered as basic activities.  The instrumental activities describe the independence of the elderly person. For example repairing, doing laundry, taking medicines, handling the financial issues, using telephone and public transportation, are included within this scope. The advanced activities in this concentration is judged by the abilities, such as using telephone, using internet, and keeping a schedule of the activities. The questions from all the aspects of routine life, providing the information related to the preferences, likes, and the requirements of elderly person. However, based on the assessment, the corresponding pretty professionals requested within the functionality of CGA team are adjoined with the patient condition (Partridge, Harari, Martin, 2017). 

The assessment outcomes

Based on the assessment outcomes for Mr. Charlie, following health information has been gained:

• The overall health consideration is appropriate however, there are some difficulties with the instrumental activities of routine life. 

• Mr. Charlie do not like the assistance provided by outsiders, rather his preferences are to seek help from the family members. 

• Mr. Charlie previously had a friend circle, however in recent time, he's not happy because of lacking a friend circle.

• He uses spectacles for vision and hearing aid for routine activities.

• She have a good record of performing proper assessment on monthly basis. The routine physiological functioning and assessment records show a good health track record. 

• There is a limited-time devoted to routine physical activities, and the nutritional consideration is also not proper.

Other important issue that are relevant to be discussed are explained in the following points:

 

• There is no acute or chronic medical disorder identify. Moreover, it is also found that no search cases exist as in family history. 

• Mr. Charlie have no record for medication in conjunction to any complications. In the present case, the complication is found mainly related to loneliness and that no symptoms for depression or anxiety is identified. Thus, none of the medical professionals have prescribed any medication, but recommended social interaction and physical activity necessary. 

• The functional status is found to be normal which include mobility, ability to perform routine tasks, cognition ability, and normal hormonal level. 

• The main frame of the problem exists in lack of social interaction and boredom them in the routine life. In addition to this, the problem also exists in lack of quality time spend by the family members. 

• The living situation is normal, as Mr. Charlie can perform the routine activities with minimal assistance. However, there are certain irregularities in the timing of food (or meal). 

It should be noted that, Mr. Charlie do not have a family history for chronic disorder. However, the current status of health is primarily affected with psychological conditions. These includes, lack of friend circles lack of company from family member, and no specific engagement into any activities. Thus, it is clear that the health condition is primarily affected with the psychological requirement and not with any diseased conditions (Avelino-Silva, Farfel, Curiati, 2014). 

Development of plan

Based on the assessment outcomes, development of a plan that aims to improve the health condition of Mr. Charlie was proposed. In particular, the primary rule assigned in this plan is to a social worker and a community nurse. In this case, no medication was recommended as the issue is only related to loneliness, but no symptoms of depression or anxiety was found. 

Since Mr. Charlie is in perfect condition to provide information and discuss the issues, the condition was discussed with him as well as with the family members. From the family perspectives, it was discussed that spending quality time among the family member is indeed helpful for maintaining a good health. In addition to this, the suggestion to join the community club to Mr. Charlie was provided. The support to spend time with activities of interest and hobbies are also discussed. The overall objective of this plan was to engage game such a back the mental health can be maintained as normal (Evans, Sayers, Mitnitski, 2014). 

The recommendation from other professionals include, timely management of food with a balanced consideration for all type of nutrients. Importantly, it was also recommended that mr. Charlie most engaged more than 60 minutes per day in proper physical activity. This include walk as well as other activities. For monitoring and assessment, the social worker have responsibilities to perform weekly assessment and record the information. It right monthly meeting with the CGA team is scheduled such that discussion of the current health status and any changes in the plan can be implemented. 

Conclusion

In summary, the present report illustrates a comprehensive geriatric assessment from an elderly person within the community. The importance of geriatric assessment is to identify social, psychological, physical, and any other important factor that have potential to affect the health. From the assessment point of view, it comprises of a team with multidisciplinary specialization. Overall, within the process, it is important to maintain the communication and coordination among the family members with that of patient and the caregiver. Based on the assessment in the given case, it was realized that the health condition of elderly person is affected not with any physical but with mental condition. The issue is related to loneliness and lack of company from family member. The corresponding development plan discuss this issue with the family member and provide a recommendation to the elderly person, to join the community club and get engaged into activities of interest. Other beneficial recommendation include nutritional guideline and routine physical activity (Balsinha, Marques, & Gonçalves-Pereira, 2018). Overall, it is learned that CGA not only focuses on the conditions that affect health of elderly people, but effectively plan to control and improve the life quality.

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