Gerontology: Assessment and Ethical Concerns

Gerontology: Assessment and Ethical Concerns

Gerontology studies currently predict that the number of people above the age of 65 will double within the next thirty years (Miller, Zylstra & Standridge, 2000). This will place a substantial strain on medical resources as geriatric patients develop age-related illnesses. It is thus important for physicians to develop efficient geriatric assessment tools and understand the various ethical concerns that arise in treating older adults.

The assessment of older patients differs in a number of ways. Most significantly, the geriatric assessment focuses on intellectual impairment, immobility, instability, incontinence, and iatrogenic disorders (Elsawy & Higgins, 2011). These are the most prevalent problems faced by elderly patients and are often missed in a standard medical evaluation. The treatment of geriatric patients also differs in scope. Due to the complex problems faced by elderly patients, often exacerbated by mental illnesses, the assessment emphasizes the functional status and quality of life and generally involves an interdisciplinary team of healthcare providers.

A comprehensive geriatric assessment focus current symptoms and illnesses and their functional impact, medications, past illnesses, recent life changes, social functionality and current living environment (Elsawy & Higgins, 2011). It tries to place the patient's illness into a social aspect. It includes objective measures of cognitive status, mobility and balance, emotional health, nutritional status but also ascertains the family situation and assistance availability.

The health history consists of both present and past illnesses. The assessment team of physicians will prompt the patient for severity and persistence of current symptoms and record childhood diseases, hospitalizations, medications and diet. Other components of the health history include a social history charting relationships, vocation and most importantly sleep, exercise, recreation, and habits of drug consumption. A family history that maps the presence of disease with recognized familial importance including diabetes, hypertension, allergies, heart disease and neurological or psychiatric diseases are also identified. Signs of osteoporosis and arthritic are also assessed in order to measure the risk of falling (Miller, Zylstra & Standridge, 2000).

There are a number of assessment tools that are specifically designed for the evaluation of older adults. Wallace and Fulmer describe the SPICES tool, which tests for the common syndromes requiring nursing intervention (2007). The acronym stands for sleeping disorders, problems with eating or feeding, incontinence, confusion, evidence of falls and skin breakdown. The validity and reliability of this tool has been confirmed in a series of studies. The Charlson Comorbidity Index (CCI) is another tool frequently used with older adults (Charlson, Pompei, Ales & Mackenzie, 1987). It is comprised of 19 comorbid conditions that give a complete indication of the patient's state of health.

The basic activities of daily living (ADLs) include bathing, dressing, toileting, transferring, continence, feeding, communication, visual capability and walking. These functions are assessed through direct examination of the specific activity. Instrumental activities of daily living (IADLs) are those needed to live an independent life. They include the functional ability to shop, prepare food, clean house, do laundry drive or use public transportation and administer medications. These functions are assessed through house visits and as a cumulative evaluation of general geriatric assessment and psychiatric assessment tools.