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F ulm er S PIC ES: A n O vera ll A ssessm en t T o ol f o r O ld er A dult s www.m an ag ed healt h care co nnect.c o m /a rtic le /6 911 B est P ra ctic e s in N urs in g C are to O ld er A dult s fr o m T he H artfo rd In stit u te fo r G eria tr ic N urs in g, N ew Y ork U niv e rs it y , C olle ge o f N urs in g I s su e N um ber 1 , R evis e d 2 007 S erie s E dit o r: M arie B olt z , M SN , A PR N, B C , G NP M anagin g E dit o r: S herry A . G re enberg , M SN , A PR N, B C , G NP N ew Y ork U niv e rs it y C olle ge o f N urs in g _ _________________________________________________________________________________________________________ W HY: N orm al a gin g b rin gs a bout in evit a ble a nd ir re ve rs ib le c h anges. T hese n orm al a gin g c h anges a re p artia lly r e sp onsib le fo r th e i n cre ase d r is k o f d eve lo pin g h ealt h -re la te d p ro ble m s w it h in th e e ld erly p opula tio n. P re va le nt p ro ble m s e xp erie nce d b y o ld er a dult s i n clu de: s le ep d is o rd ers , p ro ble m s w it h e atin g o r fe edin g, in co ntin ence , c o nfu sio n, e vid ence o f fa lls , a nd s kin b re akd ow n. F am ilia rit y w it h th ese c o m monly -o ccu rrin g d is o rd ers h elp s th e n urs e p re ve nt u nnece ssa ry ia tr o genesis a nd p ro m ote o ptim al fu nctio n o f th e a gin g p atie nt. F la ggin g c o ndit io ns fo r fu rth er a sse ssm ent a llo w s th e n urs e to im ple m ent p re ve nta tiv e a nd th era peutic in te rv e ntio ns ( F ulm er, 1 991; F ulm er, 1 991). B EST T O OL: F ulm er S PIC ES, d eve lo ped b y T e rry F ulm er, P hD , A PR N, F A AN a t N ew Y ork U niv e rs it y C olle ge o f N urs in g, is a n e ffic ie nt a nd e ffe ctiv e in str u m ent fo r o bta in in g th e in fo rm atio n n ece ssa ry to p re ve nt h ealt h a lt e ra tio ns in th e o ld er a dult p atie nt ( F ulm er, 1 991; F ulm er, 1 991; F ulm er, 2 001). S PIC ES is a n a cro nym fo r th e c o m mon s yn dro m es o f th e e ld erly r e quir in g n urs in g i n te rv e ntio n: S is fo r S le ep D is o rd ers P is fo r P ro ble m s w it h E atin g o r F eedin g I is fo r In co ntin ence C is fo r C onfu sio n E is fo r E vid ence o f F alls S is fo r S kin B re akd ow n T A RG ET P O PU LA TIO N: T he p ro ble m s a sse sse d th ro ugh S PIC ES o ccu r c o m monly a m ong th e e ntir e o ld er a dult p opula tio n. T here fo re , th e in str u m ent m ay b e u se d fo r b oth h ealt h y a nd fr a il o ld er a dult s . V A LID IT Y A ND R ELIA BIL IT Y: T he in str u m ent h as b een u se d e xte nsiv e ly to a sse ss o ld er a dult s in th e h osp it a l s e ttin g, to p re ve nt a nd d ete ct th e m ost c o m mon c o m plic a tio ns ( F ulm er, 2 001; L opez, e t a l, 2 002; P fa ff, 2 002; T u rn er, J ., e t a l, 2 001; N IC HE). P sych om etr ic te stin g h as n ot b een d one. S TR EN G TH S A ND L IM IT A TIO NS: T he S PIC ES a cro nym is e asily r e m em bere d a nd m ay b e u se d to r e ca ll th e c o m mon p ro ble m s o f t h e e ld erly p opula tio n in a ll c lin ic a l s e ttin gs. It p ro vid es a s im ple s yste m fo r fla ggin g a re as in n eed o f fu rth er a sse ssm ent a nd p ro vid es a b asis fo r s ta ndard iz in g q ualit y o f c a re a ro und c e rta in p ara m ete rs . S PIC ES is a n a le rt s yste m a nd r e fe rs to o nly th e m ost f r e quently -o ccu rrin g h ealt h p ro ble m s o f o ld er a dult s . T hro ugh th is in it ia l s cre en, m ore c o m ple te a sse ssm ents a re tr ig gere d. It s h ould n ot b e u se d a s a r e pla ce m ent fo r a c o m ple te n urs in g a sse ssm ent. F ulm er S PIC ES: A n O vera ll A ssessm en t T o ol f o r O ld er A dult s P atie nt N am e: D ate : S PIC ES E VID EN CE S le ep D is o rd ers / _ _____________________________________ P ro ble m s w it h E atin g o r F eedin g/_ _______________________ I n co ntin ence /_ ________________________________________ C onfu sio n/_ ____________________________________________ E vid ence o f F alls /_ ___________________________________ S kin B re akd ow n/_ ______________________________________ A dapte d fr o m F ulm er, T . ( 1 991). T he G eria tr ic N urs e S pecia lis t R ole : A N ew M odel. N urs in g M anagem ent, 2 2(3 ), 9 1- 9 3. © C opyrig ht L ip pin co tt W illia m s & W ilk in s, http ://lw w.c o m . 1/2 M ORE O N T H E T O PIC : B est p ra ctic e in fo rm atio n o n c a re o f o ld er a dult s : www.G ero N urs e O nlin e.o rg . F ulm er, T . ( 1 991). T he G eria tr ic N urs e S pecia lis t R ole : A N ew M odel. N urs in g M anagem ent, 2 2(3 ), 9 1-9 3. F ulm er, T . ( 1 991). G ro w Y our O wn E xp erts in H osp it a l E ld er C are . G eria tr ic N urs in g, M arc h /A pril 1 991, 6 4-6 6. F ulm er, T . ( 2 001). T he g eria tr ic r e so urc e n urs e : A m odel o f c a rin g fo r o ld er p atie nts . A m eric a n J o urn al o f N urs in g, 1 02, 6 2. L opez, M ., D elm ore , B ., A ke , J ., K im , Y ., G old en, P ., B ie r, J ., & F ulm er, T . ( 2 002). Im ple m entin g a G eria tr ic R eso urc e N urs e M odel. J o urn al o f N urs in g A dm in is tr a tio n, 3 2(1 1 ), 5 77-5 85. N urs e s Im pro vin g th e C are o f th e H osp it a liz e d E ld erly ( N IC HE) p ro je ct a t th e H artfo rd In stit u te fo r G eria tr ic N urs in g, h ttp : / / w ww.h artfo rd ig n.o rg . P fa ff, J . ( 2 002). T he G eria tr ic R eso urc e N urs e M odel: A c u lt u re c h ange. G eria tr ic N urs in g, 2 3(3 ), 1 40-1 44. T u rn er, J . T ., L ee, V ., F le tc h er, K ., H udso n, K ., & B arto n, D . ( 2 001). M easu rin g q ualit y o f c a re w it h a n in patie nt e ld erly p opula tio n: T he g eria tr ic r e so urc e n urs e m odel. J o urn al o f G ero nto lo gic a l N urs in g, 2 7(3 ), 8 -1 8. P erm is sio n is h ere by g ra nte d to r e pro duce , p ost, d ow nlo ad, a nd/o r d is tr ib ute , th is m ate ria l in it s e ntir e ty o nly fo r n ot- fo r-p ro fit e duca tio nal p urp ose s o nly , p ro vid ed th at T he H artfo rd In stit u te fo r G eria tr ic N urs in g, C olle ge o f N urs in g, N ew Y ork U niv e rs it y is c it e d a s th e s o urc e . T his m ate ria l m ay b e d ow nlo aded a nd/o r d is tr ib ute d in e le ctr o nic fo rm at, in clu din g P D A fo rm at. A va ila ble o n th e i n te rn et a t www.h artfo rd ig n.o rg a nd/o r www.G ero N urs e O nlin e.o rg . E -m ail n otif ic a tio n o f u sa ge to : hartfo rd .ig [email protected] nyu .e du . A S ER IE S P R O VID ED B Y T he H artfo rd In stit u te fo r G eria tr ic N urs in g E M AIL : hartfo rd .ig [email protected] nyu .e du H AR TFO RD IN STIT U TE W EBSIT E : w ww.h artfo rd ig n.o rg G ER O NURSEO NLIN E W EBSIT E : www.G ero N urs e O nlin e.o rg 2/2
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Date:_______________ Birthdate_________________ Patient Stress Questionnaire* Name: __________________________________________ Over the last two weeks , how often have you been bothered by any of the following problems? (please circle your answer & check the boxes that apply to you ) Not at all Several days More than half the days Nearly Every day 1. Little interest or pleasure in doing things 0 1 2 3 2. Feeling down, depressed, or hopeless 0 1 2 3 3. Trouble falling or staying asleep, or sleeping too much 0 1 2 3 4. Feeling tired or having little energy 0 1 2 3 5. Poor appetite or overeating 0 1 2 3 6. Feeling bad about yourself or that you are a failure or have let yourself or your family down 0 1 2 3 7. Trouble concentrating on things, such as reading the newspaper or watching television 0 1 2 3 8. Moving or speaking so slowly that other people could have noticed, or the opposite – being so fidgety or restless that you’ve been moving around a lot more than usual 0 1 2 3 9. Thoughts that you would be better off dead, or hurting yourself in some way 0 1 2 3 Total (10) add columns: 1. Feeling nervous, anxious or on edge 0 1 2 3 2. Not being able to stop or control worrying 0 1 2 3 3. Worrying too much about different things 0 1 2 3 4. Trouble relaxing 0 1 2 3 5. Being so restless that it is hard to sit still 0 1 2 3 6. Becoming easily annoyed or irritable 0 1 2 3 7. Feeling afraid as if something awful might happen 0 1 2 3 Total (8) *adapted from PhQ 9, GAD7, PC-PTSD and AUDIT 1/24/11 add columns: Provider:__________________________________ Please also complete back side No Yes No Yes No Yes No Yes No Yes (3) Please circle your answer 0 1 2 3 4 How often do you have one drink containing alcohol? Never Monthly or less 2-4 times a month 2-3 times a week 4+ times per week How many drinks containing alcohol do you have on a typical day when you are drinking? 1 or 2 3 or 4 5 or 6 7 to 9 10 or more How often do you have four or more drinks on one occasion? Never Less than monthly Monthly W eekly Daily or almost daily …found that you were not able to stop drinking once you had started? Never Less than monthly Monthly W eekly Daily or almost daily …failed to do what was normally expected from you because of drinking? Never Less than monthly Monthly W eekly Daily or almost daily …needed a first drink in the morning to get yourself going after heavy drinking? Never Less than monthly Monthly W eekly Daily or almost daily …had a feeling of guilt or remorse after drinking? Never Less than monthly Monthly W eekly Daily or almost daily …been unable to remember what happened the night before because you had been drinking? Never Less than monthly Monthly W eekly Daily or almost daily 0 2 4 Have you or someone else been injured as a result of your drinking? No Yes, during the last year Has a relative, friend, doctor or other health worker been concerned about your drinking or suggested you cut down? No Yes, during the last year (8) Standard serving of one drink: 12 ounces of beer or wine cooler 1.5 ounces of 80 proof liquor 5 ounces of wine 4 ounces of brandy, liqueur or aperitif Are you currently in any physical pain? In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month , you: These questions are about your drinking habits. W e’ve listed the serving size of one drink below. How often during the last year have you…… 4. Felt numb or detached from others, activities, or your surroundings? 3. Were constantly on guard, watchful, or easily startled? 2. Tried hard not to think about it or went out of your way to avoid situations that reminded you of it? Total: 1. Have had nightmares about it or thought about it when you did not want to? Drinking alcohol can affect your health. This is especially important if you take certain medication s. W e want to help you stay healthy and lower your risk for the problems that can be caused by drinking. Yes, but not in the last year Yes, but not in the last year
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1 Mini-Mental State Examination (MMSE) Patient’s Name: Date: Instructions: Ask the questions in the order listed. Score one point for each correct response within each question or activity. Maximum Score Patient’s Score Questions 5 “What is the year? Season? Date? Day of the week? Month?” 5 “Where are we now: State? County? Town/city? Hospital? Floor?” 3 The examiner names three unrelated objects clearly and slowly, then asks the patient to name all three of them. The patient’s response is used for scoring. The examiner repeats them until patient learns all of them, if possible. Number of trials: ___________ 5 “I would like you to count backward from 100 by sevens.” (93, 86, 79, 72, 65, …) Stop after five answers. Alternative: “Spell WORLD backwards.” (D-L-R-O-W) 3 “Earlier I told you the names of three things. Can you tell me what those were?” 2 Show the patient two simple objects, such as a wristwatch and a pencil, and ask the patient to name them. 1 “Repeat the phrase: ‘No ifs, ands, or buts.’” 3 “Take the paper in your right hand, fold it in half, and put it on the floor.” (The examiner gives the patient a piece of blank paper.) 1 “Please read this and do what it says.” (Written instruction is “Close your eyes.”) 1 “Make up and write a sentence about anything.” (This sentence must contain a noun and a verb.) 1 “Please copy this picture.” (The examiner gives the patient a blank piece of paper and asks him/her to draw the symbol below. All 10 angles must be present and two must intersect.) 30 TOTAL (Adapted from Rovner & Folstein, 1987) Source: www.medicine.uiowa.edu/igec/tools/cognitive/MMSE.pdfProvided by NHCQF, 0106-410 2 Instructions for administration and scoring of the MMSE Orientation (10 points): • Ask for the date. Then specifically ask for parts om itted (e.g., “Can you also tell me what season it is?”). One point for each correct answer. • Ask in turn, “Can you tell me the name of this hospital (town, county, etc.)?” One point for each correct answer. Registration (3 points): • Say the names of three unrelated objects clearly and slowly, allowing approximately one second for each. After you have said all three, ask the pat ient to repeat them. The number of objects the patient names correctly upon the first repetition determines the score (0-3). If the patient does not repeat all three objects the first time, continue saying the names until the patient is able to repeat all three items, up to six trials. Record the number of trials it takes for the patient to learn the words. If the patient does not eventually learn all three, recall cannot be meaningfully tested. • After completing this task, tell the patient, “Try to remember the words, as I will ask for them in a little while.” Attention and Calculation (5 points): • Ask the patient to begin with 100 and count backward by sevens. Stop after five subtractions (93, 86, 79, 72, 65). Score the total number of correct answers. • If the patient cannot or will not perform the subtraction task, ask the patient to spell the word “world” backwards. The score is the number of letters in correct order (e.g., dlrow=5, dlorw=3). Recall (3 points): • Ask the patient if he or she can recall the th ree words you previously asked him or her to remember. Score the total number of correct answers (0-3). Language and Praxis (9 points): • Naming: Show the patient a wrist watch and ask the patient what it is. Repeat with a pencil. Score one point for each correct naming (0-2). • Repetition: Ask the patient to repeat the sentence after you (“No ifs, ands, or buts.”). Allow only one trial. Score 0 or 1. • 3-Stage Command: Give the patient a piece of blank paper and say, “Take this paper in your right hand, fold it in half, and put it on the floor.” Score one point for each part of the command correctly executed. • Reading: On a blank piece of paper print the sentence, “Close your eyes,” in letters large enough for the patient to see clearly. Ask the patient to read the sentence and do what it says. Score one point only if the patient actually closes his or her eyes. This is not a test of memory, so you may prompt the patient to “do what it says” after the patient reads the sentence. • Writing: Give the patient a blank piece of paper and ask him or her to write a sentence for you. Do not dictate a sentence; it should be written spontaneously. The sentence must contain a subject and a verb and make sense. Correct grammar and punctuation are not necessary. • Copying: Show the patient the picture of two in tersecting pentagons and ask the patient to copy the figure exactly as it is. All ten angles must be present and two must intersect to score one point. Ignore tremor and rotation. (Folstein, Folstein & McHugh, 1975) Source: www.medicine.uiowa.edu/igec/tools/cognitive/MMSE.pdfProvided by NHCQF, 0106-410 3 Interpretation of the MMSE Method Score Interpretation Single Cutoff <24 Abnormal Range <21 >25 Increased odds of dementia Decreased odds of dementia Education 21 <23 <24 Abnormal for 8 th grade education Abnormal for high school education Abnormal for college education Severity 24-30 18-23 0-17 No cognitive impairment Mild cognitive impairment Severe cognitive impairment Sources: • Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the mini-mental state examination by age and educational level. JAMA. 1993;269(18):2386-2391. • Folstein MF, Folstein SE, McHugh PR . “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189-198. • Rovner BW, Folstein MF. Mini-menta l state exam in clinical practice. Hosp Pract. 1987;22(1A):99, 103, 106, 110. • Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992;40(9):922-935. Source: www.medicine.uiowa.edu/igec/tools/cognitive/MMSE.pdfProvided by NHCQF, 0106-410

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