Assessment tools cannot substitute for good clinical skills and judgements. As clinicians we need to be aware that assessment tools can tell us more than just a score. Show Assessment involves collecting information that gets to know the patient in detail, evaluates their risks and the nature of problems to be identified. Assessment should integrate all the relevant issues. It should explore the medical, physiological, social and psychological function of the older person. The assessment process encourages us to be curious and to consider the best possible interventions that we can employ to minimise risks and maximise our patient’s quality of life. This can ultimately involve balancing some risks with some gains and working with our team and the older person and their family to make an informed choice about this. Assessment supports us to:
We can gather information as part of the assessment process from multiple sources, and these may vary at the stages of a hospital admission. The four main sources of information are:
Unless there are reasons to suspect otherwise the older person is considered the best source of information about their own health1. Direct observation is the best source of information about physical function; however, we should consider how the environment or setting where observations take place may impact on the older person’s performance. Assessment tools can be focussed on exploring one particular condition such as pain, pressure injury or nutrition. They can also be more comprehensive and encompass a broader focus beyond one particular issue. Examples of these types of tools include:
The assessment tool or scale should enable collection of useful patient data that supports interpretation of the holistic health status, identifies patient needs, and informs care planning and interventions to restore health and wellbeing. Selecting an assessment toolConsider the following factors when selecting an assessment tool include:
The format used will also depend on the discipline, skill and expertise of the clinician, the context and setting of the assessment, the time available and the number of assessors involved. The assessment can be:
Comprehensive Geriatric AssessmentThere is no gold standard for assessment of older people; however, a Comprehensive Geriatric Assessment is highly recommended to understand the multidimensional complex care needs of frail older people and to determine both short and long term care needs. A Comprehensive Geriatric Assessment can be undertaken by any member of the interdisciplinary healthcare team who has the required knowledge and skills. Multiple team members with specific skills may need to be involved depending on the patient’s needs. Ideally, the assessment should be completed within the patient’s first 24 hours in hospital and communicated to all team members, the patient and informal carers. Conducting assessmentsWe also need to be aware of the following when conducting assessments of older people:
Applying clinical skills to assessmentGood clinical skills, observation, listening, interpreting and clinical judgement are all vital in decision-making. When we assess older patients, we use tools and draw on our clinical reasoning skills. The reasoning cycle2 sets out the elements of effective clinical decision-making:
1. Levett-Jones, T. (2013). Clinical Reasoning: Learning to think like a nurse. Frenchs Forest: Pearson Australia 2. Dorevitch 2004 p 229 in Nay, R., Garratt, S., & Fetherstonhaugh, D. (2013). Older People: Issues and Innovations in Care (4th ed.). Australia: Churchill Livingstone Australia |