Page 67 Complete Your CE Test Online - Click Here Is the patient alone or accompanied by a family member or friend? Observe the interaction between the patient and whomever is accompanying him or her. Does the patient seem comfortable with this companion? Do they interact appropriately? Is there any indication that the patient is intimidated by the companion? What, briefly, is the patient’s health history? For example, is there is history of heart attack, stroke, diabetes, etc.? What medications is the patient taking? What is the patient’s cultural and ethnic background? Is English the patient’s first language? If not, how well is s/he able to communicate in English? Will an interpreter need to be present during the assessment to facilitate communication? Remember that you need to adapt your communication to the specific needs of the older adult patient. Never assume that because patients are older that they will be unable or unwilling to participate actively in their healthcare regimens. Communicate directly with patients whenever possible. Do not bypass them and/or belittle them by talking to family or caretakers instead. Make sure that, if needed, glasses are on and hearing aids in place. And always let patients know exactly what you are doing during an assessment [7]. Ask the patients how they would like to be addressed. Ask if you may call them by their first names, or if they would prefer to be addressed as Mr., Mrs., Ms. etc. Never “talk down” to an older adult patient by calling them “sweetie” or “dear” or other nicknames. These patients are not infants nor children, and should be treated with respect. Introduce yourself by giving your full name and your title/role. For example, “My name is Andrea Burns. I am a registered nurse and I will be taking care of you today.” This “first glance” of the patient can provide a great deal of information about the patient’s physical, mental, and emotional state. Use this first glance as a foundation for the detailed assessment of the older adult patient. Consider the following two scenarios Jillian has written for discussion with her classmates: Critical thinking exercise: When assessing any patient, it is important to be alert to signs of abuse and neglect. In the older adult patient for example, wearing clothes that are inappropriate for the time of year and/or weather, and lack of personal hygiene may indicate a physical problem, a cognitive problem, or, in some cases, deliberate neglect of the older adult person by family members or others who are responsible for his or her care. Mr. Newman is 80 years old. He has an appointment with his physician for flu-like symptoms. He is accompanied by his daughter. Both are wearing blue jeans that are clean but faded and areas where the jeans have been patched are apparent. It is a cold, winter’s day and Mr. Newman has on a jacket with a button missing. He is wearing a woolen scarf that is faded. You overhear Mr. Newman say to his daughter, “It’s a shame we had to go out today with it being so cold. It was nice of you to let me wear your scarf since I don’t feel well. When my social security check comes in, I’m going to buy you a nice warm scarf. We’ll be able to afford warmer clothes after you find another job so don’t worry about me spending my money.” Mr. Adams is also 80 years old and is at his physician’s office for a routine check-up. He comes from a well-to-do family that is known to own several prosperous businesses in town. He, too, is accompanied by his daughter. His daughter is dressed in an expensive cashmere coat with matching scarf and knee-high boots. Mr. Adams is wearing a winter coat that appears to be too small for him but is obviously of good quality. He complains of being cold and is not wearing a scarf or gloves. Underneath the coat he has on a short-sleeved polo shirt and slacks that appear wrinkled and somewhat dirty. His daughter rolls her eyes and tells him, “You’ll be warm enough when we get back in the car. Honestly, I don’t know why you couldn’t reschedule this appointment. I have enough to do today without driving you around.” Which of the preceding patients is most likely a victim of some form of neglect? Some of Jillian’s classmates believe that Mr. Newman is most likely to be neglected because he and his daughter are wearing old clothes and apparently do not have much money. Others believe Mr. Adams is most likely to suffer from neglect as, although he comes from a family that is financially well-off, his clothes are ill-fitting and inappropriate for the weather. Additionally, his daughter is impatient with him and shows little concern for his welfare. The use of critical thinking skills shows that Mr. Adams, despite his financial well-being, seems to be at greater risk for neglect. He is inappropriately dressed and his clothes are soiled. His daughter shows little regard for him. A more thorough analysis is needed. Mr. Adams may have some physical and/or cognitive problems that are causing him to neglect his appearance and hygiene; however, it also seems that he is not receiving the assistance that he needs from his daughter or other family members. Mr. Newman does have some risk factors for neglect. There seems to be a lack of money, which can cause stress and tension in the home. However, his clothes are clean and it is apparent that his daughter is trying to take care of her father and is concerned about his well-being. The family situation should still be evaluated (as should all family situations) as part of a good assessment. The Newman family may need to be referred to resources for financial assistance as well. Nursing consideration: It is important that nurses and other healthcare professionals not stereotype patients and families based on income or social status. Abuse and neglect occur in people regardless of income, race, religion, sexual orientation, or educational status. As the “first glance” is completed the nurse must be aware of other factors that need to be quickly assessed: cultural considerations and nutritional status. Cultural considerations Cultural considerations must be incorporated into an older adult’s physical assessment. Failure to provide culturally appropriate and competent care can lead to lack of patient compliance, frustration, and even hostility. Patients need and expect that their cultural perspectives will be respected. The demographics in the U.S. have changed significantly in the past few decades. According to the U.S. Census Bureau, the 2000 census indicated that the white, non-Hispanic majority represented 69.1% of the population. The 2014 census data showed that this percentage had decreased to 62.1% [1]. Currently, non-white and/or Hispanic individuals comprise about 39% of the U.S. population, and this percentage is expected to increase to 57% by 2060. Cultural sensitivity encompasses many issues as culture is complex and is made up of thoughts, values, beliefs, and traditions of racial, ethnic, religious, or social groups [9]. Culture influences morals, communication, gender roles, expressions of emotion, family interactions, diet, dress, and beliefs regarding health and wellness. The large numbers of different cultures that exist in the U.S. make it impossible for all healthcare providers to have an intimate knowledge of each one. Here are some suggestions to incorporate cultural appropriateness into the assessment process [9, 10, 11]: ● ● Identify the various cultural populations for which you are most likely to provide healthcare services. Familiarize yourself with appropriate cultural responses for these populations. For example, in Middle Eastern cultures, sexual segregation is often very important, and same-sex caregivers should be assigned whenever possible. ● ● Investigate if interpreters must be used to facilitate communication, e.g. if the patient has difficulty communicating in English. ● ● Develop written patient educational materials in large font in the most common languages (in addition to English) that are spoken by your patient populations. ● ● Remember to be sensitive to any dietary practices that are important to cultural and religious viewpoints. ● ● Be alert to the appropriateness of eye contact. Most Americans expect you to make direct eye contact and view this as a sign that you are actively listening to them. However, in some Asian cultures direct eye contact is believed to be rude and intrusive. ● ● Remember that expression of emotions may vary from culture to culture. Some cultures are vocal and overt when expressing fear or