Assessing older people
Assessment means finding out what the person needs before helping. Look at the whole person, not only the illness.
- Body: pulse, blood pressure, weight, pain, skin, teeth, eyes and ears.
- Mind: memory, mood, and how clearly the person thinks.
- Daily tasks: can they eat, wash, dress, use the toilet and walk alone?
- Home and people: stairs, light, family, money, who helps.
Ask, watch and listen. Write down what you find. Repeat the assessment because older people change quickly.
Communication
Many older people hear less, see less or think slowly. Good talk makes care easier.
- Stand in front, in good light, and smile. Say your name.
- Speak slowly and clearly. Do not shout. Use short sentences.
- Check hearing aids and glasses first.
- Wait for the answer. Do not hurry or talk down like to a child.
- Call them by their name or title (Uncle, Mrs. Rao).
For a person who cannot speak, use gestures, pictures, a writing board and touch.
Meals and nutrition
With age, taste, smell and thirst fade and teeth are lost. Older people may eat too little.
- Give soft, tasty food in small, frequent meals with enough protein, fruit and vegetables.
- Offer water often, even if they do not feel thirsty.
- Seat them upright. Keep them sitting 30 minutes after the meal to prevent choking.
- Check dentures. Weigh them every month. Weight loss is a warning.
Excretion (toilet)
Many older people have constipation or leaking urine. This hurts self-respect, so keep privacy and be kind.
- Fix toilet times, for example after meals.
- Give fibre (vegetables, fruit, whole grains), water and walking.
- Keep a clear, lit, short path to the toilet, with a raised seat and handrail.
- Use pads or a commode only when needed. Keep the skin clean and dry.
Cleanliness
Clean skin, mouth and clothes prevent infection and bedsores, and lift the mood.
- Dry skin cracks, so use warm (not hot) water, mild soap and a moisturiser.
- Clean teeth or dentures twice a day. Trim nails. Check the feet.
- Let them wash whatever they can by themselves. Help only with the rest.
- Dry skin folds well. Change position of a bedridden person every 2 hours.
Walking and moving
Muscles and bones weaken with age, and a fall can break a hip. Moving keeps muscles, joints and heart strong.
- Remove loose mats and wires. Add light and handrails. Use non-slip footwear.
- Give a stick or walker if needed, at the right height.
- Walk a little every day, with someone beside them if they are unsteady.
- Help them stand up slowly, to avoid dizziness.
Sleep
Older people sleep lighter and wake more often. Poor sleep makes the day tiring and can cause falls and low mood.
- Keep a fixed time for sleeping and waking.
- Quiet, dark, cool room. Less tea and coffee in the evening.
- Walk or sit in daylight. Avoid long afternoon naps.
- Treat pain or night-time toilet needs. Do not give sleeping tablets without the doctor.
Activity and purpose in life
A person who feels useful stays healthier in body and mind. Loneliness is a real danger.
- Help them keep hobbies: prayer, gardening, music, stories, cards, craft.
- Give small jobs in the family. Meet friends and neighbours.
- Use group activities and community clubs. Respect their wishes and religion.
Try it
At home: walk through a room with your eyes half closed. Where would you trip? Find three things to move or fix. In the 3D, press each block and tell a friend one thing the nurse does.
Key formulas and definitions
- Key term: Assessment = collect facts about body, mind, home and daily tasks
- Key term: ADL (activities of daily living) = eating, washing, dressing, toilet, walking
- Fall prevention = clear floor + good light + handrails + non-slip shoes + walking aid
- Pressure sore prevention = change position every 2 hours + dry clean skin
- Respect rule = keep what they can still do; add help only where needed
Worked examples
1. Mrs. Rao, 78, eats only a few bites and has lost 3 kg in a month. What should the nurse do?
Assess teeth or dentures, mouth sores, taste and mood. Offer small, soft, tasty meals more often, with protein and water. Weigh her monthly and tell the doctor about the weight loss.
2. Mr. Khan, 82, gets up at night and nearly falls on the way to the toilet. Suggest three changes.
1) Put a night light on the path. 2) Remove mats and wires and add a handrail. 3) Offer the toilet before bed and keep a commode nearby. Also check that his shoes are non-slip.
3. A woman who lives alone says she feels useless and sleeps badly. Plan one change in activity and one in sleep.
Activity: ask her to join a morning prayer or music group, or teach her skill to children. Sleep: fix a bedtime, give daylight walks, and no tea after 4 pm. Review in two weeks.
Common mistakes
- Doing everything for the older person. This takes away their independence and strength.
- Shouting or talking to them like a child. Slow, clear and respectful speech works better.
- Offering water only when they ask. Older people feel thirst less, so offer it often.
- Calling poor sleep or sadness "just old age". These are problems to assess and treat.