Assessing the Nursing and Care Needs of Older Adults

A Patient-Centred Approach

Helen Taylor

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781315358307
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Health resources are becoming increasingly constrained. So it is essential that professionals, and the public, recognise the need to work together in establishing local priorities and collaborate in their implementation. Priority Setting and The Public challenges many widely accepted beliefs and perceptions. It links together academic literature, critical overviews of methods and approaches with practical applications and original research. It shows the different approaches to engaging the public, challenges and how progress can be achieved. A wide number of methods, from a range of disciplines are described, reviewed and guidance is given on factors to consider for selection. This book is essential reading for all health service and primary care organisations, especially those responsible for resource allocation, clinical governance and public health.

Chapter 1
Introduction

Setting the scene

There is much talk of the ‘ageing population’, and it is certainly true that for the first time ever there are more people aged over 60 years in the UK than there are below the age of 16 years.¹ The 2001 UK Census revealed that whereas 16% of the population was aged over 60 years on the 1951 Census Day, this had increased to 20% 50 years later. The proportion of those aged over 85 years also increased during this period, from 0.4% (0.2 million) to 1.9% (1.1 million).¹

The primary aim of this book is to investigate the way in which nurses assess older adults who are in their care. By differentiating between this and other client groups, there is an implication that their needs differ in some way. Indeed, it is acknowledged that although not a homogenous group, older adults do form a special group, often with their own special requirements.² While it should be pointed out that many older adults live active and independent lives, free from illness and other incapacity, this is certainly not true for all. For these individuals, their continuing independence may be reliant on the input and support of healthcare professionals, including nurses. Indeed, statistics issued by Age Concern UK³ indicate that in one three-month period during 2002, those aged over 75 years were almost twice as likely to have visited a hospital outpatients or emergency department as younger adults (25% compared with 14%). If an overnight hospital stay had been necessary, this would have been almost twice as long for the over-75s than for the younger age group (12 nights compared with seven nights). Older adults are also more likely to need some help and support with their daily living, requiring them to live in sheltered housing (19% of those aged over 85 years compared with 4% of 65-69 year olds), for example.

However, if the needs of an older person become too great and life at home is no longer an option, care in a care home or hospital may become necessary. This is usually because they are in need of a combination of medical, personal and nursing assistance.⁴ The probability of becoming a long-term resident in a care home or hospital increases with age (20.7% of those aged over 85 years compared with 0.9% of 65-74 year olds). As such care commences, the patient will need to be assessed in order to identify and evaluate their needs,⁵,⁶ and if nursing needs are identified, nurses will then work with that individual in an attempt to accommodate these needs.⁷

Davies et al.⁸ conducted a review of the relevant literature and concluded that if patients are to be afforded a maximum level of independence and autonomy, their nursing care must accommodate their own particular and individual needs. It was proposed that effective assessment and subsequent individualised care planning are necessary components of this.⁹ However, extensive research has been conducted into the nursing assessment of the older adult,¹⁰-¹⁴ and issues have been raised relating to the reliability and validity of assessment practices.¹⁵-¹⁷

A number of concerns have been raised about how nurses actually conduct assessments. Middleton¹⁸has suggested that rather than promoting the collection of objective patient information, assessments may simply be used as a means of formatting and presenting the nurse’s pre-made decisions. The criticism has also been made that the process of assessment is in itself restrictive, confining data collected to the format prescribed by the tool being used.¹⁹ It has also been proposed that where nurses are required to select from predetermined assessment options, the option selected may not adequately represent the patient.²⁰,²¹ In addition, concerns have been voiced about the accuracy of assessments made by assessors who lack the skill or training necessary to complete those assessments.⁶

That being said, recent Department of Health publications have emphasised the importance of effective nursing assessment in the planning and delivery of care to the older adult, for quality assurance, to enable the ‘costing’ of the registered nursing care of older adults and to ensure consistency in the provision of care.⁷ However, although the ethical, professional and legal significance of involving older patients in assessment of their health status and needs has been asserted, there is strong evidence that, for a variety of reasons, such collaboration may not occur. Other potential problems have also been raised, including a lack of consistency in the assessment of older people,⁴ compounded by ineffective communication between care professionals.²²

An overview of the book

It is clear that any deficits in the assessment process would have an impact on the reliability and validity of any evaluation of patient needs, and thus the care that the patients receive. The primary aim of this book is therefore to explore the way in which nurses assess the older adults in their care, and to identify and address potential problems and deficiencies with regard to the assessment process, both for individual patients and for older adults as a group.

The difficulties associated with establishing older adults as a distinct group have already been mentioned in this introduction. That being said, it cannot be denied that the healthcare needs of older adults do differ from those of younger adults,⁴ or that a significant proportion of older adults do need some form of healthcare intervention. This is demonstrated by the fact that the NHS and social services spent approximately 40% and 50%, respectively, of their budgets on people aged over 65 years in the year 1998-99.²³ In addition to this, from 31 March 2001 there were 269 760 residential care home beds for older people in the UK.²⁴

Much has already been said about assessment (for a definition of this concept, see p. 7). Having considered this, Chapter 2 explores the idea of old age itself, and gives an indication of the difficulties and potential dangers that are encountered when defining and classifying older adults as a group. Care needs specific to older adults are then identified. This chapter concludes with an overview of the political context of assessment, and identifies a number of key policy reforms in the provision of care for older adults.

Having examined the concept of assessment, and the special care needs of older adults, Chapter 3 explores the contribution of registered nurses to the care of older adults, and analyses this in relation to recent government publications and reforms. Furthermore, subsequent sections address the suggestion that individual patients and nurses may have different expectations of the registered nursing role. Difficulties associated with defining nursing needs are then appraised.

Further to considering the professional and political role of nurses in the assessment and provision of care for older adults, Chapter 4 looks at the process of assessment itself. Judgement and decisions are established as being inherent to the assessment process, with three different perspectives of decision-making theory being evaluated, namely information processing, intuition and the cognitive continuum. Having considered the decision-making process, the need for decisions to be reliable and valid is deliberated, and finally the issue of accuracy in decision making is explored and defined.

While Chapter 4 was concerned with the cognitive processes associated with decision making and assessment, Chapter 5 goes on to provide an overview of a number of ways in which the nurse who is making the assessment may compromise its reliability and validity. For example, the role of memory and information recall are explored. The possibility that the way in which a nurse regards their patients could influence the reliability and validity of an assessment is also considered.

Having explored the role of the nurse in the assessment process, Chapter 6 investigates the many and complex ways in which the nurse, the patient and other healthcare professionals interact during the assessment process. The areas considered include older adults’ expectations of healthcare services, the role of informal caregivers, and the effect of culture and taboos. Some additional ways in which the efficacy of the assessment process may be compromised are also highlighted.

The book concludes with an evaluation of the ethical, professional and legal implications of assessing older adults. The emphasis is placed firmly on both the need and the requirement for the patient to be involved in assessment and decision making. This is considered in relation both to ethical theories and principle...