Advancement of age is associated with many chronic health issues that affect the quality of life. Elderly patients form a unique subset of the patient population that many advanced practice nurse practitioners (APNP) will interact with in their practice for evaluation and treatment. Some of the chronic conditions associated with advancing age include dementia, osteoporosis, and other forms of cognitive impairment.
It is the mandate of the health care providers to ensure that elderly patients have a full functional ability to care for themselves fully. To elicit problems facing elderly patients, comprehensive history taking, physical examination, and mental state examination are necessary. Several assessment tools for their health conditions and functioning are available; hence, APNPs should appropriately use those that can be of help in evaluating the patients they meet.
In this case, Mr. W is a 92-year-old retired college professor living at home with his wife in an upscale suburban neighborhood that offers little public transport. Her wife prefers him to drive despite her ability to operate a motor vehicle. Mr. W’s medical history includes obstructive sleep apnea (OSA), hypertension managed with lifestyle modification, chronic anemia, osteoporosis, edema, history of prostate cancer, and edema. However, he can carry out his activities of daily living appropriately.
He reports presenting to his geriatrician 8 years ago and reported forgetfulness when he lost his way while driving to a family museum. He has a history of difficulty in recalling his personal art collection and has experienced falls. In 2009, he reported troublesome memory loss that made his driving more difficult, although there were no reported unsafe practices. His geriatrician diagnosed him with mild cognitive impairment (MCI) secondary to early onset Alzheimer’s disease with recommendations of assessment at a driving evaluation clinic.
In developing an evaluation plan for the patient, it is important to note that the history of falls and confusion indicating underlying immobility, cognitive dysfunction, and sensory deprivation may require adequate attention. From the history, only hypertension is being managed and his only medication is vitamin B12. There is a need for the patient to be on iron supplements to manage the anemia as well as restless leg syndrome (Trotti & Becker, 2019), as well as bisphosphonates, which will manage his osteoporosis and reduce the risk of falls (Reid & Billington, 2022). The edema would be suggesting a cardiac issue such as heart failure and being that he is hypertensive, it is crucial to evaluate the cardiovascular system comprehensively.
There are many assessment tools for the patient. As stated by Arevalo-Rodriguez et al. (2021), the mini-mental state examination (MMSE) is a brief neuropsychological test that is used in evaluating for cognitive function in the setting of individuals with symptoms of cognitive dysfunction. Patients who have mild cognitive impairment, like Mr. W, should be evaluated and monitored as they have a high risk of progressing into dementia.
As outlined in the history, the patient underwent two MMSE evaluations, for which, in the first presentation, he scored 30/30 and in the second assessment, 29/30. The MMSE is a 30-question assessment of cognitive function that is based on attention, orientation, memory, registration, recall, calculation, language, and the ability to draw a complex polygon. The MMSE is appropriate for this patient, with no ethical issues being involved. Since he is still driving, there are assessment tools that can be used to measure his driving competency.
According to Toups et al. (2022), driving is a complex work that requires learned skills and coordination of complex cognitive and physical tasks. On-road evaluations such as performance-based road tests and driving simulation studies can be used to identify and remediate poor driving behaviors to prevent adverse outcomes (Toups et al., 2022). Again, the MMSE can be a psychometric evaluation test that can be used to evaluate driving competency as it evaluates cognitive functioning, which is applied in driving.
The comprehensive geriatric assessment (CGA) is a multidisciplinary instrument that can be used in elderly patients with a risk of falling (Appeadu & Bordoni, 2023). The instrument uses scales such as the Berg Balance Scale to evaluate static and dynamic balance, the Falls Efficacy Scale to assess the fear of falling, and the Timed Up and Go Test to assess a patient’s mobility. Other assessment tools for fall risk among elderly patients include the Tinetti Gait and Balance Assessment Tool and the one-l
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