Utilizing Standardized Tools for Recreational Therapy Treatment With Geriatric Clients Jo Lewis,...
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Transcript of Utilizing Standardized Tools for Recreational Therapy Treatment With Geriatric Clients Jo Lewis,...
Assessment of the Older Adult:
Utilizing Standardized Tools for Recreational Therapy Treatment With Geriatric
Clients
Jo Lewis, MS/CTRSMegan Janke, Ph.D., LRT/CTRS
Upon successful completion of this session, the participant will be able to:
Identify 3 standardized assessment tools that may be utilized in Recreational Therapy treatment with older adults.
Verbalize 2 benefits of utilizing standardized assessments during Recreational Therapy treatment
Utilize internet resources for standardized assessment tools in Recreational Therapy practice with older adults.
Objectives
Validity◦ Does it measure what it is intended to measure?
External Internal
Reliability◦ Does it consistently measure what is intended?
Internal Consistency Inter-rater Reliability
Responsiveness Can it detect real change when it happens?
Key Concepts For Assessments
Measure what you intend to measure Justification of Services Accepted across discipline boundaries
Why Use Standardized Assessments?
Brief Interview for Mental Status Short Portable Mental Status Questionnaire Blessed Orientation-Memory-Concentration Test Global Deterioration Scale Brief Cognitive Rating Scale Clock Drawing Test Montreal Cognitive
Assessment (MoCA)
Cognitive Scales
Utilized for the MDS 3.0 Areas measured:
◦ attention◦ orientation◦ the ability to register and recall new information
Maximum Score: 15◦ 13-15 Cognitively intact◦ 8-12 Moderate impairment◦ 0-7 Severe impairment
Brief Interview for Mental Status
10 Items Maximum Score: 10
◦ 0-2 errors Intact◦ 3-4 errors Mild impairment◦ 5-7 errors Moderate impairment◦ 8-10 errors Severe impairment
5-10 minutes to administer
Short Portable Mental Status Questionnaire (SPMSQ)
Domains assessed◦ Orientation◦ Immediate and delayed episodic recall◦ Working memory
6 Items Maximum Score- 28 Higher score indicates greater impairment 3-6 minutes to administer
Blessed Orientation-Memory-Concentration Test
Rating scale 1: No cognitive impairment2: Very mild cognitive decline3: Mild cognitive decline4: Moderate cognitive decline5: Moderately severe cognitive decline6: Severe cognitive decline7: Very severe cognitive decline
Used with Brief Cognitive Rating Scale
Global Deterioration Scale
5 Axes◦ Concentration◦ Recent Memory◦ Past Memory◦ Orientation◦ ADL & Functional Abilities
Each axis is measured on a scale of 1-7 ◦ Scores from each axis added then divided by 5
Higher scores indicate higher level of impairment
Brief Cognitive Rating Scale
Correlates well with other cognitive assessment instruments
Visuospatial Assessment of Cognitive Functioning
6 point scoring system The higher the score, the greater the
degree of impairment Score of 3 or more indicative of cognitive
loss Completed in about 5 minutes
Clock Drawing Test
Screening tool for mild cognitive dysfunction Cognitive Domains
◦ Attention and concentration◦ Executive functioning◦ Memory ◦ Language◦ Visuoconstructional skills◦ Conceptual thinking◦ Calculations◦ Orientation
10 Minutes to Administer Possible score of 30
◦ 26 or above is considered normal
Montreal Cognitive Assessment(MoCA)
Barthel Index Berg Balance Scale Katz Index of Independence in
Activities of Daily Living Lawton Instrumental Activities of Daily
Living Tinetti Mobility Scale
◦ Performance-Oriented Assessment of Balance◦ Performance-Oriented Assessment of Gait
Get-Up & Go Test
Physical/ ADL Functioning
Self-report ◦ 2-3 minutes
Trained observation ◦ 10-15 minutes
3 point scale for each item
Barthel Index
Assesses:FeedingGroomingBowel & Bladder
ContinenceDressingToiletingWalkingStairsBathing
Barthel Index
Performance measure◦ Self-report◦ Trained observer
Scoring◦ Letter score from A-G
A= Most independent G= Most dependent
Katz Index of Independence in Activities of Daily Living
Bathing Dressing Toilet use Transfer ability Feed self Maintenance of
bowel & bladder continence
Self-report ofPerformance
Scoring ◦ O= Low functioning◦ 8= High functioning
Gender bias- ◦ transportation
Lawton Instrumental Activities of Daily Living Scale
Telephone usage Housekeeping* Food preparation* Laundry* Transportation Medications Money
management
5 point scaleHigher score indicates more difficulty with
gait and balanceScoring
1 = Normal2 = Very slightly abnormal3 = Mildly abnormal4 = Moderately abnormal5 = Severely abnormal
Score of greater than 3 at risk for fallingCan be performed as a timed assessment
Get-Up & Go
14 item scale5 point scale, ranging from 0-4
Completion time: 15-20 minutes Equipment needed:
RulerTwo standard chairsFootstool or stepStopwatch or wristwatch
Scoring41-56: Low fall risk21-40: Medium fall risk0-20: High fall risk
Berg Balance Scale
3 point scale per itemUsed in conjunction with Gait
AssessmentAssessment Process:
Sitting in chairRising from chairImmediate standing
balanceStanding balanceBalance with eyes closedTurning balance
Tinnetti Mobility ScalePerformance Oriented Assessment of Balance
Nudge on sternumNeck turningOne leg standing
balanceBack extensionReaching upBending downSitting down
8 Items◦ 2 point scale
Tinnetti Mobility ScalePerformance-Oriented Assessment of Gait
Assessment ProcessInitiation of gaitStep heightStep lengthStep symmetryStep continuityPath deviationTrunk stabilityWalk stanceTurning while walking
PHQ-9 Geriatric Depression
Scale Zung Self-Rating
Depression Scale Cornell Scale for
Depression in Dementia
Zung Self-Rating Anxiety Scale
WHOQOL-BREF
Emotional/ Psychosocial
Part of the Patient Health Questionnaire (PHQ)◦ PHQ-9- Depression Module
Self-report Multiple choice Measures severity of depression Implemented in the MDS3.0
PHQ-9
30 Questions◦ Short version available- 15 questions
Administration◦ Self –administered◦ Rater-administered
Questionable with older adults with severe dementia
Scoring◦ >5 indicates potential depression-
Should have a comprehensive assessment◦ => 10 almost always indicative of depression
Geriatric Depression Scale
Screening tool Self-report 20 items
◦ 4 point scale◦ Half of the items are positively worded; half
negatively Respondents rate frequency of occurrence Older adults score higher than other age
groups
Zung Self-Rating Depression Scale
Administration◦ Observation◦ Interview
Patient Caregiver
3 Point Scale◦ 0- Absent◦ 1- Mild or intermittent◦ 2- Severe
Cornell Scale for Depression in Dementia
Assessment Areas ◦ Mood related signs◦ Behavioral
disturbances◦ Physical signs◦ Cyclic functions◦ Ideational
disturbance
Self-report 20 items
◦ 5 affective◦ 15 somatic
Score range: 20-80 Administration Time: 10-15 minutes Used in psychiatric and medical patients
and with normal older adults
Zung Self-Rating Anxiety Scale
Measures the impact of disease◦ Impact of disease and impairment of daily
activities and behavior◦ Perceived health measures◦ Disability/ functional status measures
26 Questions Self-Administered Interviewer assisted or administered Manual is recommended to score the
assessment
World Health OrganizationQuality of Life (WHOQOL-BREF)
Faces Pain Scale Numeric Scale Pain Thermometer Brief Pain Inventory Checklist of
Nonverbal Pain Indicators Pain Assessment in Advanced Dementia
Scale
Pain
Originally developed for pediatrics No verbal component
◦ Language impairments◦ Difficulty with expression
7 point scale
Faces Pain Scale
Self-rating Scale of 0-20
◦ O= No pain◦ 20= Pain as bad as it could be
Scores can be averaged over time
Numeric Scale
Pain Thermometer
Widely used in clinical and research settings Originally developed for used with cancer
patients Currently used with individuals experiencing
chronic nonmalignant pain 16 items
◦ Measures pain and impact on daily function Completion time: 5 minutes (short form)
Brief Pain Inventory
Measures pain in older adults with cognitive impairment
Observation during movement and at restScoring: 0 or 16 items
Nonverbal, vocal complaintsFacial grimacingBracingRestlessnessRubbingVerbal, vocal complaints
Checklist of Nonverbal Pain Indicators
ObservationScore ranges from 0-10 points
1-3 Mild pain4-6 Moderate pain7-10 Severe pain
5 Areas AssessedBreathingNegative vocalizationFacial expressionBody languageConsolabilty
Pain Assessment in Advanced Dementia
BANDI-RT Utilizes information from MDS 3.0 Guides the therapist
◦ Identified problems◦ Care plan◦ Physician’s Orders◦ RT treatment
Flow sheet
Buettner Assessment of Needs, Diagnosis, and Interests for Recreational Therapy in LTC
Iowa Geriatric Education Center Geriatric Assessment Tools◦ http://www.healthcare.uiowa.edu/igec/tools/
Hartford Institue of Geriatric Nursing Try This◦ http://hartfordign.org/practice/try_this/
Dementia Practice Guidelines for Recreational Therapy◦ Buettner & Fitzsimmons (2003) Available
through the ATRA Bookstore
Resources for Assessments
Questions