Geriatric Syndromes & Assessment
Questions With Complete Solutions
Geriatric Syndrome (definition) - ANS A symptom, or a complex of symptoms, resulting
from multiple diseases and risk factors
Geriatric Syndrome (causes) - ANS - Multiple medications, reactions
- Multiple diseases
- Environmental conditions
- Age-related changes
Geriatric Syndromes (the "giants") - ANS - Pressure ulcers
- Cognitive changes/confusion
- Gait instability
- Falls
- Urinary incontinence
- Sleep disturbances
- Pain
- Malnutrition
"SPICES" Framework (Fulmer) for assessing for Geriatric Syndromes - ANS S - Sleep
disorders/disturbance
P - Problems eating or feeding
I - Incontinence
C - Confusion
E - Evidence of falls
S - Skin breakdown
*S*PICES - Sleep Disturbance - ANS Problem: decreased sleep efficiency
Contributing factors:
- co-morbidities & sleep disorders
- medications
- environment & lifestyle
Implications: prolonged illness
Assessment tools:
- sleep diary
- Epworth Sleepiness Scale
- Pittsburgh Sleep Quality Index
, Sleep efficiency (definition) - ANS - A ratio of the amount of time spent sleeping compared
to the amount of time spent in bed (time sleeping / time in bed)
- Sleep efficiency decreases with age
- In older adults, sleep efficiency drops below 0.8 to as low as 0.4 and people spend less time in
later stages of sleep
Pittsburg Sleep Quality Index (PSQI) - ANS - A self-rated questionnaire that assesses
sleep quality and disturbances over 1-month
- Seven "component" scores generated:
(1) subjective sleep quality
(2) sleep latency
(3) sleep duration
(4) habitual sleep efficiency
(5) sleep disturbances
(6) use of sleeping medication, and
(7) daytime dysfunction
- Sum the seven components yields one global score
Epworth Sleepiness Scale (ESS) - ANS - A scale intended to measure *daytime
sleepiness*, by administration of short questionnaire
- Subjects rate their probability of falling asleep on a scale of increasing probability from 0 to 3
for eight different situations
Sleep Disturbance - Nursing Interventions - ANS - Avoid chemicals, especially ETOH &
caffeine before bed
- Avoid heavy meals & fluids before bed (nocturia is common)
- Avoid activity/excitement after 17:00
- Encourage a regular schedule - going to bed and waking at the same time everyday
- Alternative therapies - guided imagery aromatherapy, relaxation
S*P*ICES - Problems with Eating and Feeding - ANS Problem: inadequate feeding
Contributing factors:
- inability to feed self
- bedside table out of reach, poor positioning
- food gets cold
- IV lines/equipment in the way
- poor appetite, nausea r/t medications, worry/anxiety, pain
Implications: malnutrition, prolonged illness
Assessment tools: *The Mini Nutritional Assessment*
Problems with Eating & Feeding - Nursing Interventions - ANS - Identify food preferences
- Position OOB in chair, upright
- Make meal time as normal as possible, avoid interruptions
- Encourage significant others to be there when eating (socialization)
Questions With Complete Solutions
Geriatric Syndrome (definition) - ANS A symptom, or a complex of symptoms, resulting
from multiple diseases and risk factors
Geriatric Syndrome (causes) - ANS - Multiple medications, reactions
- Multiple diseases
- Environmental conditions
- Age-related changes
Geriatric Syndromes (the "giants") - ANS - Pressure ulcers
- Cognitive changes/confusion
- Gait instability
- Falls
- Urinary incontinence
- Sleep disturbances
- Pain
- Malnutrition
"SPICES" Framework (Fulmer) for assessing for Geriatric Syndromes - ANS S - Sleep
disorders/disturbance
P - Problems eating or feeding
I - Incontinence
C - Confusion
E - Evidence of falls
S - Skin breakdown
*S*PICES - Sleep Disturbance - ANS Problem: decreased sleep efficiency
Contributing factors:
- co-morbidities & sleep disorders
- medications
- environment & lifestyle
Implications: prolonged illness
Assessment tools:
- sleep diary
- Epworth Sleepiness Scale
- Pittsburgh Sleep Quality Index
, Sleep efficiency (definition) - ANS - A ratio of the amount of time spent sleeping compared
to the amount of time spent in bed (time sleeping / time in bed)
- Sleep efficiency decreases with age
- In older adults, sleep efficiency drops below 0.8 to as low as 0.4 and people spend less time in
later stages of sleep
Pittsburg Sleep Quality Index (PSQI) - ANS - A self-rated questionnaire that assesses
sleep quality and disturbances over 1-month
- Seven "component" scores generated:
(1) subjective sleep quality
(2) sleep latency
(3) sleep duration
(4) habitual sleep efficiency
(5) sleep disturbances
(6) use of sleeping medication, and
(7) daytime dysfunction
- Sum the seven components yields one global score
Epworth Sleepiness Scale (ESS) - ANS - A scale intended to measure *daytime
sleepiness*, by administration of short questionnaire
- Subjects rate their probability of falling asleep on a scale of increasing probability from 0 to 3
for eight different situations
Sleep Disturbance - Nursing Interventions - ANS - Avoid chemicals, especially ETOH &
caffeine before bed
- Avoid heavy meals & fluids before bed (nocturia is common)
- Avoid activity/excitement after 17:00
- Encourage a regular schedule - going to bed and waking at the same time everyday
- Alternative therapies - guided imagery aromatherapy, relaxation
S*P*ICES - Problems with Eating and Feeding - ANS Problem: inadequate feeding
Contributing factors:
- inability to feed self
- bedside table out of reach, poor positioning
- food gets cold
- IV lines/equipment in the way
- poor appetite, nausea r/t medications, worry/anxiety, pain
Implications: malnutrition, prolonged illness
Assessment tools: *The Mini Nutritional Assessment*
Problems with Eating & Feeding - Nursing Interventions - ANS - Identify food preferences
- Position OOB in chair, upright
- Make meal time as normal as possible, avoid interruptions
- Encourage significant others to be there when eating (socialization)
