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Aged patients regularly fail to present in a typical way, and atypical responses to sickness are normal. A patient eliciting confusion might not have a neurologic issue but might have an infection instead. Social and mental components may likewise veil the usual or classic way diseases present in elderly persons. For instance, even though 30 percent of elderly persons aged 85 years and over have dementia, numerous doctors miss the diagnosis (Elsawy and Higgins, 2011). Hence, a progressively organized way to deal with evaluation can be useful. Herein is a personal reflection of the implications of age-related changes in geriatric patients explicating how a nurse practitioner might differentiate between normal behaviors/disorders due to aging and abnormal behaviors/disorders that are not age-related including how functional assessments might help distinguish “normal” from “abnormal”.
As Stangor and Walinga (2014) define it, a disorder is a progressing dysfunctional sequence of an idea, feeling, and conduct/behavior that causes noteworthy pain and distress, and that is ostensibly deviant in that individual’s way of life or society. The bio-psycho-social model of diseases is a framework for comprehending a disorder that assumes that a disorder is brought about by biological/organic, psychological/mental, and social variables. The biological component of the bio-psycho-social model addresses the effects on a disorder that originates from the working of the person’s body (Stangor and Walinga, 2014). Especially significant are hereditary/genetic qualities that make a few people more prone to a disorder than others and the impact of neurotransmitters. The psychological segment of the bio-psycho-social model incorporates the effects that originate from the individual mental-cognition domain, for example, patterns of negative reasoning and stress reactions (Stangor and Walinga, 2014). The social part of the bio-psycho-social model dwells on the impacts on a disorder arising from social and cultural factors, for example, financial status, vagrancy, abuse, as well as discrimination (Stangor and Walinga, 2014). This model is ostensibly a basic framework for clinicians to use when distinguishing between normal and abnormal behavior/disorders amongst elderly patients.
Dementia and mellow cognitive impairment
Although dementia and mellow cognitive impairment are both common observations amongst geriatric patients, even the individuals who do not encounter these conditions may face unnoticeable cognitive changes related to aging. These typical cognitive changes are critical to comprehend because, first, they can influence an aged person’s everyday capacity and, second, they can enable healthcare practitioners to recognize ordinary from illness states (Harada, Natelson Love & Triebel, 2013). Therefore, from a personal and professional point of view, to correctly distinguish between a normal and an abnormal behavior/disorder in a geriatric patient, there is a need to follow the bio-psycho-social framework in evaluating the behavior/disorder.
It is not enough to evaluate the patient’s genetic lineage to conclude that they are schizophrenic because it is medically established that there are genetic traits that make an individual susceptible to schizophrenia. As a nurse practitioner, there is a need to look at other social and psychological factors in an individual to draw a line between normal and abnormal behavior/disorder. Among other biological factors other than the genetic makeup of the person are the brain structure and status as well as the state and structure of the individual’s neurotransmitters (Stangor and Walinga, 2014). The social components to evaluate as a practitioner include the societal and cultural expectations, how the societal defines normality and a disorder, stigma/prejudice, discrimination, abuse, and homelessness (Stangor and Walinga, 2014). The psychological facets to evaluate are the individual’s response to stress and stressors and the individual’s patterns of negative thinking (Stangor and Walinga, 2014). A comprehensive evaluation of all these factors will give a basis for clinical observation and distinction between normal and abnormal behavior/disorders amongst aged patients.
Unlike medical conditions, psychological disorders have no clear tests. However, functional assessments can be a desirable way that clinicians can use to differentiate the normal from the abnormal. According to Geriatric Medicine (n.d.), frailty, and cognitive impairment are the basis of functional assessments. Patients aged 75 or more and have cognitive and physical impairments often experience frailty, which affects how they perform their Activities of Daily Living (ADLs) (Geriatric Medicine, n.d.). Frailty is the reliance a patient may have in at least one action of day-by-day living, or psychological disintegration or diminished outside mobility (Geriatric Medicine, n.d.). Amongst the instruments that clinicians use in functional assessments are the Katz ADL Scale, the Lawton-Browdy IADL Scale, the Get-Up-and-Go Test, or the Time Get-Up-and-Go Test, the Clock Drawing Test, the Mini-Mental Exam, and the Geriatric Depression scale (Geriatric Medicine, n.d.). A functional assessment establishes the current and future healthcare and psychosocial needs of a frail geriatric patient. If a functional assessment is comprehensive enough, it will yield crucial prognostic and diagnostic information that the clinician can use to understand the patient’s current and future needs and desires, in terms of care provision.
A comprehensive functional assessment
A comprehensive functional assessment cannot be a one-man’s show, and it cannot be a one-time activity. According to Elsawy and Higgins (2011), the examination of a geriatric patient should be multifaceted and interdisciplinary in approach targeting the patient’s social-economic environment, functional capacity, physical health, cognition as well as mental health. Elsawy and Higgins (2011) also add that, for geriatric patients with numerous concerns, the utilization of a “rolling” assessment spanning more than a few visits is worth considering. The rolling evaluation focuses on at least one area for screening during every office visit or each point-of-care interaction with the patient. Assessments tools driven by the patients themselves are quite popular, and clinicians should make geriatric care patient-driven and patient-centered. Having patients complete polls and perform specific assignments spares time, yet besides, gives helpful knowledge into their inspiration and cognitive capacity.
- Elsawy, B., & Higgins, K. (2011). The Geriatric Assessment. American Family Physician, 83(1), 48-56. Web.
- Geriatric Medicine. (n.d.). Functional Assessment of the Elderly [Ebook] (pp. 1-14). Geriatric Medicine. Web.
- Harada, C., Natelson Love, M., & Triebel, K. (2013). Normal Cognitive Aging. Clinics in Geriatric Medicine, 29(4), 737-752. doi: 10.1016/j.cger.2013.07.002
- Stangor, C., & Walinga, J. (2014). Chapter 13. Defining Psychological Disorders – 13.1 Psychological Disorder: What Makes a Behaviour Abnormal? In Introduction to Psychology – 1st Canadian Edition (1st ed.). BCcampus. Web.