Résidents Profiles Gallery.

We are going to construct the network of ALFs in Baltics. We are frequently asked who will live there. In this post we present the profiles of our future residents, created based on the different assessment systems.

Different assessment tools.

Entire geriatric world uses a wide range of different assessment tools for dependency measurement.

Barthel Index

The simplest and the most widely spread in the world is Barthel Index of Activities of Daily Living. It’s really clear, the calculations can be done on “back of envelope”, but it covers only functional disabilities, not cognitive ones. Barthel is used in the US mainly.

The criteria used in Barthel:

  • 1. Feeding
  • 2. Wheelchairs or bed transfers
  • 3. Personal toilet (grooming)
  • 4. Toilet Transfers
  • 5. Bathing self
  • 6. Walking
  • 7. Stairs, ascending & descending
  • 8. Dressing and undressing
  • 9. Bowel control
  • 10. Bladder control

The really good and simple on-line tool is here: http://www.pmidcalc.org/index.php

Palliative Performance Scale of PPS

The Palliative Performance Scale was designed to assess the physical and functional status of patients receiving palliative care. It has been used to evaluate progression of disease, symptom management and other care needs, prognosis, and the timing of hospice referral.

Scores are given in 10-point increments, ranging from 0 (death) to 100 (full or normal, no disease). Five categories of function are scored, and lower scores indicate greater functional impairment.

The criteria:

  • 1.Ambulation
  • 2. Activity Level Evidence of Disease
  • 3. Self-Care
  • 4. Intake (eating)
  • 5. Level of Consciousness

Geriatric Health Questionnaire

The Geriatric Health Questionnaire is a tool for brief yet comprehensive functional assessment of geriatric patients. It has not been validated, but anecdotal experience has demonstrated its usefulness to clinicians in the busy office practice.

The used criteria are:

  • 1. General Health Self- Perceptions
  • 2. ADL need
  • 3. Geriatric Review of Systems
  • 4. Family connections
  • 5. Medication
  • 6. Sexual life
  • 7. Panic
  • 8. Vaccination
  • 9. Cognitive

Index of Independence in Activities of Daily Living (Katz Index of ADL)

This index measures functionaly valuable indicators of the changes experienced by aging and chronically ill patients. The Index of Independence in Activities of Daily Living was developed in 1963. To evaluate changes in these populations, assessing a patient's overall performance of six self-care functions:

  • bathing,
  • dressing,
  • toileting,
  • transferring,
  • continence, and
  • feeding.

The scale is changed from A ( Independent in feeding, continence, transferring, toileting, dressing, and bathing) to G (Dependent in all six functions).

Instrumental Activities of Daily Living (IADL)

The Instrumental Activities of Daily Living (IADL) scale measures eight complex activities related to independent functioning, objectively evaluating a patient's ability to perform these functions and assessing how much assistance he or she requires for each activity, if any. The more these abilities are impaired, the more services will be necessary to maintain a person in the community.

The IADL scale is a brief tool that aids in the formulation, implementation, and evaluation of treatment plans. It is useful in elderly community populations and provides information about a patient's need for support services. It can be completed by obtaining the requested information from either the patient or an informant, such as a family member or other caregiver.

Criteria:

  • A. Ability to use telephone
  • B Shopping
  • C. Food Preparation
  • D. Housekeeping
  • E. Laundry
  • F. Transportation
  • G. Responsibility for own medication
  • H. Ability to handle finances

GIR

The AGGIR (Autonomy, Iso-Resources Group Gerontology) is now universal assessment tool of the degree of dependence of the elderly used in France. The person's level of dependency is determined by allocating to one of 6 pre-defined groups: GIR 1 to 6.

Criteria:

10 discriminating variables: they relate to the loss of physical and mental autonomy:

  • 1 - consistency
  • 2 - Guidance
  • 3 - toilet
  • 4 - dressing
  • 5 - Feeding
  • 6 - urinary and bowel elimination
  • 7 - transfer: stand up, lie down, sit
  • 8 - movement within the house
  • 9 - Travel outside
  • 10 - Remote communication

7 illustrative variables: they relate to the loss of domestic and social autonomy

  • 1 - Management
  • 2 - kitchen
  • 3 - Household
  • 4 - Transport
  • 5 - Purchases
  • 6 - Follow-up treatment
  • 7 - free time activities

Profiles:

To create the typical profiles we’ve used the GIR evaluation system and several additional characteristics.

  1. Family situation,
  2. Clinical history,
  3. Documented needs,
  4. Characteristics of mobility.

The Summary and Care plan version is presented for each profile.

1.1. Average ALF résident. Barbara. GIR4.

1.1.1. Family situation, Сlinical record, Documented needs.

Female, age 78, widow, one adult son who lives in England. She has lived in Latvia most of her adult life and chooses to remain instead of relocating nearer to her son.

She has diabetes, heart and respiratory illnesses (chronic heart failure and chronic obstructive pulmonary disease). She suffers from mild depression and short-term memory loss. She was hospitalized recently for uncontrolled diabetes and is no longer able to live alone. Poor circulation from the diabetes has caused some gait problems and she currently uses a walker to ambulate. She has occasional incontinence due to the inability to walk quickly.

She needs supervision and some physical assistance with all ADLs. She needs help bathing and washing her hair, and minimal assistance getting dressed. She is at risk of falling and needs help stabilizing herself when arising from a bed or chair. The assisted living home will provide assistance with daily medication and a special diet to help control her diabetes.

1.1.2. Characteristics of mobility

  • Can support herself to some degree and uses walking frame or similar
  • Dependent on caregiver in some situations
  • Usually no risk of dynamic overload for staff. A risk of static overload can occur if not using proper aids
  • Stimulation of functional mobility is very important

1.1.3. Summary & Care Plan

Barbara is partly capable of performing daily activities independently and the assistance she requires is not generally physically demanding for the caregiver.

Assistance will consist of verbal social support, feedback or indications, but light physical assistance may also be necessary. This assistance will be provided in combination with minor aids (walking aids, support or grips and handles) in adapted resident environment. Barbara’s remaining capacities will be stimulated.

1.2. Maximum level of Care in ALF. DORIS. GIR2.

1.2.1. Family situation, Clinical history, Documented needs

Female, 67, lived for the last several year in family of elder daughter who is burnt out after the last hospitalisation of her mother.

Dorys has a history of of severe respiratory illnesses with recurrent bouts of pneumonia that require hospitalization.
She is high risk for bed sores, frequent turning and skin monitoring necessary. Dorys has a gastronomy tube for feeding and all medications are administered through tube. He is incontinent of bowel and bladder.

Bed and wheelchair bound, maximum assistance required with all ADLs, including Hoyer lift for transferring from bed to wheelchair and bath.

1.2.2. Characteristics of mobility:

  • Cannot stand and is not able to weight bear. Is able to sit if well supported.
  • Dependent on caregiver in most situations
  • A high risk of dynamic and static overload for staff when not using proper aids
  • Stimulation of functional mobility is very important

1.2.3. Summary & Care plan

Dorys is incapable of performing daily activities independently or actively contributing in any substantial or reliable way.

Dorys is unable to substantially contribute to the movement. Equipment should be used to eliminate this risk of physically overloading the caregiver.

However, wherever and whenever possible, it is important to activate these her. The assistance provided for Doris might include transfers with a Hoyer lift. One extra point to remember is prevention, when it comes to the problems associated with immobility, e.g. provide good skincare.

It is important to slow down the deterioration of her mobility.

1.3. Maximum level of care in ALF with Dementia. CARL. GIR2.

1.3.1. Family situation, Clinical history, Documented needs

Carl, Male, 92, in the advanced stages of Alzheimer’s disease. This client has family in the community, but is no longer able to recognize them.

He is able to move around in wheelchair and has few other physical health problems. He has a poor appetite, is unable to chew and has difficulty swallowing. All food must be pureed and she needs physical assistance to swallow. He is incontinent of bowel and bladder and is afraid of bathing. He is often agitated and can be verbally abusive. He has difficulty sleeping and often gets up in the night and wanders around, trying to get out of the house.

1.3.2. Characteristics of mobility:

  • Is able to partially weight bear on at least one leg. Often sits in a wheelchair and has some trunk stability
  • Dependent on caregiver in many situations
  • A risk of dynamic and static overload for staff when not using proper aids
  • Stimulation of functional mobility is very important

1.3.3. Summary & Care plan

Carl is incapable of performing daily activities without assistance, but is able to contribute to the action or perform part of the action independently when he is not agitated.

The transportation equipment should be used to prevent the caregiver from being exposed to unsafe levels of load and wandering signalisation to prevent the unauthorised leaving of place of living.

However, these patients are able to actively contribute to the movement and it is important that they maintain or improve this capacity as far as possible. The assistance provided for Carl might include transfers using a standing and raising aid. It is important to stimulate Carl's remaining capacity and slow down the deterioration and of the cognitive abilities.

1.4. Minimum level of care in ALF . Albert. GIR5.

1.4.1. Family situation, Clinical history, Documented needs,

Male, 76, with high blood pressure and coronary artery disease, past history of mild strokes. He has never been married, and has only a few friends that visit infrequently. He has some right side paralysis that inhibits his ability to perform his ADLs without supervision. He is able to eat on his own, but cannot prepare meals. He is still able to handle his own financial affairs and makes his own medical appointments. His primary needs from the assisted living home are supervision and cueing.

1.4.2. Characteristics of mobility:

  • Ambulatory, but may use a walking stick for support
  • Independent, can clean and dress himself
  • Usually no risk of dynamic or static overload for staff
  • Stimulation of functional mobility is very important

1.4.3. Summary & Care plan

This resident/patient is able to perform daily activities independently without assistance from another person.

The resident/patient may require social aids or appliances. Generally, there is no risk of physically overloading the caregiver. Albert requires careful monitoring.

1.5. Not accepted in ALF. EMMA. GIR1.

In Emma’s case, it is no longer considered important that she be stimulated to contribute to the movement and become active. In some cases, such as residents/patients in the terminal stages of cancer or Alzheimer’s dementia, this active contribution may even have to be avoided or may be undesirable.

1.5.1. Characteristics of mobility:

  • Might be almost completely bedridden, can sit out only in special chair
  • Always dependent on caregiver
  • A high risk of dynamic and static overload for staff when not using proper aids
  • Stimulation of functional mobility is not a primary goal

1.5.2. Summary Care plan

This resident/patient is incapable of performing daily activities independently or actively contributing to them

Sources of information.