19/03/2015 Measuring I ndependent Living and Participation in Older - PDF document

19/03/2015 Measuring I ndependent Living and Participation in Older People: Choosing the Right Assessm ent Tool for the Job. # OTLearn Shelley Hughes SROT; 19/03/15 Agenda • Ageing related issues • W hy use standardised assessm ents • Assessm ents Suitable for use W ith Adults and Older People 3 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 1

19/03/2015 Ageing Related I ssues 1 4 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 Percentage of older people in the UK, 1985, 2010, 2035 25 23 20 15 17 15 10 5 5 1 2 0 1985 2010 2035 65 and over 85 and over Sources: 1985 and 2010 Mid-year population estimates, ONS, NRS, NISRA; 1985 and 2010 Mid-year population estimates, ONS, NRS, NISRA; 5 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 Conditions More Prevalent in Older People… • Diabetes Increased by 5% in those aged 75 and older between 2003 and 2012 1 in 7 people aged 65 or over have been diagnosed with diabetes • Dem entia 5% of people over aged 65 • Heart Disease One in five people aged 75 or over • Stroke 11% of those aged 75 and over have had a stroke • Cancer 63% of cancers diagnosed in people aged 65 and over • Mental Health I ssues Depression affects 1 in 5 older people living in the community, and 2 in 5 living in care homes • Multiple conditions Concurrent problems, hidden illness, under-reporting Sources: Health and Social Care Information Centre Mental Health Foundation 6 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 2

19/03/2015 Conditions to be Aw are of W hen W orking W ith Older People… • Sleep Disorders Consequences include cognitive problems such as memory and attention, mental health problems such as depression and anxiety, increased risk of falls, decreased QOL, increased incidence of pain. • Eyesight problem s Do they have correct lens prescription? • Hearing loss Difficulty tuning in to high and low frequencies; use of hearing devices; communication tools (e.g. telephone use) • Medication Multiple medications; noncompliance (remembering medications; over-medicating; communication / instructions; side effects). Adverse effects that mimic other issues (fatigue, cognitive issues, depression, pain, falls) • Pain Affects ADLS; sleep disturbance; social interactions; depression / anxiety; some may not be able to express pain; significantly affects quality of life 7 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 Rem em ber… …Conditions can fluctuate and recover. 8 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 W hy do w e use Standardised Assessm ents? 2 9 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 3

19/03/2015 The Pros…and Cons! Advantages Disadvantages Support your professional • Can become out-dated judgement • Cost of materials Provide structure • • Using the wrong assessment Developed by experts in the • • wastes time and money field How do you relate to Based on latest research • • everyday life Save time and money in the • long term Support intervention planning • 10 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 Considerations W hen Selecting Assessm ents • Age Range: For what age range is it intended? Can you use outside of age range? • Clinical Application: Were clinical samples used for validation? What is the research basis for the tool? On what population was it developed? 11 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 Considerations W hen Selecting Assessm ents • Physical Requirem ents: Do you have the necessary materials and/or space to administer the assessment? Is the service user capable of completing the assessment? • W hat is the intention behind using the assessm ent: Progress monitoring – consider practice effects Supporting placement decisions Evaluating strengths and/or impairment levels. 12 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 4

19/03/2015 Areas of Assessm ent and I ntervention Supported by Standardised Assessm ents… • Personal ADL – dressing, feeding, bathing, grooming • I nstrum ental ADL – Cooking, cleaning, shopping, managing money • Mobility / balance – transfers, inside and outside • Sensory and language im pairm ents – vision, hearing, receptive and expressive language • Cognitive / Behaviour Problem s – in context • Mental Health • Caregiver support – additional support needs • Relationships / social factors • Environm ent – comfort, accessibility 13 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 Assessm ents Suitable for use W ith Adults and Older People 3 14 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 15 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 5

19/03/2015 16 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 Developm ent Goals: • Provide a motor assessment that targets more than pure motor skills, in selecting motor tasks directly related to ADL • To develop an assessment to support service users, families, and clinicians in making placement decisions or determining adjustments to support ADL • To provide an age and task appropriate assessment to support intervention planning and monitor progress • To provide an assessment which allows tailored administration to target specific motor areas to support clinical and research purposes • To develop an assessment sensitive to changes in the impaired range 17 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 Determine motor Short Form Author – strengths and available expert in areas for the field Progress intervention monitoring for disease Simple and progression and flexible rehabilitation administration Specifically for adults aged 40+ Sensitive to Links motor Large normative subtle domains to increments of sample; validated activities of against a motor change in the daily living impaired group impaired range 18 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 6

19/03/2015 Transferring Pennies: Preferred Hand Related ADL tasks: Dressing Handling small objects • • o Fastening Coins o Pills o Buttoning o Food Preparation • 19 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 20 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 Developm ent Goals: Designed as a brief yet reliable measure for cognitive screening • Developed in response to a need for a psychometrically robust tool sensitive to educational level • and age - Several measures already exist that are useful for determining elements of delirium and possible dementia. - Additional tasks developed for the BCSE that are known to be useful in identifying significant cognitive problems (clock drawing, incidental memory, inhibitory control, and verbal productivity) Developed as part of the Wechsler Memory Scale – Fourth Edition (WMS-IV), the gold standard • for memory assessment Intended for use by medical professionals in different settings, for example occupational • therapists, medical doctors, mental health units, supported living environments The UK version was developed in response to a need for a brief cognitive screener with UK • normative data Weighted Items – more sensitive to items to dementia • Not a diagnostic assessment; provides an indicator of current status • 21 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 7

19/03/2015 UK Validation A brief cognitive For ages data screen. 17 and Co-developed Typically 15 – older with TFLS 20 minutes Gold standard assessment Simple classification system Interpreted in Helps terms of age evaluate and years of global education Weighted cognitive Suitable for scoring functioning repeated system assessment 22 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 Content Covers seven content areas: • ― Orientation ― Time Estimation ― Mental Control ― Clock Drawing ― Incidental Recall ― Inhibitory Control ― Verbal Production Exam inees are asked to perform sim ple tasks: to create an overall • picture of cognitive functioning 23 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 I nterpretation Guidelines Consider issues that may influence performance – vision, hearing, fatigue, • medication Educational level • Scores in the very low range are not diagnostic: a number of cognitive • and non-cognitive factors can contribute to such a score Borderline scores: interpretation should focus on specific aspects of • assessment Interpret in light of the clinical question, history, and overall presentation • 24 Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 8