Chair of Development in Nursing, Medical University of Lublin

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1 GERONTOLOGIA POLSKA 2016; 24: ARTYKUŁ ORYGINALNY/ORIGINAL PAPER Zgłoszono , orawiono , zaakcetowano Elements of the comrehensive geriatric assessment of seniors staying in social welfare homes Elementy całoœciowej oceny geriatrycznej seniorów w domach omocy sołecznej Wiesław Fidecki 1, Mariusz Wysokiński 1, Konrad Skuiński 1, Irena Wrońska 1, Kornelia Kędziora-Kornatowska 2, Zofia Sienkiewicz 3, Dorota Kulina 1, Jadwiga Burian 1 1 Chair of Develoment in Nursing, Medical University of Lublin 2 Chair and Clinic of Geriatrics, Collegium Medicum in Bydgoszcz, Nicolaus Coernicus University in Torun 3 Deartment of Social Nursing Medical University of Warsaw Abstract Introduction. Comrehensive geriatric assessment is a multi-faceted and interdiscilinary diagnostic rocess that aims at recognizing medical, hysical and mental issues in a atient. The rocess includes secifying atients otential for activity as well as a comrehensive lan for taking care of them. Aim. The aer aims at geriatric assessment, by means the scale, of seniors staying in social welfare homes. Material and methods. The investigation was conducted in the cohort of 195 elderly eole staying in social welfare homes of Lublin. Nurses Observation Scale for Geriatric Patients, which facilitates both rofessional and non-rofessional carers to make a romt and easy assessment of their elderly atients hysical, mental and social condition, was emloyed to administer the study. Results. Having made atients assessment by means of the scale, the Authors found the score for the comlete study grou to average out at oints. Investigated atients functioned best within the scoe of disrutive behaviours (average 8.87 oints). Memory and daily living activities averaged out resectively at 9.58 and 9.85 oints, while the domain of moods/ emotions scored oints, and social behaviours averaged out at Investigated atients functioned worst in the field of instrumental activities of daily living (11.13 oints). Conclusions. The greatest deficits in the cohort of elderly eole staying in social welfare homes were found within the scoe of instrumental activities of daily living. Females were found to be fitter in comarison with males. Patients age significantly differentiated fitness levels the older the atients the worse their fitness. On the other hand, it was found that the higher the atients education, the better their bio-sycho-social fitness. (Gerontol Pol 2016; 24: 26-31) Key words: scale, comrehensive geriatric assessment, social welfare home Streszczenie Wstę. Komleksowa ocena geriatryczna jest wieloasektowym i interdyscylinarnym rocesem diagnostycznym. którego celem jest rozoznanie roblemów medycznych. fizycznych oraz sychicznych acjenta. wraz z określeniem jego otencjału czynnościowego i wrowadzeniem całościowego lanu oieki. Cel. Celem racy było dokonanie oceny geriatrycznej seniorów rzebywających w domach omocy sołecznej rzy omocy skali. Materiał i metody. Badania rzerowadzano na gruie 195 osób w odeszłym wieku rzebywających w domach omocy sołecznej miasta Lublin. Badania rzerowadzono rzy użyciu skali (Nurses Observation Scale for Geriatric Patients). Skala ta umożliwia rofesjonalnymj jak i nierofesjonalnym oiekunom seniora szybkie i łatwe dokonanie oceny fizycznegoj umysłowego i socjalnego stanu acjenta. Wyniki. Dokonując oceny acjentów za omocą skali stwierdzonoj że średni wynik dla badanej gruy wyniósł 60,41 kt. Badani najleiej funkcjonowali w obszarze zachowań zakłócających (średnia 8,87 kt). Na odobnym oziomie uzyskano wyniki w zakresie amięci i aktywności codziennego życia, średnie odowiednio: 9,58 kt oraz 9,85 kt. Obszar nastrojów/emocji kształtował się na oziomie 10,05, a zachowań socjalnych na oziomie 10,94 kt. Badani najgorzej funkcjonowali w zakresie instrumentalnej czynności codziennego życia (11,13 kt). Wnioski. W badanej gruie osób starszych rzebywających w domach omocy sołecznej największe deficyty stwierdzono w zakresie instrumentalnych czynności codziennego życia. Kobiety wykazywały wyższy stoień srawności w orównaniu z gruą mężczyzn. Wiek badanych istotnie różnicował ich stoień srawności. Wraz z wiekiem ogarszała się srawność badanych osób. Wraz ze wzrostem wykształceniem badanych. lesza była ich srawność biosychosołeczna. (Gerontol Pol 2016; 24: 26-31) Słowa kluczowe: skala, komleksowa ocena geriatryczna, dom omocy sołecznej Adres do koresondencji: Wiesław Fidecki; Chair of Develoment in Nursing Medical University of Lublin; 4-6 Staszica Str.; Lublin (+48 81) fidecki@interia.l Ó Akademia Medycyny

2 ELEMENTS OF THE COMPREHENSIVE GERIATRIC ASSESSMENT OF SENIORS Introduction Comrehensive geriatric assessment is a multifaceted and interdiscilinary diagnostic rocess whose aim is to recognise atients medical, hysical and mental roblems as well as to secify their otential for activities and to introduce an all-inclusive care lan [1]. Aart from the classical subject and object examination, a comrehensive geriatric assessment always involves an analysis of the functional fitness within the scoe of basic and comlex activities of daily living. Further elements of the assessments include an araisal of mental functions (deression and senile dementia), as well as an evaluation of the risk of falls and malnutrition [2]. Occurrence of ain and its intensity should also be assessed. Patient s socio-economic situation ought to be taken into account as well. Emloying tools of a comrehensive geriatric assessment considerably imroves detectability of disorders that are tyical for the old age. It is defining atient s functional state and its restrictions, rather than concentrating on resent disorders and conditions that is most imortant within the scoe of a comrehensive assessment. So much so that numerous incurable disorders allow for a ositive rognosis in the scoe of imroving atients functional fitness. Hence, any activities undertaken within the scoe of geriatric assessment consist in discovering reversible roblems and solving them [3,4]. Aim The aim of the aer was to make a geriatric assessment of seniors staying in social welfare homes. Material and methods The investigation was administered in the grou of 195 elderly eole staying in social welfare homes of Lublin. The study was aroved by the Bioethical Committee of the Medical University in Lublin. Investigated atients gave their informed consent for articiating in the research. Socio-demograhic characteristics of investigated atients is resented in Table I. The study involved using the scale (Nurses Observation Scale for Geriatric Patients), which allows both rofessional and non-rofessional carers of the elderly to evaluate hysical, mental, and social state of their atients quickly and easily. The scale is comrised of 30 questions and covers six s: memory, instrumental activities of daily living (IADL), activities of daily living (ADL), mood, social behaviour, destructive behaviour, and disturbing behaviour. Values on the scale range from 1 to 5. A minimum score a atient can score is 30 and the maximum score is 150. Within each domain, a atient s score can range from 5 to 25 oints. The higher the score one obtains during observation, the worse their condition is [5-10]. Findings were analysed statistically and values of the measurable arameters being analysed were resented by means of the mean value, median, and standard deviation, while cardinality and ercentage were used for the non-measurable values. The U Mann-Whitney test was used to comare two indeendent grous, whereas the Kruskal-Wallis test was emloyed to comare more than two grous. The relevance level of < 0.05 was adoted to indicate statistically significant differences or correlations. The database and statistical analysis were administered by means of the STATISTICA 9.0 software. Table I. Socio-demograhic characteristics of the research ool % No. Gender Female Male years Age years Over 90 years Elementary Education Secondary Higher Single Marital Status Married Divorced Widow/ Widower

3 28 WIESŁAW FIDECKI1 ET AL. Results The atients having being evaluated by means of the scale, the average score for the grou was found to be oints. Investigated atients functioned best in the domain of disrutive behaviours (average 8.87 oints). Similar levels were obtained within the domain of memory and activities of daily living, average values were resectively 9.58 oints and 9.85 oints. The field of moods/ emotions averaged out at oints, and social behaviours at oints. Investigated atients functioned worst in the domain of instrumental activities of daily living (11.13 oints). Detailed statistical analysis of resective domains is resented in Table II. Table II. Statistical values of the scale Memory IADL ADL Mood Social behaviour Disturbing behaviour Females were found to be fitter (59.67) than males (61.68) according to gender-based atient evaluation. Nevertheless, the difference roved not to be statistically significant (Table III). The next asect to be analysed was a comarison of seniors state deending on their age. Patients from the youngest age bracket scored highest (averagely oints). Those from the age grou scored slightly worse (60.51 oints), and those over 90 functioned worst (72.53 oints) (Table IV). Table V resents assessment results deending on investigated atients education. The data rove those with higher education to function best (51.50 oints) and those with elementary education to function worst (61.67 oints). Nevertheless, no statistically significant difference was discovered between features analysed. Assessment of elderly eole deending on their marital status was the final asect to be analysed. Divorced eole featured greatest fitness (58.68 oints), and widowed atients scored similarly (59.71). Single atients averaged out at oints. Married atients roved to function worst, scoring oints (Table VI). Table III. vs. Gender Male Female Statistical analysis Z Memory ADL Mood IADL Social behaviour Disturbing behaviour Z - Mann-Whitney U test Table IV. vs. Age Statistical analysis H Memory ADL Social behaviour IADL Mood Disturbing behaviour H Kruskal -Wallis test

4 ELEMENTS OF THE COMPREHENSIVE GERIATRIC ASSESSMENT OF SENIORS Table V. vs. Education Elementary Secondary Higher Statistical analysis Memory ADL Social behavior IADL Mood Disturbing behavior H Kruskal-Wallis test. H Table VI. vs. Marital Status. Single Married Divorced Widow/ Widower Statistical analysis Memory ADL Social behaviour IADL Mood Disturbing behaviour H Kruskal -Wallis test H Discussion Growing old is a rogressive rocess of decreasing mental and hysical fitness in a human being. The incidence of various somatic and mental diseases increases with age, furthermore, there is a greater risk of dementia-based diseases with their wide range of symtoms that may rove very arduous. Furthermore, there is a change of social roles and a gradual loss of close relatives. All the aforementioned factors contribute to a unique nature of the needs that elderly eole develo. Such needs, either satisfied or frustrated, manifestly correlate with the quality of life the elderly erceive, and thus correlate indirectly with the quality of their treatment. It is owing to an assessment of a atient s needs that a direction and an otimum range of theraeutic and social activities may be established. Care customized for individual demands seems to be most beneficial as it allows to increase atients quality of life and is the best solution economically-wise [11]. Authors own findings roved investigated atients to enjoy a relatively high degree of fitness, both in the general scale fitness assessment, and in the scale s resective domains. However, another research by Fidecki et al. [12] roduced data that roved assessment results to be better. The investigation involved elderly eole in their home environment. In this study, assessment results obtained by means of the scale averaged out at oints. Further research by Fidecki et al. [13] roduced significantly different assessment results. 202 elderly eole who were assessed in long-term care institutions averaged out at oints on the scale, which roves atients to have a decreased fitness level and a large demand for care from other eole. Authors own research secified bio-sycho-social assessment of elderly eole deending on their gender.

5 30 WIESŁAW FIDECKI1 ET AL. Females roved to enjoy slightly better sycho-motor condition in comarison with males in all domains of the scale (excet for the moods/emotions domain, where males scored slightly higher). Investigations by Bońkowski and Klich-Rączka [14] and by Wilmańska and Gułaj [15] roduced different findings as they clearly showed females to have worse functional state than males. Literature of the subject and findings by other Authors rove fitness of elderly eole to decrease with age, believe a decrease in functional fitness, esecially within the scoe of movement to be the cause). An analysis of administered investigations roved there was a correlation between age and the level of functional fitness. In this study, best results were obtained in the cohort of year-olds. They enjoyed better functional fitness in comarison with other grous. Płażewska-Żywko et al. [16] obtained similar research findings as this age grou also scored best in their investigation. Authors own investigations roved married eole to have worst fitness, whereas studies by other authors ointed out widowed eole to have worst fitness [17, 18]. Numerous factors negatively influencing human life cumulate in the old age. If such factors are romtly identified, minimized or liquidated, elderly eole s lifesans may be lengthened, while their fitness and quality of life are imroved [16]. Conclusions 1. Greatest deficits in the investigated cohort of elderly eole staying in social welfare homes were found in the domain of instrumental activities of daily living. 2. Females roved to enjoy greater fitness than males. 3. Investigated atients age significantly differentiated their fitness levels. The older the atients, the worse their fitness. 4. On the other hand, the higher atients education, the better their bio-sycho-social fitness. Conflict of interest None References 1. Bień B, Wojszel ZB. Komleksowa ocena geriatryczna. W: Kędziora-Kornatowska K.. Muszalik M. (red.) Komendium ielęgnowania acjentów w starszym wieku. Lublin: Wyd. Czelej; s Wieczorowska-Tobis K. Ocena acjenta starszego. Geriatri.a 2010; 4: Wieczorowska-Tobis K, Grodecka-Gazdecka S. Pacjent onkologiczny - geriatryczny unkt widzenia. Geriatria. 2010; 4: Wieczorowska-Tobis K, Rajska-Neumann A, Styszyński A, Joźwiak A. Komleksowa ocena geriatryczna jako narzędzie do analizy stanu funkcjonalnego acjenta starszego. Gerontol Pol. 2006; 2: Brunner C, Siegel R. Eine Validierungsstudie mit der (Nurses Observation Scale for Geratric Patients), einem neuen Beurteilungsinstrument für die Psychogeriatrie. Z Klin Psychol. 1990; 19 (3): Siegel R, Brunner M, Ermini-Fünschilling D. and al. A new behavioral Assessment Scale for Geriatric Outand In Patients: the (Nurses Observation Scale for Geriatric Patients). J Am Geriatrics Soc. 1991; 39 (4): Tremmel L, Siegel R. Clinical exerience with the (Nurses Observation Scale for Geriatric Patients): tentative normative data and sensitivity to change. Int J Geriatr Psychiatry. 1993; 8: Wahle M, Häller S, Siegel R. Validation of the (Nurses Observation Scale for Geriatric Patients): reliability and validity of a caregiver rating instrument. Int Psychogeriatr. 1996; 8 (4): Liszewska M. Zdążyć na czas. Senior z demencją a zastosowanie (Nurses Observation Scale for Geratric Patients). Wsólne tematy. 2005; 1: Fidecki W, Wysokiński M. Zastosowanie skali w raktyce ielęgniarskiej. W: Kachaniuk H. (red.) Pielęgniarska oieka nad osobami starszymi. Warszawa: Dr Josef Raabe Sółka Wydawnicza S. z o.o.; s Rymaszewska J, Szmigiel A. Potrzeby osób w starszym wieku definicje i narzędzia oceny. Psychogeriatr Pol 2008; 5(2):

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