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

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

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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

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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

Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 3

Agenda

  • Ageing related issues
  • W hy use standardised assessm ents
  • Assessm ents Suitable for use W ith Adults and Older People
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Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 4

Ageing Related I ssues

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15 17 23 1 2 5 5 10 15 20 25 1985 2010 2035

Percentage of older people in the UK, 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; Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 6

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

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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

Shelley Hughes | Pearson Clinical Assessment | #OTLearn | 19/3/2015 8

Rem em ber…

…Conditions can fluctuate and recover.

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W hy do w e use Standardised Assessm ents?

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The Pros…and Cons!

Advantages

  • Support your professional

judgement

  • Provide structure
  • Developed by experts in the

field

  • Based on latest research
  • Save time and money in the

long term

  • Support intervention planning

Disadvantages

  • Can become out-dated
  • Cost of materials
  • Using the wrong assessment

wastes time and money

  • How do you relate to

everyday life

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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?

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.

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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

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Assessm ents Suitable for use W ith Adults and Older People

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  • 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

Developm ent Goals:

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Links motor domains to activities of daily living Author – expert in the field Determine motor strengths and areas for intervention Specifically for adults aged 40+ Large normative sample; validated against a motor impaired group Progress monitoring for disease progression and rehabilitation Simple and flexible administration Short Form available Sensitive to subtle increments of change in the impaired range

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Related ADL tasks:

  • Handling small objects
  • Coins
  • Pills
  • Dressing
  • Fastening
  • Buttoning
  • Food Preparation

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Transferring Pennies: Preferred Hand

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  • 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

Developm ent Goals:

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A brief cognitive screen. Typically 15 – 20 minutes UK Validation data Helps evaluate global cognitive functioning Interpreted in terms of age and years of education Co-developed with TFLS Suitable for repeated assessment For ages 17 and

  • lder

Gold standard assessment Weighted scoring system Simple classification system

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

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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

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Developm ent Goals

  • Developed out of a need for a brief performance based measure of

activities of daily living (ADL)

  • Originally developed in response to the limitations of functional

assessment approaches for individuals with dementia, while being brief and easy to administer

  • Further research expanded use to other populations
  • Designed to assess instrumental ADL – understood to be more susceptible

to cognitive decline than personal ADL

  • Provide an objective measure

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UK Validation Co-developed with BCSE Ecologically valid, performance-based screening tool to help identify the level of care an individual requires Particularly useful for identifying early cognitive decline For ages 16 to 90 years 11 months Emphasis on instrumental activities of daily living (IADL) skills Brief and simple to administer. Typically 15 minutes Excellent Face Validity Applicable to multiple populations

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Content

The TFLSUK covers four functional dom ains:

  • Time

― clocks and calendars

  • Money and Calculation

― count money and write cheques

  • Communication

― prepare a snack, use a phone and phone books

  • Memory

― remember simple information and to take medications

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I nterpretation Considerations

  • Consider issues that may influence performance – vision, hearing, fatigue,

medication

  • Look at individual scores, not just the overall score
  • Avoid over-interpretation
  • Use the assessment to inform intervention

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Thank you for listening! Questions?

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Contact I nform ation

www.pearsonclinical.co.uk Customer Services: 0845 630 8888 Chat function available online Social Media:Twitter Facebook Tumbler Google+ You Tube Channel

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Pricing

TFLS: Complete Kit £199 + VAT ISBN: 9780749162726 BCSE: Complete Kit £144 + VAT ISBN: 9780749162245 BMAT: Complete Kit £514 ISBN: 9780749165666

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References

  • Health and Social Care Information Centre; Focus on the Health and Care
  • f Older People; 2014; ISBN Number: 978-1-78386-178-1
  • Mental Health Foundation: http://www.mentalhealth.org.uk/

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