Assessment of the Older Adult:

Utilizing Standardized Tools for Recreational Therapy Treatment With Geriatric

Clients

Jo Lewis, MS/CTRSMegan Janke, Ph.D., LRT/CTRS

Upon successful completion of this session, the participant will be able to:

Identify 3 standardized assessment tools that may be utilized in Recreational Therapy treatment with older adults.

Verbalize 2 benefits of utilizing standardized assessments during Recreational Therapy treatment

Utilize internet resources for standardized assessment tools in Recreational Therapy practice with older adults.

Objectives

Validity◦ Does it measure what it is intended to measure?

External Internal

Reliability◦ Does it consistently measure what is intended?

Internal Consistency Inter-rater Reliability

Responsiveness Can it detect real change when it happens?

Key Concepts For Assessments

Measure what you intend to measure Justification of Services Accepted across discipline boundaries

Why Use Standardized Assessments?

Brief Interview for Mental Status Short Portable Mental Status Questionnaire Blessed Orientation-Memory-Concentration Test Global Deterioration Scale Brief Cognitive Rating Scale Clock Drawing Test Montreal Cognitive

Assessment (MoCA)

Cognitive Scales

Utilized for the MDS 3.0 Areas measured:

◦ attention◦ orientation◦ the ability to register and recall new information

Maximum Score: 15◦ 13-15 Cognitively intact◦ 8-12 Moderate impairment◦ 0-7 Severe impairment

Brief Interview for Mental Status

10 Items Maximum Score: 10

◦ 0-2 errors Intact◦ 3-4 errors Mild impairment◦ 5-7 errors Moderate impairment◦ 8-10 errors Severe impairment

5-10 minutes to administer

Short Portable Mental Status Questionnaire (SPMSQ)

Domains assessed◦ Orientation◦ Immediate and delayed episodic recall◦ Working memory

6 Items Maximum Score- 28 Higher score indicates greater impairment 3-6 minutes to administer

Blessed Orientation-Memory-Concentration Test

Rating scale 1: No cognitive impairment2: Very mild cognitive decline3: Mild cognitive decline4: Moderate cognitive decline5: Moderately severe cognitive decline6: Severe cognitive decline7: Very severe cognitive decline

Used with Brief Cognitive Rating Scale

Global Deterioration Scale

5 Axes◦ Concentration◦ Recent Memory◦ Past Memory◦ Orientation◦ ADL & Functional Abilities

Each axis is measured on a scale of 1-7 ◦ Scores from each axis added then divided by 5

Higher scores indicate higher level of impairment

Brief Cognitive Rating Scale

Correlates well with other cognitive assessment instruments

Visuospatial Assessment of Cognitive Functioning

6 point scoring system The higher the score, the greater the

degree of impairment Score of 3 or more indicative of cognitive

loss Completed in about 5 minutes

Clock Drawing Test

Screening tool for mild cognitive dysfunction Cognitive Domains

◦ Attention and concentration◦ Executive functioning◦ Memory ◦ Language◦ Visuoconstructional skills◦ Conceptual thinking◦ Calculations◦ Orientation

10 Minutes to Administer Possible score of 30

◦ 26 or above is considered normal

Montreal Cognitive Assessment(MoCA)

Barthel Index Berg Balance Scale Katz Index of Independence in

Activities of Daily Living Lawton Instrumental Activities of Daily

Living Tinetti Mobility Scale

◦ Performance-Oriented Assessment of Balance◦ Performance-Oriented Assessment of Gait

Get-Up & Go Test

Physical/ ADL Functioning

Self-report ◦ 2-3 minutes

Trained observation ◦ 10-15 minutes

3 point scale for each item

Barthel Index

Assesses:FeedingGroomingBowel & Bladder

ContinenceDressingToiletingWalkingStairsBathing

Barthel Index

Performance measure◦ Self-report◦ Trained observer

Scoring◦ Letter score from A-G

A= Most independent G= Most dependent

Katz Index of Independence in Activities of Daily Living

Bathing Dressing Toilet use Transfer ability Feed self Maintenance of

bowel & bladder continence

Self-report ofPerformance

Scoring ◦ O= Low functioning◦ 8= High functioning

Gender bias- ◦ transportation

Lawton Instrumental Activities of Daily Living Scale

Telephone usage Housekeeping* Food preparation* Laundry* Transportation Medications Money

management

5 point scaleHigher score indicates more difficulty with

gait and balanceScoring

1 = Normal2 = Very slightly abnormal3 = Mildly abnormal4 = Moderately abnormal5 = Severely abnormal

Score of greater than 3 at risk for fallingCan be performed as a timed assessment

Get-Up & Go

14 item scale5 point scale, ranging from 0-4

Completion time: 15-20 minutes Equipment needed:

RulerTwo standard chairsFootstool or stepStopwatch or wristwatch

Scoring41-56: Low fall risk21-40: Medium fall risk0-20: High fall risk

Berg Balance Scale

3 point scale per itemUsed in conjunction with Gait

AssessmentAssessment Process:

Sitting in chairRising from chairImmediate standing

balanceStanding balanceBalance with eyes closedTurning balance

Tinnetti Mobility ScalePerformance Oriented Assessment of Balance

Nudge on sternumNeck turningOne leg standing

balanceBack extensionReaching upBending downSitting down

8 Items◦ 2 point scale

Tinnetti Mobility ScalePerformance-Oriented Assessment of Gait

Assessment ProcessInitiation of gaitStep heightStep lengthStep symmetryStep continuityPath deviationTrunk stabilityWalk stanceTurning while walking

PHQ-9 Geriatric Depression

Scale Zung Self-Rating

Depression Scale Cornell Scale for

Depression in Dementia

Zung Self-Rating Anxiety Scale

WHOQOL-BREF

Emotional/ Psychosocial

Part of the Patient Health Questionnaire (PHQ)◦ PHQ-9- Depression Module

Self-report Multiple choice Measures severity of depression Implemented in the MDS3.0

PHQ-9

30 Questions◦ Short version available- 15 questions

Administration◦ Self –administered◦ Rater-administered

Questionable with older adults with severe dementia

Scoring◦ >5 indicates potential depression-

Should have a comprehensive assessment◦ => 10 almost always indicative of depression

Geriatric Depression Scale

Screening tool Self-report 20 items

◦ 4 point scale◦ Half of the items are positively worded; half

negatively Respondents rate frequency of occurrence Older adults score higher than other age

groups

Zung Self-Rating Depression Scale

Administration◦ Observation◦ Interview

Patient Caregiver

3 Point Scale◦ 0- Absent◦ 1- Mild or intermittent◦ 2- Severe

Cornell Scale for Depression in Dementia

Assessment Areas ◦ Mood related signs◦ Behavioral

disturbances◦ Physical signs◦ Cyclic functions◦ Ideational

disturbance

Self-report 20 items

◦ 5 affective◦ 15 somatic

Score range: 20-80 Administration Time: 10-15 minutes Used in psychiatric and medical patients

and with normal older adults

Zung Self-Rating Anxiety Scale

Measures the impact of disease◦ Impact of disease and impairment of daily

activities and behavior◦ Perceived health measures◦ Disability/ functional status measures

26 Questions Self-Administered Interviewer assisted or administered Manual is recommended to score the

assessment

World Health OrganizationQuality of Life (WHOQOL-BREF)

Faces Pain Scale Numeric Scale Pain Thermometer Brief Pain Inventory Checklist of

Nonverbal Pain Indicators Pain Assessment in Advanced Dementia

Scale

Pain

Originally developed for pediatrics No verbal component

◦ Language impairments◦ Difficulty with expression

7 point scale

Faces Pain Scale

Self-rating Scale of 0-20

◦ O= No pain◦ 20= Pain as bad as it could be

Scores can be averaged over time

Numeric Scale

Pain Thermometer

Widely used in clinical and research settings Originally developed for used with cancer

patients Currently used with individuals experiencing

chronic nonmalignant pain 16 items

◦ Measures pain and impact on daily function Completion time: 5 minutes (short form)

Brief Pain Inventory

Measures pain in older adults with cognitive impairment

Observation during movement and at restScoring: 0 or 16 items

Nonverbal, vocal complaintsFacial grimacingBracingRestlessnessRubbingVerbal, vocal complaints

Checklist of Nonverbal Pain Indicators

ObservationScore ranges from 0-10 points

1-3 Mild pain4-6 Moderate pain7-10 Severe pain

5 Areas AssessedBreathingNegative vocalizationFacial expressionBody languageConsolabilty

Pain Assessment in Advanced Dementia

BANDI-RT Utilizes information from MDS 3.0 Guides the therapist

◦ Identified problems◦ Care plan◦ Physician’s Orders◦ RT treatment

Flow sheet

Buettner Assessment of Needs, Diagnosis, and Interests for Recreational Therapy in LTC

Iowa Geriatric Education Center Geriatric Assessment Tools◦ http://www.healthcare.uiowa.edu/igec/tools/

Hartford Institue of Geriatric Nursing Try This◦ http://hartfordign.org/practice/try_this/

Dementia Practice Guidelines for Recreational Therapy◦ Buettner & Fitzsimmons (2003) Available

through the ATRA Bookstore

Resources for Assessments

Questions