Screening is the process of identifying risks that indicate a patient would benefit from further or more detailed assessment.
Assessment is the process of collecting information to identify the exact nature of a patient’s problems and protective factors (medical, physical, social and psychological). The information collected during an assessment should be analysed, interpreted, verified and communicated. It is used to inform the development of a prioritised, individualised person-centred care plan that includes evidence-based responses to treat a problem and prevent harm.
Screening and assessment are more than completing forms. As clinicians, we draw on our clinical reasoning skills, work with our team, and with the older person and their family, to establish their needs, wants and status.
Screening and assessment of our older patients, on admission and throughout their hospital stay, can identify concerns and changes, monitor progress and inform safe, effective and appropriate care.
Screening and assessment of older patients
Screening and assessment for older people is different to screening and assessment of younger people because older people often present to hospital with non-specific symptoms, and those symptoms may indicate different concerns and mask other issues that occur with ageing. For example, the symptoms of a urinary tract infection in a younger person may be frequent urination, pain from bladder spasms, blood in the urine, and fever. In an older person, the first sign of a urinary tract infection may be confusion or a fall as the other symptoms can be masked by changes that occur with ageing.1
Normal age-related changes
Older age provides a challenge for patients and clinicians to identify ‘normal’ from ‘abnormal’. While everyone is different and therefore ages in a different way and at a different rate, ‘normal’ ageing is generally accompanied by a decline in many homeostatic and metabolic processes.
Normal ageing can cause changes that require interventions to prevent further deterioration and to assist the person maintain their wellness. If illness does occur, the older person often has less reserve and less capacity to recover than younger people.
Changes in physical, cognitive and mental function are ‘normal’ ageing. Things to consider for older people in hospital include:
- Decreased muscle strength and aerobic capacity
- Decreased bone density and joint flexibility
- Vasomotor instability
- Skin thins and loses elasticity
- Changes in nutritional requirements and loss of appetite
- Changes in bladder and bowel function
- Decreased glucose tolerance
- Reduction in sensory perception
- Memory loss and reduced cognitive awareness
- Changes in mental health and wellbeing
- Altered sexual functioning.
Losses, such as bereavement and changes in function, are common experiences for older people and can be risk factors for loneliness and social isolation. These can in turn increase risk of various health problems.2 Older patients are also more likely to have multiple comorbidities which may increase their risk of social isolation.3
It is up to us to be curious, determine what matters to our patients, think about the information we collect and consider the best possible interventions that we can employ to minimise risks and maximise our patient’s quality of life. This can involve balancing some risks with some gains and working with our team and the older person and their family to make an informed choice about this.
1. Nay, R., Garratt, S., & Fetherstonhaugh, D. Older People: Issues and Innovations in Care, 2013 (4th ed.): Churchill Livingstone, Australia.
2. Vanderhorst, R. K., & McLaren, S. Social relationships as predictors of depression and suicidal ideation in older adults, (2005). Aging & mental health, 9(6).
3. Victor, C. R., Scambler, S. J., Bowling, A. N. N., & Bond, J. The prevalence of, and risk factors for, loneliness in later life: a survey of older people in Great Britain, (2005). Ageing and Society, 25(06).