Thirty years ago, if a hospitalized older woman became incoherent, tried to get out of a bed with siderails, pulled out her iv, and was incontinent, she would have been labeled a "crazy old lady." What else was a nurse to do but put her in wrist restraints, restart the iv, and call the physician to order a sedative and a Foley catheter? It didn't occur to most nurses in the 1970s that assessing for dementia, delirium, dehydration, or other common geriatric conditions might prevent further complications.
But even if it had occurred to them, they didn't have the standardized, quick, reliable screening tools that are now available. For example, if a patient developed delirium, nurses had no tools for systematically addressing possible underlying causes with the health care team. Voiding patterns weren't considered in seeking to prevent or treat incontinence; Foley catheters, which often became the source of infections, were used instead.
The New York University College of Nursing's Hartford Institute for Geriatric Nursing has been publishing an online series of tools, called Try This, on assessing and managing the care of older adults (http://www.hartfordign.org/trythis). But despite their availability, these and other evidence-based assessment methods won't be used if nurses don't know about them or aren't sure how to use them.
This month AJN, in partnership with the Hartford Institute, launches a series of articles and videos on Try This. Called How to Try This and designed to help clinicians, students, and faculty, it'll be published monthly for 15 months, and all articles and videos will be available free online (http://www.nursingcenter.com/ajnolderadults). The videos demonstrate use of the tools with real patients and can be viewed in their entirety or as chapters that are linked to the articles. The videos can be downloaded to a computer or PDA for a quick review of how to administer a tool or interpret its findings.
Some of the assessment tools have better evidence supporting their use than others, but all represent the best available approaches. Nancy A. Stotts, coeditor of the series, has written a brief article, "Define Your Terms," page 71, on how to understand an instrument's psychometrics-reliability, validity, sensitivity, and specificity-which describe its strengths and limitations. Also this month, Terry Fulmer provides a framework for thinking about assessing older adults (page 40), and Sherry A. Greenberg, series coeditor, discusses assessment for depression (page 60).
The series is funded in part by a generous grant from the John A. Hartford Foundation, the largest foundation in the United States dedicated solely to aging and health: http://www.jhartfound.org. With an investment in geriatric nursing exceeding $60 million to date, the foundation funds scholarships and fellowships, faculty development, and the Hartford Centers of Geriatric Nursing Excellence. To learn more about the Hartford Geriatric Nursing Initiative, go to http://www.hgni.org. The Hartford Institute for Geriatric Nursing at New York University, established in 1996, was the foundation's first investment in geriatric nursing. To learn more about the Hartford Institute, go to http://www.hartfordign.org.
Failure to assess older adults adequately can raise the risk of complications, unnecessary or prolonged hospitalization, and death. These instruments can help you to ensure valid patient assessment by different clinicians, compare changes in patient status over time, develop approaches to preventing complications, and evaluate the effectiveness of interventions. So why wait to hone your assessment skills? Read it. Watch it. Try it.