Assessment of Older People's Health and Social Care Needs and ...

Background to the Development of the Assessment ToolIn terms of ole"r people, PHN's concentrate on providing a service to older people aged 75 yearsand over. The service includes provision of a surveillance programme, screening programme,monitoring of the elderly at risk and treatment and care service. PHN's by tradition maintain aregister of persons at risk, but the criteria for inclusion have not yet been standardised at regionalor national level. The PHN department in the WHB, conscious of the need to standardise criteriafor identifying older people at risk, set about developing a procedure for functional assessmentscreening of the elderly by PHN's which would be consistent throughout the health board area. ARegional Working Group, comprising PHNs, DPHNs and a Consultant Geriatrician was established towork on the project.Development of the ToolFour criteria were observed in developing the Functional and Social Assessment Tool. It needed to:• be brief• be easy to carry out• involve no extra cost• be pertinent for use in home/community settings by PHNs.The first goal in developing the tool was to identify unappreciated functional disabilities that shouldbe systematically reviewed for older people. After the list was formulated, suitable procedures toevaluate the disabilities were devised. A pilot study was carried out in 1993 and the screeningprogramme introduced in 1994, following education of all PHNs in the region on the use andinterpretation of the findings.The WHB Functional and Social Assessment ToolThe WHB tool was divided into functional assessment and social assessment. Many of the functionalproblems of older people are relatively minor, but can have a significant effect on the quality of life.Screening has an important part to play in helping people to realise that their problems are not partof a normal ageing process and that solutions can be found. Functional assessment is of the olderperson's vision, hearing, continence, mental status, vulnerability to falls and mobility. Socialassessment is of the older people's social support (for example who they would call in anemergency); their social risk (for example, whether they are in need of support services); theireconomic situation; their housing and house-keeping ability.Limitations of the WHB ToolPHNS in the WHB found that the functional and social assessment tool was easy to use. However,they have also identified some limitations. These are as follows:• it did not necessarily identify people at risk• the carer's opinion was not taken into account• it did not highlight persons suffering physical and emotional abuse due to family stress anddisharmonyConference Proceedings