Instructions:
Create your own questions that you would want to use for a clinical assessment on an older
adult.
– Address validity
– What are you trying to access? (depression, anxiety, alcoholism, etc.)
– Figure out what you want to access and come up with four maximum questions
– Offer a way to get a response (interview, self-report, number or feeling on a scale, etc.)
– Don’t worry about reliability
– Explain your rationale
o why do you believe those questions are good?
o I want to understand how you came up with this
Do not use any outside resources – please refer to and include information from lecture notes
only at the bottom of this document.
Format:
1. Typed
2. Doubled Spaced
3. Times new Roman font
4. 12 point font
5. 1 inch margins all around
6. Title page (student id)
7. All pages numbered
Notes:
– What are you trying to access?
o Depression in older adults
▪ It is important to recognize that depression in older adults may be harder
to identify because older people typically exhibit distinct symptoms than
younger people due to their age….
– Presumptions
o Include how important this information is and why it is needed (refer to notes)
Four Questions:
– Question 1:
o There are some specific areas I want to focus my questions on starting with their
social functioning and asking about the social interactions of the older adults. An
essential component of the social functions evaluation is figuring out how
involved the older adult is in his or her surroundings.
▪ Question: ???
– Question 2:
–
–
o Then I wanted to direct a question at addressing the older adults ADL. The
activities of daily living of older adults are crucial for me to access because these
activities could reveal concerns with their physical health and cognition.
▪ Question: ???
Question 3:
o Observing two things—where someone is now and where they were before—
will help me in the process of a clinical assessment on an older adult. By basing a
question on knowledge of an individual’s prior level of functioning, I may
discover or detect the loss of specific functions.
▪ Question 3: ???
Question 4:
o The last question I want to direct at an older persons collateral contact, for
example their caregiver. I can learn useful details about the older adult by
enlisting the help of a third party, which will assist me in creating a complete
picture of the individuals condition. This question will also relate to the older
adults ADL’s.
▪ Question 4: ????
(Please go into greater detail about the description of why and how I chose these questions) –
do not use word for word from the document.
Method of response:
– There are two major questions I asked myself when creating these questions
o First: What am I assessing?
▪ I will be assessing depression in older adults
o Second: what is the best way to find this information? (what method)
▪ Face-to-face Interview
• I decided to go with interviews as my research method. By
employing this method, I will be able to collect extensive data and
make thorough judgments while taking into account nonverbal
indications, and emotional responses.
(Please include more in-depth information as why I chose interviews, what are the advantages
in using them among older adults, benefits…)
Lecture:
Clinical Assessment of Older Adults
•
Assessment facilitates addressing Bx and internal processes through measurement,
understanding, and predicting Bx (p. 269).
• When engaging with older adults and anyone else we want to understand
(psychological, cognitive, behavioral factors) trying to get a sense of internal
process as it pertains to behaviors going on
• Assessments serve many purposes
• Early diagnosing of disorders is beneficial –
• Mild cognitive impairment is a well recognized risk factor for dementia, and
represents a critical window of opportunity for intervening and altering the
trajectory of cognitive decline in seniors (Liu-Ambrose, 2012)
Having good questions to assess cognitive processes can help with any changes that can effect
overall cognition
Clinical Assessment of Older Adults
• Ask yourself – What are you assessing and what is the best way to do it?
• Two primary questions ^^
• Need something Valid – does the question access what you are trying to access
• When coming up with questions we want validity and …reliability
• Face validity (how are you doing now) – valid questions for the issue at hand
• Ex. Face valid way of addressing domenstic violence
• Are you experiencing domestic violence ( maybe its not the good
question)
• We want to find out if the questions are appropriate to the
things we want to access)
• Need something Reliable – do you have consistency in your answers
• Will the results tend to be consistent – not does the individual answer the same
all the time but rather doss the test appear to access this thing consistently
across repeated questions
• If I ask this question all the time will the response be consistent
• Emotional state – most likely answer the same
• Physical state – most likely answer will change
• What is the individual focusing on
• Need something for Older Adults
• Reliability and validity take a whole other stance in older adults
Example:
– In the questions how are you; how are you today, what are you assessing
o We can be assessing: Feelings, emotions, physical body
– What is something you want to assess in older adults
o How is your social life?
– What is the thing we want to access and lets find ways to access –
Clinical Assessment of Older Adults
Methods for assessment
What are some ways to get at that assessment? We can give them…(look below)
Interview
Paper and pencil
Self-report
Where person comes in and tells you what is going on
Ex. I am here because…
What makes self-report valuable?
Self-awareness they can say what is going on
What is the down side?
They can lie
Report by others (collateral contacts)
Another way of getting information – collateral contacts – the people who
around the older adults the people who live with them express what they think
Negative side of collateral contact – the person or people who are the collateral
contact can have bias – hyper focus on what’s wrong or ignoring something that
is wrong
Clinical Interview is the best method among all methods above
– Best way to get a sense of what is going on – face to face – getting expressions of
individual
– You get to see persons response and reaction
– Non verbal stuff – during interviews we see body language, the texture
Clinical Assessment of Older Adults
Age related norms are important.
Norms facilitate same-age comparisons
Age related norms need to depict the variability for that age group
The number of things that can influence outcome for older adults is higher than other
groups
Clinical Assessment of Older Adults
Reliability
Different types of reliability
Test-re-test reliability
If I give it to you today in about 6 months from now you most likely will perform
in a similar way
Interobserver reliability
Not much about the paper pencil test but rather interviews
Would other people observing the same thing reach the same conclusions
Clinical Assessment of Older Adults
Validity
Make sure whatever tools we are using to access an older adults we have to
make sure it has validity so that the thing or test we are using whatever methods
we are using we have to apply to the older adults that is being access or older
adults in general
Content Validity (type of validity)
Does the content relate to Older Adults?
When looking at assessments we want to make sure we our assessments are
appropriate for older adults
We would expect older adults to: take longer to accomplish tasks, have a
sleeping problems…
Is this depression or is this aging
Disorders like depression or anxiety may look different for older adults so need content
to reflect that.
Don’t manifest in the same way as they do in young adults compared to older
adults
Zarit (1980) note presence of somatic & cognitive complaints more for older adults.
Side note: Do the items address what they are supposed to address
Sx’s for Older adults may not be same for some disorders when compared with younger people
Paper and pencil test
– Standard way of answering “what is your mood now?”
o SCALE not great=>okay=>fine=>good
o Or 1(not great)=> 2(okay)=>3(fine)=>4(good)
▪ What is the problem with these scales?
– Another options to get at information
o This method is Measurable, observable, quantifiable
▪ Using symbols (example happy face – sad face)
▪ Get away from verbal – the scale is not known to client only to yourself
o Asking someone to answer in language can provide an incomplete answer
Clinical Assessment of Older Adults
Correlating factors need to be accounted
Prior level of functioning
Physical
Mental status (MMSE)
Is the person overwhelmed
Good way to identify if there are any client concerns
Other stressors
Environmental conditions (can lead to lethargy and under stimulation and
negative self view)
When accessing older adult we have to keep in mind any things that need
to be taken into account for example their primary function and all other
factors above
Clinical Assessment of Older Adults
Factors that impact Assessment:
Tests that are designed in ways that pull for a certain type of response
Caution for tests that pull for certain results (TAT, GDS)
Series of pictures charcoal and black and white photos that have a bazar content
to it and you look for themes that emerges from stories
Based on themes you can find clinical impressions
It wont be a big shock if pictures are bazar that people will have similar
themes
These tests can lead to predetermined outcome
Contamination of assessment process
This is an issue
If you are doing an assessment and for example there is a person there making
them happy or they practiced the test beforehand
Contamination happens often
Leads to results not being accurate
Examiner biases – how assessor views Older Adults
Bias against or in favor lead to results that are not accurate
Presumptions about what needs assessing
Presumptions re: interpretation (trained with a hammer all things are nails)
You interpret results in a certain category
Ex: anyone that scores high on a test is psychotic
Presumptions about how pathological the symptoms really are (e.g., senility is normal,
depression is normal…. Really?)
Goes back to examinator bias
Clinical Assessment of Older Adults
More factors that impact assessment
Environment in which assessment takes place (e.g., temperature, accessibility to place
and placement of materials given physical restrictions)
Physical concerns (e.g., health, pain, sensory issues)
Clinical Assessment of Older Adults
Collateral contacts
How valuable it is to get people who are more in touch with things and observing
the older adult
You want to get this information to get more accuracy but be careful for
bias
Can aid in getting accurate profile of client’s condition (Edelstein et al. 1996)
Still need caution re: this information
Can tell how others see client (Morrison, 1988)
How does the POV of others impact environment for the Older Adult?
Clinical Assessment of Older Adults
Caution for how assessor views Older Adults
Presumptions about what is needing assessing
Presumptions re: interpretation
Presumptions about how pathological the symptoms really are (e.g., senility is normal,
depression is normal…. Really?)
Clinical Assessment of Older Adults
Look at social functioning
Very important
Sense of social connectedness – how are older adults connecting with people,
are they active
This helps with a sense of self-esteem
Good social environment helps with well being – valuable
Social connection/activity is positively correlated with indicators of wellbeing
Social connection reinforces self-esteem factors
Social connection becomes a natural component in maintaining health (more eyes on
the ball!) (Antonucci, Birditt, & Akiyama, 2009)
Clinical Assessment of Older Adults
Performance-based assessment includes
Not just what the person is capable of doing in the room but also what are they
doing for themselves
For example are they keeping up with bills or hygiene (the activities of
daily living) this is very critical to see how well the older person is
operating now
ADL’s – for ability to function
Prior level of functioning (can also lead to understanding any emotional distress now –
possibly result of recognizing loss of functioning)
They could be geniuses with memory but if they don’t keep up with their
basic hygiene, their basic nutrition then there are serious concerns
ADL’s are extremely important if you’re doing a clinical assessment with an
older adult there has to be time set aside to ask about the ADL’s and if
their are collateral contacts ask them as well
Prior levels do function are very important
example: how does a person respond to stress
Prior levels of functioning whether cognitive functioning, emotional
functioning are critical in understanding the now
You don’t know someone’s trajectory unless you get two
observations: Where they are and where they use to be
Clinical Assessment of Older Adults
Makes sure you give feedback in proper way
Whenever you are assessing an older adult you want to make sure you are
understood
You want to give feedback; let them know what is going on, educate them
on the results and what they may be dealing with
Give them a sense of what they can do or what they should be doing to
improve their situation better
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