Mental and Emotional Assessment in the Elderly

Posted on Feb 12, 2025 in Psychology and Sociology

Mental and Emotional Ratings

Mental and emotional ratings encompass three areas of mental valuation: cognitive, affective, and behavioral.

1. Cognitive Assessment

A comprehensive assessment is designed to collect, at a minimum, the following information: appearance, behavior, mood, senses, language, thought, perception, level of consciousness, orientation, memory, information capital, abstraction and judgment, gnosis and praxis, calculation, and somatic symptoms of mental illness. A structured cognitive assessment uses structured rating scales to detect mild impairments that might otherwise go unnoticed. Knowledge of the degree of deterioration can:

  • Assess the quality of information the patient provides about themselves and their illness.
  • Assess the ability to understand information, either when applying for consent to treatment or deciding the degree of supervision required.
  • Detect changes in cognitive level.
  • Influence diagnostic, therapeutic, and placement decisions.

Instruments Used in Brief Cognitive Assessment

Tests for detecting cognitive problems:

  • Blessed, Tomlinson, and Roth Scale (Information, Memory, and Concentration Test): This is the oldest scale, and there is a reduced version with the same validity. It is used in patients with Alzheimer’s and served as the basis for many others.
  • Pfeiffer SPMSQ Scale: Developed in the United States and widely used, it presents some items of difficult import to our environment, such as remembering the mother’s maiden name. It’s easy, reliable, and with fixed rules adapted to the cultural level.
  • Shulman’s Clock Drawing Test: The patient is asked to dial a certain time on the circumference of a clock drawing. There are five degrees of errors. It is a short test and easy to administer.

Tests for evaluating cognitive function:

  • Folstein Mini-Mental State Examination (MMSE): A widely used cognitive screening tool.
  • Lobo Mini-Mental State Examination (Spanish adaptation): Adapted from the MMSE and validated in Spanish, it is the only Spanish version with sensitivity and specificity similar to the English version.

2. Emotional Assessment

Its objective is the detection of depression, anxiety, and behavioral alterations. The Yesavage Geriatric Depression Scale is most used to detect depression in the elderly. It consists of thirty yes/no questions, and there is a reduced version of fifteen items.

3. Social Assessment

Assessment addresses the social relationship between the elderly and the social environment in which they live and establishes a path so that social resources are used appropriately. Improving the well-being and health status of the elderly favors the approach to the problems posed by the disease and greatly helps to preserve the individual’s autonomy. The social role encompasses all social relationships and activities that the individual provides within their environment. Kane and Kane divided social function into three sections:

  1. Relationships
  2. Social and welfare resources
  3. Personal adjustment to the social environment

Instruments Used in Assessing Social Interactions and Resources

  • Family APGAR (Smilkstein, 1978): Measures family health.
  • Social Dysfunction Rating Scale (SDRS)
  • Zarit Burden Interview (SBI): Caregiver burden test.
  • Older Americans Resources and Services (OARS) Questionnaire: Assesses social resources.

Well-being Adaptation Measures

  • Life Satisfaction Index (LSI)
  • Philadelphia Geriatric Center Morale Scale (Lawton, 1972)

Nursing Environment Adaptation

History Taking:

  • Breathing.
  • Food and drink: In this analysis, it is necessary to assess a normal diet, both quantitatively and qualitatively, and a good assessment of the state of the mouth.
  • Urinary and fecal elimination: Evaluate usual habits and episodes of incontinence.
  • Moving and maintaining proper posture: Challenges for mobilization, routine physical exercise, and the need for relief supplies.
  • Sleep and rest: Number of hours of sleep and difficulties at bedtime.
  • Dressing and undressing: Ability to do it without help and, if needed, to what extent.
  • Maintaining body temperature: If the person usually feels cold.
  • Avoiding dangers: Safety measures used, history of falls, and possible causes.
  • Maintaining cleanliness and skin integrity: Hygiene and regular level of help needed.
  • Communication: Presence of visual and auditory deficits and what support systems they use, who they live with, and who they can count on.
  • Living according to their values and beliefs: Religious beliefs and rituals practiced.
  • Taking care of their personal accomplishment: Developing a role within their family and social group, satisfaction with that role.
  • Participating in recreational activities: Leisure activities.
  • Learning: Awareness of the disease, learning difficulties, and the most effective systems for acquiring knowledge.