• Suggest alternative assessment tools and explain why these tools might be appropriate for your colleagues’ patients.
• Recommend strategies for mitigating issues related to use of the assessment tools your colleagues discussed.
• Explain other health promotion considerations for patients in this population or with related issues.

Reply to this discussion:

 Mr. Perkins is 81 years old making him a part of a very vulnerable population. My first evaluation would be of the significant increase in right hip pain over that last 6 months. Inquiring about any recent injury or falls would be important. Assessing functional limits to include active and passive range of motion in the hip would determine the need for possible imaging or referral to orthopedics. Imaging may help with recognizing fractures or the degree of degeneration of the bones. Mr. Perkins would be eligible for the flu vaccine and could be administered in any local pharmacy. Influenza, Tetanus every 10 years, HZV, and the pneumococcal vaccine (23vPPV) are included in the recommended vaccinations for his age group. A 23-valent pneumococcal vaccine has been funded under that National Immunization Program since 2005 and its effectiveness is said to be between 61 and 71% against pneumonia for adults aged >65 years (Zaouk et al, 2020). An interview about immunization history would determine which ones are needed.

     Age, physical presentation, and subjective information collected from patient would lead me to use the fall risk assessment tool and the functional independence/dependence assessment tool. The patient has reported a significant decline in mobility now requiring a cane to ambulate. He is observed using the cane incorrectly and requires teaching. The fall assessment would help gauge his risk for falling and maybe refer to physical therapy for strength building. The functional independence assessment tool would help us determine if patient is able to dress or bathe himself. How well he performs transfers from standing to sitting, balance issues may warrant a referral for home health for assistance performing those tasks.

      These tools are warranted and very specific to this patient population with gait instability and difficulty performing ADLS being two things that contribute to falls. A study conducted from 2018 through 2020 on patients 65 and older admitted to a level I hospital trauma service with a fall related injury determined in 63% of cases, ground level fall was the predominant mechanism (Holt & Testerman, 2022). Pain, fatigue and environment can have an effect on these assessments. Being sure to ask about patient’s home environment is essential in determining barriers to health. Safety, further testing on patients’ right hip and vaccinations would be primary concern for this patient.