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“I wasn’t sure what to expect when I went to occupational therapy for the first time. During my first evaluation, the occupational therapist built an environment that made me feel hope to be able to use my arm again. I was inspired to work to meet my own objectives and get back to doing the things I enjoy most.”
—Allen M. Vietnam Veteran
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LEARNING OUTCOMES
By the end of this chapter, readers will be able to:
21-1. Differentiate among the various purposes and types of assessments and evaluations.
21-2. Determine the different special and ethical considerations of assessment tools when evaluating the occupational and functional performance of older adults.
21-3. Apply different theoretical models when evaluating functional and occupational performance for older adults.
21-4. Distinguish key areas of functional and occupational performance that should be assessed in older adults.
21-5. Analyze factors that affect the functional and occupational performance of older adults and need to be considered during assessment.
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Mini Case Study
Ms. Annette Altman is a 68-year-old woman with a medical history of hypertension, obesity, and osteoarthritis in her cervical spine, hands, and left knee. She had a cortisone injection in her left knee that provided temporary relief of her symptoms. Ms. Altman has four adult children and lives alone in an urban townhouse. She has recently retired, having worked as a personal support worker for 25 years and, more recently, as an educational assistant in an elementary school. When asked about her current level of physical function, she reported having difficulty traversing the stairs and crouching and kneeling due to her knee pain. She is experiencing shortness of breath with exertion, which makes walking distances difficult for her. She also describes pain in her hands that affects her ability to do many of her daily chores and activities. Ms. Altman was asked by the occupational therapist working with her to identify important activities that she is unable to do or is having difficulty with due to her health. She listed five activities: (1) walking in the park and on local trails with her family, (2) using her hands to perform fine motor activities for dressing herself or for hobbies (knitting and crocheting), (3) bowling, (4) water exercise, and (5) gardening.
Provocative Questions
How would the occupational therapiest proceed to conduct a functional assessment with Ms. Altman based on the information presented?
What assessment considerations need to be made based on Ms. Altman’s history?
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This chapter discusses assessing and evaluating functional and occupational performance in older adults and why they need to be assessed, how to evaluate older adults’ performance, conceptual frameworks to guide assessment, priority areas that often require evaluation, and specific issues to consider when evaluating older adults. This information will assist occupational therapists with completing an ethical and thorough evaluation of older adults to create the most appropriate plan of care for their clients.