FEU – Institute of Nursing
NUR 1215: Care of the Older Adults AY 2020-2021
Geriatric Assessment Tool
Name of Patient: _(initials) Date of Assessment:
Age:
Vital Signs:
Temperature: Pulse Rate Respiratory Rate: Blood Pressure: BMI:
Height:
Weight:
INTEGUMENTARY CHANGES Interpretation and Analysis
(Indicate used reference)
Dry Skin
Decrease sensation
Lentigo Senilus (brown "age spots")
Pale skin
Hollow or gaunt hand
Baldness and hair loss
Loss of hair (gray/white hair)
Thickened and brittle fingernails and toenails
Double chin
Sagging eyelids and earlobe
Wrinkles
(In women) breast are smaller
Decrease tolerance to cold
BODY TEMPERATURE
Decrease in body temperature
NEUROMUSKULOSKELETAL CHANGES
Slowed voluntary or automatic reflexes
Decrease ability to respond to multiple stimuli
Easy tiring
Kyphosis (humpback to upper spine)
Stiffness of joint
Visible range of motion
Limited range of motion
CARDIOPULMONARY CHANGES
Short breaths taken
Dyspnea
High blood pressure
SENSORY PERCEPTUAL CHANGES
A. Visual:
Sunken eyes
Slowed blinked reflexes
Blurry vision
INTEGUMENTARY CHANGES Interpretation and Analysis
(Indicate used reference)
Decreased color perception
Decrease tear production
Increased sensitivity to glare
B. Hearing:
Decrease ability to distinguish high frequency
sounds
Decrease ability to hear
C. Taste and Smell:
Less stimulated by food
D. Pain and Touch:
Increases threshold for sensations
GASTROINTESTINAL SYSTEM
Impaired mastication
Decrease gag reflex
Decrease salivary production
Increased incidence of hiatus hernia
Constipation
URINARY CHANGES
Urinary Urgency
Urinary frequency
Nocturnal frequency
Increased concentration of urine
MOOD
Nervous with strangers
Difficulty in making decisions
Lack of concentration of memory
Lonely or depressed
Cries often
Hopeless outlook
Difficulty relaxing
Worries a lot
Frightening dreams or thoughts
Shy or sensitive
Dislikes criticism
Losses temper
Annoyed by little thing
Assessed by:
(Signature)
Printed Name
Section and Group No.