Abdominal pain, food intolerances? Heartburn, nausea? Decreased sense of taste? Issues with teeth? Dentures? Have you recently had a major weight gain or loss? What is your current weight and height? How often do you grocery shop? How do you get to the grocery store? 2. Stress and Coping(worth 4 points)Individuals among all population groups experience risk from stress throughout the lifespan. According to the How would a friend describe you? How do you manage stress?
In your opinion what is your biggest stressor? What gives you strength during difficult times? 3. Mobility (worth 4 points) All individuals are potentially at risk for altered mobility regardless of age, ethnicity, race, or socioeconomic status. Because of the effects of aging the population at greatest risk for impaired mobility is the older adult. Osteoporosis, hip fractures, osteoarthritis etc. Have you ever experienced a fall? Do you have any issues with chronic pain? Do you use an assistive device to help you walk? If so, how long have you used it and why? How many stairs do you climb to get into your home? Have you ever had any orthopedic surgeries or broken bones? Make sure you ask about hearing and visual acuity and think about how these could impact mobility? 4. Pain (worth 4 points) The incidence of pain increases with age. Pain has been shown to be very common in the older adult both in inpatient and outpatient settings. The older adult is at a high risk for under-treatment of pain because many are reluctant or unable to report their pain because of illness and cognitive impairment. Please use the PQRST method (as outlined in the next column) P = Provocation/Palliation What causes it? What makes it better or worse? What seems to trigger it? Stress? Position? Certain activities? What relieves it? Medications, massage, heat/cold, changing position, being active, resting? What aggravates it? Movement, bending, lying down, walking, standing? Q= Quality/Quantity What does it feel like? Use words to describe the pain such as sharp, dull, stabbing, burning, crushing, throbbing, nauseating, shooting, twisting or stretching. R = Region/Radiation Where is the pain located? Does the pain radiate? Where? Does it feel like it travels/moves around? Did it start elsewhere and is now localized to one spot? 3
S = Severity Scale How severe is the pain on a scale of 0 to 10, with zero being no pain and 10 being the worst pain ever? Does it interfere with activities? How bad is it at its worst? Does it force you to sit down, lie down, slow down? How long does an episode last?
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