Lesson 4: Interviewing and Assessment

Attention

Assessment is key to understanding the factors that are involved in the situation...which is what you need to know to come to solutions. We have "instincts" for what might be going on in a persons' life, but we need "evidence" before we act!

Learning Outcomes

Upon completion of this lesson's material, students will be able to:

  • Conduct a mini-mental health status assessment
  • Identify legal and ethical considerations when interviewing an elderly client
  • List major areas of consideration when establishing an alliance with an elderly client

Teaching

Reading

Read Chapter 3 - The Past and How Much it Matters in Vaillant

Vaillant's Chapter 3 is all about the importance of early childhood environment on later development. It is not the only factor, but we might consider that it is not uncommon for a person with minor neurocognitive disorders (dementia) or Alzheimer's to revert to the "past" as if it is happening right now. In those circumstances, the past, whatever their early years were like, are all they have.

Read Chapter 4 from Bowles, D. (2011). Gerontology Nursing Case Studies: 100 Narratives for Learning. New York: Springer Publishing Company. This chapter includes 3-4 case study stories of individuals who are struggling with various issues in their lives and seek some support for these issues.

Assessment

Chapter 4 in Bowles outlines the different types of situations involved when individuals enter the medical care system. As part of the evaluation process various types of assessment tools will be used to make diagnostic determinations. There are some assessments used more frequently than others. The chapter includes the CAGE Questionnaire for alcohol abuse, Mini Mental Status Exam and the Geriatric Depression Scale (GDS). These are a few of the assessments that are performed when an older person is being brought in for services. They may be conducted by intake professionals, social workers, nurses, doctors, etc. Some of these assessments require you to be trained in how to implement them and other ones require no additional training.

CAGE Questionnaire:

1. Have you ever felt you should cut down on your drinking? 0 = No /1 = Yes

2. Have people annoyed you by criticizing your drinking? 0 = No /1 = Yes

3. Have you ever felt bad or guilty about your drinking? 0 = No /1 = Yes

4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye opener)? 0 = No /1 = Yes

Copyright: © American Psychiatric Association

CAGE Scoring: Item responses on the CAGE are scored 0 or 1, with a higher score an indication of alcohol problems. A total score of 2 or greater is considered clinically significant. Updated: February 2002

Review a copy of the Mini Mental Status Exam (MMSE).

Review a copy of the Geriatric Depression Scale (GDS).

Interviewing & Assessment

Read Chapter 2 on Unstructured Interviewing of Adults from Thomas, J. C., Hersen, M. (2007). Handbook of Clinical Interviewing with Adults. Sage eReference (Online service). Los Angeles: SAGE Publications, Inc. There are so many things to consider as you enter into any interviewing sitution with another person. You need to be thoughtful about ethical issues such as consent, confidentiality, and autonomy. Part of an interview and assessment includes learning about an individual's cultural and beliefs, his/her personal history, communication styles, assessing any sensory and cognitive impairment. You are going to monitoring the person's verbal and nonverbal communication styles and eye contact.

How do the following issues pertain and impact the ethical issues when working with older adults?

  • Presence and involvement of family members? Do you have a release to talk with them? How much information do you ethically share before you have shared too much. It is important to remember to only share the minimum necessary to accomplish the task.
  • Power of Attorney (POAs) - A power of attorney is a document you can use to appoint someone to make decisions on your behalf. The person you designate is called an "attorney-in-fact." The appointment can be effective immediately or can become effective only if you are unable to make decisions on your own. A durable power of attorney lets your attorney-in-fact make financial decisions for you. If you want your attorney-in-fact to make healthcare decisions (e.g., whether or not to be kept on life support) on your behalf if you become unable to make them on your own, you will need a separate document, known as a living will or healthcare power of attorney. (Legal Zoom).
  • Cognitive ability - Assessing an individuals competence is very important as part of the interview and assessment process. This ARTICLE from The Gerontologist on Everyday Cognitive Competence in Elderly Persons: Conceptual Issuesand Empirical Findings by Willis (1996) provides a nice perspective on assessing for competency and what that means.

Emotional Development

As people deal with their changed bodies and abilities, and the consequences of such, they have to redefine themselves. Consider the individual with a very rigid sense of "independence". This is much more than a health crisis, it is an identity crisis when they feel they cannot be as independent they want to be. For individuals who have identified themselves by their job, familial role or hobbies/athletics to then be unable emotionally, cognitively or physically engage in those activities can really result in an identity crisis.

Establishing a Relationship

  • Issues related to transference and counter transference between yourself as a mental health worker and getting to know an older client
    • How do you relate to older people in your own life?
    • What if they remind you of relatives?
    • What if YOU remind THEM of their relatives?
  • Trust
    • How do you establish a sense of trust between you and your client in order to get their "story"?

Assessment in the "Real World"

Assessment

Lesson 4 Discussion (for online students only)

Using either the Social Service Interview or either one of the Montreal Cognitive Assessment documents (A or B) above, interview a person in your life. Report your findings and reflect on how you felt administering an assessment like this. Were you comfortable you were asking some of the questions? What would you differently in the future?

Lesson 4 Quiz

  1. How do you relate to older adults in your own life?
  2. How might a client who displays behaviors similar to a relative or friend impact your interactions with him or her?
  3. How might you react to an older client who treats you like a child of theirs?
  4. List some important factors related to establishing a trusting relationship with your older adult clients.