What questions should be asked to assess the health and well-being of nursing home patients during visits?

Essential Questions for Nursing Home Patient Assessment

A comprehensive assessment of nursing home patients should include questions about physical health, mental health, functional status, social well-being, and quality of life to ensure optimal care and reduce morbidity and mortality.

Physical Health Assessment

• Vital signs and physical symptoms:

  • "Are you experiencing any pain? Where is it located? How severe is it on a scale of 1-10?" (Pain is often underreported in nursing home residents) 1
  • "Have you had any fever, chills, cough, or shortness of breath recently?" (Respiratory symptoms are common presentations of infection in elderly) 1
  • "Have you noticed any changes in your appetite or weight recently?"
  • "Are you having any problems with urination or bowel movements?" (UTIs are common but may present atypically) 1

• Medication-related questions:

  • "Have you experienced any new side effects from your medications?"
  • "Are you having trouble taking any of your medications?"
  • "Do you have any concerns about your medications?"

Mental Health Assessment

• Depression screening:

  • "Over the past two weeks, have you felt down, depressed, or hopeless?"
  • "Over the past two weeks, have you had little interest or pleasure in doing things?" 2

• Anxiety assessment:

  • "Do you feel nervous, anxious, or on edge?"
  • "Are you able to stop or control worrying?" 1

• Cognitive assessment:

  • "Have you noticed any changes in your memory or thinking?"
  • "Do you sometimes feel confused about where you are or what time it is?" 2

Functional Status Assessment

• Activities of Daily Living:

  • "Are you able to dress yourself? Do you need help with buttons or zippers?"
  • "Can you bathe yourself independently? What assistance do you need?"
  • "Are you able to use the toilet without help?"
  • "Can you feed yourself without assistance?" 2

• Mobility assessment:

  • "Can you walk without assistance? Do you use a walker or wheelchair?"
  • "Have you fallen in the past month? Are you afraid of falling?" 2, 3
  • "Are you able to get out of bed and into a chair by yourself?"

Social Well-being Assessment

• Social connections:

  • "How often do you have visitors? Who visits you?"
  • "Do you participate in any group activities here? Which ones do you enjoy?"
  • "Do you feel lonely or isolated?" 1

• Autonomy and decision-making:

  • "Do you feel you have enough choice in your daily activities?"
  • "Are you able to decide when to wake up, eat meals, or go to bed?" 1
  • "Do you feel your preferences are respected by the staff?" 2

Quality of Life Assessment

• Environment:

  • "Do you feel comfortable in your room?"
  • "Is there anything about your living space that bothers you?"
  • "Do you feel safe here?" 2

• Life satisfaction:

  • "What brings you joy during your day?"
  • "Is there anything you would like to change about your care?"
  • "Do you have any unmet needs that we should address?" 4

Sleep Assessment

• Sleep quality:
  • "How well do you sleep at night?"
  • "Do you wake up frequently during the night? What causes you to wake up?"
  • "Do you feel rested when you wake up in the morning?" 2

Advance Care Planning

• Goals of care:
  • "Have you thought about your wishes for future medical care?"
  • "Do you have an advance directive or living will?"
  • "Who would make healthcare decisions for you if you couldn't make them yourself?" 2

Caregiver Burden Assessment (for family members)

• "How are you coping with your loved one's care needs?"
• "Do you feel stressed or overwhelmed by caregiving responsibilities?"
• "What support do you need to continue providing care?" 1

Important Considerations

• Use open-ended questions when possible to elicit more detailed responses rather than yes/no answers 4
• Observe non-verbal cues as many nursing home residents may have difficulty expressing themselves verbally
• Compare resident self-assessment with staff observations as discrepancies can reveal important care needs 3
• Adapt questions based on cognitive status and communication abilities
• Reassess regularly as conditions can change rapidly in this population

Common Pitfalls to Avoid

• Overlooking pain assessment - Pain is frequently underreported and undertreated in nursing home residents
• Failing to screen for depression - Depression is common but often missed in this population
• Ignoring mobility concerns - Mobility is strongly linked to quality of life and independence 3
• Not addressing social needs - Social isolation can significantly impact health outcomes
• Focusing only on physical symptoms - Psychological and social well-being are equally important

By systematically addressing these domains through targeted questioning, healthcare providers can better identify and address the comprehensive needs of nursing home residents, ultimately improving their quality of life and health outcomes.