學習目標 個案評估簡介 -...

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2012/8/16 1 個案評估簡介 張淑卿 [email protected] 學習目標 瞭解長期照護的整體性評估概念 瞭解長期照護的整體性評估常用工具 能瞭解長期照護需求之生心暨社會評估工具 評估的異同 長期照護個案評估的特色 評估是一種透過對個案需求情境進行全人、多面向和功能取 的測量。目的在於確認案主及案家需求,運用內外資源, 滿足其個別化的需求,強調建立整合性全人照顧服務模式。 主要工作 決定案主是否適合於個案/照顧管理服務 在案主需求與外在需求,及案主的能力與可用資 源間取得平衡 瞭解案主的優勢,以作為後續服務介入基礎 了解資源使用的內在與外在障礙(Ballew & Mink1996:282) 長期照護個案評估的重要性 透過有效的評估 確認個案現存與潛在的健康問題 個人疾病 個人自我照顧功能 個人認知功能 確認個案及其家庭(主要照顧者)的照顧資源 照顧人力 情緒支持 財力支持 照顧知能 設計合宜的照顧計畫達長期照護的照護目標 提升失能者身體功能 提供個案自我照顧能力重建與維護 維持失能者身體功能 合適的生活照顧 良好的照護 創造最佳社會互動模式 失能者需求評估 照護者資源整合 老人評估各面項間關係概念圖

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  • 2012/8/16

    1

    [email protected]

    /

    (Ballew & Mink

    1996:282)

    ()

  • 2012/8/16

    2

    //

    ()

    ()

    (

    )

    /

    ()

    //

    /

    (/)

    ()

    (/)

    -

    Minimum Data Set (MDS) Residential Assessment Protocols (RAPs)

    1. ()(demographic information) 2. (Customary routine) 3. (Cognitive patterns) 4. /(Communication/ Hearing patterns) 5. (Vision patterns) 6. /(Mood/Behavior) 7. (Psychosocial well-being) 8. (Physical functioning and structural problems)

    9. 14(Continence in last 14 days)

    10. (Disease diagnoses) 11. (Health conditions) 12. /(Oral/Nutritional status) 13. /(Oral/Dental status) 14. (Skin conditions) 15. (Activity pursuit patterns) 16. (Medications) 17. (Special treatments and procedures)

    18. (Discharge potential and overall status)

    1.(Delirium) 2. /(Cognitive Loss/Dementia) 3. (Visual Function) 4. (Communication) 5. /(ADL Function/Rehabilitation)

    6. (Urinary Incontinence and Indwelling Catheter)

    7. (Psychosocial Well-Being) 8. (Mood State) 9. (Behavior Symptoms) 10. (Activities) 11. (Falls) 12. (Nutritional Status) 13. (Feeding Tubes) 14. /(Dehydration/Fluid maintenance)

    15. (Dental Care) 16. (Pressure Ulcers) 17. (Psychotropic Drug Use) 18. (Physical Restrains)

    1. 2. 3. 4.

    5.

    6.

    7. 8. 9. 10. 11. 12. 13.

    14.

    15.

    16.

    17()

    18.physical restraints

    (Glasgow Coma Scale)

    (ADL)-

    (karnofskyscale)

    (IADL)

    (Mini Nutritional Assessment)

    CDR

    (Mini-Mental State Examination,MMSE)

    (The Short Portable Mental Status Questionnaire,SPMSQ)

    GDS

    /

  • 2012/8/16

    3

    ()

    -

    -

    (,2012)

    ()

    -11

    ()

    -

    -

    -?VS.ADL

    (,2012)

    () ADL-10

    (.....)

    (1~2) (3~4)(5)

    :

    1.

    2.

    3.

    4.

    5.

    (,2012)

    ()

    BIADL-8

    .

    IADL.

    :

    1.

    2.

    3. (,2012)

    ()

    (SPMSQ)

    1210

    (,2012)

  • 2012/8/16

    4

    V.S

    ///

    .

    (,2012)

    -?

    V.S.(,2012)

    (Key- Person)

    V.S?

    ~

    /

    (,2012)

    (,2012)

    1.

    2.

    3.

    4.

    (LETTERS TO SAM: A GRANDFATHERS LESSONS ON LOVE, LOSS, AND THE GIFTS OF LIFE, DANIEL GOTTLIEB,2007)

    ()

  • 2012/8/16

    5

    (Alert)

    (Lethargic)

    (Obtunded)

    (Stuporous) (Semicomatose)

    (Comatose)

    (ADL)(Barthel Index)I

    1.

    10

    50

    ()

    2.50

    3.

    1050

    4.50

    ()

    5.

    1050

    (Barthel Index) II

    6.

    1050

    ()

    7.

    1050

    ()()

    8.

    151050

    5050()50

    9.

    1050

    10.

    151050

    (Karnofsky scale)

    (90~100)

    (70~80)

    (50~60)

    50%(30~40)

    (10~20)

    (IADL) Lawton I

    3210

    3210

    3210

    43210

    (IADL) Lawton II

    210

    43210

    3210

    210

  • 2012/8/16

    6

    (MINI NUTRITIONAL ASSESSMENT)

    1.0 1 2

    14>=12 =23

    MNA 30(+)

    (MNA24) (17~23.5) MNA17

    16

    7.()? 0 1

    8.? 0 1

    9.? 0 1

    10. 0 1 1 2 2 3

    11.() 0 0 1 0.5 2 1 3

    12. ? 0 1

    13.()(1 240c.c.) 0 3 0.5 3~5 15

    14.? 0 1 2

    15.0 1 2

    16.0 0.5 1 2

    17.MAC() 0 MAC21 0.5 21MAC23 1 MAC>=23

    18.C.C.() 0 C.C31 1 C.C>=31

    (CDR)

    CDR 0

    CDR 0.5

    CDR 1

    CDR 2

    CDR 3

    :0 0.5 1 2 3 4 5

    Mini-Mental State Examination(MMSE)

    ()

    1111111111

    1 1

    1

    ()

    193 10077186 179 172 165

    ()

    1 1

    1

    MMSE

    ()

    1 1 1()()1

    1

    ()

    1 1 1 ()

    1

    MMSE

    30

    24~30 9~12()

    (15)15

    50~69 17/16 21/20 25/24

    70 15/14 20/19 24/23

  • 2012/8/16

    7

    ~(Short Portable Mental Status Questionnaire; SPMSQ )

    X

    1.?

    2.? 3.?

    4-1.?(4-14-2)

    4-2.?

    5.?

    6.?

    7.? 8.? 9.?

    10.2033

    0~2 3~45~7 8~10

    Brink19821983

    GDS

    1 1

    1 1

    1

    1

    1

    1

    1 1

    1 1 1

    1 1 1

    1 11

    1 10

    59

    OBSERVES

    Sickness

    Environment

    Variations

    Relationship

    Eating area

    Safety

    Behavior

    Outside

    ()()

    ( ) ( )

    ( ) ( )

  • 2012/8/16

    8

    APGAR (Smilkstein,1978

    resolve

    0

    1

    2

    71046

    03

    affection

    growth

    partnership

    Adaptation

    (OARS, Social Resource Scale)1.

    2.?

    3.? (1)? (2) (3)

    ? 1-3 (4), 2 1

    4.? 3-4

    5.()?() 2 1

    6.()?

    7.?

    8.?

    9.,?

    10.() , ?

    11.()?()? ()

    12. .