Complexity of Clinical Assessment

Assessing geriatric residents in a skilled nursing home setting is an extremely challenging, complex, and emotionally demanding clinical task. The overwhelming majority of residents have multiple co-morbid medical diagnoses. They often are prescribed literally dozens of medications, all of which have side effects, as well as interaction effects.

Many of those for whom I receive a referral have long-term psychiatric diagnoses, too. Superimposed upon all of these factors are multiple psychosocial losses, secondary to advanced age. Often, these residents have reduced hearing, as well as diminished visual acuity.

Older residents may not feel terribly comfortable with the idea of receiving a psychological assessment; such evaluations received extra social scrutinization during their lifetimes. Such assessments would prove to be sufficiently challenging for a healthy clinical psychologist to complete competently.

They are even more challenging to complete competently when a clinician is dealing with multiple chronic conditions of her own.

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