WHY: Normal aging leads to inevitable—and sometimes irreversible—changes that can increase older adults’ risk for health-related conditions. Common concerns include sleep disorders, problems with eating or feeding, incontinence, confusion, evidence of falls, and skin breakdown. Recognizing these frequently occurring issues helps nurses prevent unnecessary iatrogenesis and support optimal function in older adults. Identifying conditions requiring further assessment enables nurses to implement preventive and therapeutic interventions (Fulmer, 1991; Fulmer, 2007). Many studies use the SPICES tool and references can be found via PubMed.

BEST TOOL: Fulmer SPICES is an efficient and effective instrument for obtaining the information necessary to prevent health alterations in the older adult patient (Fulmer, 1991; Fulmer, 1991; Fulmer, 2001; McRae, 2019). SPICES is an acronym for the common syndromes of the elderly requiring nursing intervention:

S is for Sleep Disorders
P is for Problems with Eating or Feeding
I is for Incontinence
C is for Confusion
E is for Evidence of Falls
S is for Skin Breakdown

TARGET POPULATION: The problems assessed through SPICES are common across the entire older adult population. Therefore, the instrument should be used for both healthy and frail older adults.

VALIDITY AND RELIABILITY: The instrument has been used extensively to assess older adults in the hospital setting to prevent and detect the most common complications. Validation has been conducted (Aronow, Borenstein, Haus, Braunstein, & Bolton, 2014; Fulmer, 2007; Mitty, 2010). Used in the acute care setting within 24 hours of admission, SPICES has been shown to be valid and predictive of adverse events, as well as significantly correlated with age and other validated assessments for vulnerability, comorbidities, and depression (Aronow et al., 2014).

STRENGTHS AND LIMITATIONS: The SPICES acronym is easy to remember and can help clinicians identify common problems among older adults across clinical settings. It provides a simple way to flag areas that require further assessment and supports standardized quality care around key parameters. SPICES functions as an alert system focused on the most frequently occurring health issues in older adults. This initial screening can prompt more comprehensive assessments, but it should not replace a complete nursing assessment.

MORE ON THE TOPIC:

Aronow, H. U., Borenstein, J., Haus, F., Braunstein, G. D., & Bolton, L. B. (2014). Validating SPICES as a screening tool for frailty risks among hospitalized older adults. Nursing Research and Practice, 2014, 1-5. doi: 10.1155/2014/846759

Fulmer, T. (1991). Grow Your Own Experts in Hospital Elder Care. Geriatric Nursing, March/April 1991, 64-66. Fulmer, T. (2001). The geriatric resource nurse: A model of caring for older patients.  American Journal of Nursing, 102, 62.

Fulmer, T. (2007). How to try this: Fulmer SPICES. AJN, 107(10), 40-48; quiz 48-49.

Mitty, E. (2010). Iatrogenesis, frailty, and geriatric syndromes. Geriatric Nursing, 31(5), 368-374.

McRae, K. R. (2019). Assessment Protocol for Older Adults With Substance Use. Journal of Addictions Nursing, 30(4), 242–247. https://doi.org/10.1097/JAN.0000000000000306