Best Practices in Nursing: Fulmer SPICES - Assessing Health Issues in Older Adults
Added on 2023-04-25
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From The Hartford Institute for Geriatric Nursing, New York University Rory Meyers College of Nursing
Best Practices in Nursing
Care to Older Adults
general assessment series
Issue Number 1, Revised 2019 Editor-in-Chief: Sherry A. Greenberg, PhD, RN, GNP-BC
Managing Editor: Robin Coyne, MSN, RN, AGACNP-BC
New York University Rory Meyers College of Nursing
Fulmer SPICES: An Overall Assessment Tool for Older Adults
By: Terry Fulmer, PhD, RN, FAAN
The John A. Harford Foundation
WHY: Normal aging brings about inevitable and irreversible changes. These normal aging changes are partially
responsible for the increased risk of developing health-related conditions within the older adult population. Prevalent
issues experienced by older adults include: sleep disorders, problems with eating or feeding, incontinence, confusion,
evidence of falls, and skin breakdown. Familiarity with these commonly-occurring issues helps the nurse prevent
unnecessary iatrogenesis and promote optimal function of the aging individual. Flagging conditions for further assessment
allows the nurse to implement preventative and therapeutic interventions (Fulmer, 1991; Fulmer; 2007).
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). 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 occur commonly among the entire older adult
population. Therefore, the instrument may 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. Full psychometric testing has not been done, however,
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 easily remembered and may be used to recall the
common problems of the elderly population in all clinical settings. It provides a simple system for flagging areas in need
of further assessment and provides a basis for standardizing quality of care around certain parameters. SPICES is an alert
system and refers to only the most frequently-occurring health issues of older adults. Through this initial screen, more
complete assessments are triggered. It should not be used as a replacement for a complete nursing assessment.
Permission is hereby granted to reproduce, post, download, and/or distribute, this material in its entirety for not-for-profit educational purposes only, provided that
The Hartford Institute for Geriatric Nursing, New York University, Rory Meyers College of Nursing is cited as the source. This material may be downloaded and/or distributed in electronic
format, including PDA format. Available on the internet at www.ConsultGeri.org. E-mail notification of usage to: nursing.hign@nyu.edu.
Best Practices in Nursing
Care to Older Adults
general assessment series
Issue Number 1, Revised 2019 Editor-in-Chief: Sherry A. Greenberg, PhD, RN, GNP-BC
Managing Editor: Robin Coyne, MSN, RN, AGACNP-BC
New York University Rory Meyers College of Nursing
Fulmer SPICES: An Overall Assessment Tool for Older Adults
By: Terry Fulmer, PhD, RN, FAAN
The John A. Harford Foundation
WHY: Normal aging brings about inevitable and irreversible changes. These normal aging changes are partially
responsible for the increased risk of developing health-related conditions within the older adult population. Prevalent
issues experienced by older adults include: sleep disorders, problems with eating or feeding, incontinence, confusion,
evidence of falls, and skin breakdown. Familiarity with these commonly-occurring issues helps the nurse prevent
unnecessary iatrogenesis and promote optimal function of the aging individual. Flagging conditions for further assessment
allows the nurse to implement preventative and therapeutic interventions (Fulmer, 1991; Fulmer; 2007).
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). 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 occur commonly among the entire older adult
population. Therefore, the instrument may 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. Full psychometric testing has not been done, however,
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 easily remembered and may be used to recall the
common problems of the elderly population in all clinical settings. It provides a simple system for flagging areas in need
of further assessment and provides a basis for standardizing quality of care around certain parameters. SPICES is an alert
system and refers to only the most frequently-occurring health issues of older adults. Through this initial screen, more
complete assessments are triggered. It should not be used as a replacement for a complete nursing assessment.
Permission is hereby granted to reproduce, post, download, and/or distribute, this material in its entirety for not-for-profit educational purposes only, provided that
The Hartford Institute for Geriatric Nursing, New York University, Rory Meyers College of Nursing is cited as the source. This material may be downloaded and/or distributed in electronic
format, including PDA format. Available on the internet at www.ConsultGeri.org. E-mail notification of usage to: nursing.hign@nyu.edu.
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