Assessment of Elderly Patient/ Geriatric

Assessment of An Elderly Patient or Geriatric Client

1. Assessment of elderly Patients 1 Elderly client Variations

2. Objectives By the end of the unit, learners will be able to; Describe the variations in history taking for an elderly client. Differentiate health assessment variations for elderly clients. Identify any differing examination techniques or skills for elderly client.

3. Elderly Population 3 Elderly client Variations Elderly Population have difficulty in carrying out activities of daily living (ADLs ) include bathing, dressing, toileting, transferring, and feeding. They also have difficulties with instrumental activities of daily living (IADLs ). IADLs include ability to use the telephone, shopping, food preparation, housekeeping, laundry, using transportation, managing money .

4. Common medical problems: Arthritis Hypertension Heart disease Diabetes Visual impairments Hearing impairments Varicose Veins Dementia 4 Elderly client Variations

5. Nursing Problems 5 Elderly client Variations Impaired physical mobility Self care deficit Altered home management Decreased nutrition Incontinence Social Isolation Sensory perceptual alterations High risk for fall / injury Confusion

6. Geriatric Syndrome (functional decline, morbidity and mortality) Mental status impairment (3Ds Depression, Dementia, Delirium ) Functional impairment (ADL, Fall) Poor nutrition Incontinence Sleep problems Inappropriate medication use Relate this to FHP assessment form 6 Elderly client Variations

7. Altered Clinical Presentation 7 Elderly client Variations In Elderly client Classic symptoms of disease is missing E.g. Myocardial infarction may present with mental confusion Presence of one condition may mask another. E.g. Symptoms of COPD and Ischemic Heart Disease

8. Accumulate d life history 8 Elderly client Variations Treat older adults with respect for their intelligence, wisdom, and accumulated life history. Older adults may have long life history To direct the interview say “ This is valuable information that I would like to hear about at some later point in time, but right now I need to focus on your problem of dizziness”

9. Interviewing Principles - Old Client 9 Elderly client Variations Process may be longer and slower Physical or cognitive alterations (memory loss, slow response, hearing /vision impairment) Ask simple direct questions and avoid shouting Face the patient to allow lip reading Allow the person to recall Avoid giving impression, this is not valued

10. Examination Principles 10 Elderly client Variations Assess degree of help needed for movement Give ex t ra time to understand the instructions Keep the person warm Alternative positions if impaired mobility Guard whenever required Inspect areas at risk of skin breakdown

11. Examination Findings 11 Elderly client Variations Skin: Wrinkling & sagging of skin Hypo pigmentation spots - Pseudoscar Hyper pigmentation - Senile lentigens Telangiectasias – dilated vessels Spider & cherry angiomas Senile purpura - easy bruising Dry skin – Xerosis Seborrheic keratosis - raised warty benign Actinic keratosis- pink, dry scaly lesions Basal cell carcinoma-pearl nodule rolled borders

12. Wrinkling & sagging of skin 12 Elderly client Variations Hypopigmentation Hyperpigmentation Dilated vessels Cherry Angioma Senile Purpura

13. Xerosis/ dry skin 13 Elderly client Variations Seborrheic keratosis Actinic keratosis- Basal Cell Carcinoma

14. Cont… 14 Elderly client Variations Nails & Hair: Thin/ less/ gray scalp, axilla & pubic hair Eyebrow, nostril & ear hair coarser, darker Nails may be thick / thin & split Eyes: Sunken eyes & ectropion Dry eye syndrome Cataract & Glaucoma Arcus senilis - grayish halo arc at limbus Presbyopia - poor accommodation, and vision  Fundoscopy – yellow retina

15. Sunken eyes 15 Elderly client Variations Arcus senilis Pr e sb y o p ia yellow retina

16. Cont… 16 Elderly client Variations Nose: Smell sensation less, dry mucosa Mouth: Taste ability intact, Dry mouth - xerostomia Less salivation - oral candidiasis Dental caries / periodontal disease Ears: Pinna size increase, cerumen dries, pruritis & impaction – Conductive loss Presbycusis (S/N loss) - use of aids TM – translucent & rigid

17. xerostomia 17 Elderly client Variations oral candidiasis Periodontal disease Pr e sb y cu s is Translucent & Rigid Tympanic membrane

18. Cont… 18 Elderly client Variations Respiratory: Calcification ribs - less compliant chest wall Spinal changes - AP diameter increase Cardiac & Peripheral Vascular System Maximum heart rate & Cardiac Output decreases Athero/ Arterioscleroses - Systolic HTN Orthostatic Hypotension Fibrosis of aortic valve – Systolic murmur Abdomen : Muscle wasting or fatty, obese

19. Cont… 19 Elderly client Variations Musculoskeletal System : Height, mass & strength decrease - kyphosis Osteoarthritis & Osteoporosis Heberden’s and Bouchard’s nodes Nervous system : Deep Tendon Reflex difficult to elicit, Tremors (medicines) Vibratory sense decrease, Posture imbalance Delirium - Attention & sensory deficit Dementia- confusion, cognitive memory deficit

20. 20 Elderly client Variations

21. Cont… 21 Elderly client Variations Male reproductive : Testosterone & testes size decrease Sperm motility & seminal fluid decrease Prostate enlargement Female reproductive : Estrogen decreases Vagina atrophies, Uterus, ovaries & cervix size decreases Breast/Genitalia : Breast size less, Gland atrophies – pendulous

22. Elderly client Variations 25 PVS : Pulse weak and thready, rate low, B.P. high, 160/90 with no symptoms, orthostatic hypotension DVT and varicosities, skin pale and cooler. MS: Thinning of the intervertabral disks and shortening or collapse of disc-loss of height. Changes in spine-kyphosis- increase antero-posterior diameter. Cont…

23. Elderly client Variations 23 Muscle mass and strength low . Osteoarthritis, particularly of spine, knee, hip and fingers. Prone for injury to cartilages leads to deterioration of joint. Loss of cartilage and joint capsule lead to bone over growth cause pain, deformities, and limited mobility called ost eo phytes , common in distal joint of finger called Heberden’s nodes and in proximal joints of finger called-Boucherd’s nodes. Cont…

24. Elderl y Client s Needs Nursing Care Elderly client Variations 24