2. • To identify the problems & needs of the older
adults, you must integrate a sound theoretical
knowledge of the geriatric population with
your best assessment skills.
3. • Assessment may take place in various settings:
– Acute care facility
– Home
– Senior center
– Adult day-care center
– Long-term care facility
4. Obtaining the Health Hx
• Health hx & interview is the 1st phase of the
health assessment, provide subjective account
of the older adults’ present & past health
status.
5. Variables Affecting Assessment
• The factors listed here affect the overall atmosphere of
trust, caring & confidentiality when assessing elderly
patients.
1. Your attitude
2. The patient’s attitude
3. Language
4. Deficits
5. Consent
6. Time & energy level
7. Environment
6. Current Health Status
The first part of the interview explores the person’s
chief complaint & his current health status.
Begin by asking the pt’s full name, address, age, date of
birth, birthplace & contact persons in case of an
emergency. Record the information on an appropriate
patient hx form.
Although mental status is assessed towards the end of the
physical examination, you can assess certain aspects of 8it
during the general conversation in a nonthreatening way.
Ask the patient to state his name & date of birth, then
calculate his age, to test his ability to calculate, as well as
his remote, recent & immediate memory.
7. Record the reason for admission, or the chief complaint,
the person’s own words. Evaluate each complaint in terms
of onset, location, duration, timing, intensity, aggravating
or alleviating factors, tx measures & lifestyle impact.
Ask the patient about current prescription &
nonprescription medications, including the name, dosage,
frequency & reason for medication. Older people typically
use multiple medications w/ him, ask to see them.
Next, ask about tx’s he’s receiving, such as pulmonary tx’s,
wound care or pain control.
Finally, list devices that the person uses, such as cane,
walker, corrective lenses or hearing aid. Ask if he uses
home safety devices, such as grab rails in the shower or
tub, smoke alarms, nonskid floor surfaces & strong
lighting.
8. Medical Hx
• Includes an overview of the person’s general
health status, a hx of his adult illnesses, a
record of past hospitalizations & their
purpose, the frequency of doctor’s visits &
previous use of medications & tx’s & their
purpose.
Ask open-ended questions about medical hx, such
as “How would you describe your overall health?”
This can provide specific information about the
pt’s hx & reveal how he perceives his health
status.
9. Determine the pt’s reaction to previous hospitalizations.
Someone who has a bad experience may fear readmission &
thus withhold important information.
Ask about hx of cardiac, respiratory, renal, or neurologic
disorders, cancer, sx, trauma, falls or fractures. The pt’s detailed
recall of major illnesses, sx’l procedures & injuries is necessary
for you to complete the hx. For ex. Fractures he experienced
early in life may figure significantly now in osteoporosis. As you
record his past hx, try to get an idea of thye amount of stress he
has had recently & the way he has handled previous health
problems. Don’t be concerned if he can’t relate th8is medical
hx chronologically; just be sure to record his age at the time of
each medical condition occurred. Try to obtain chronological
report, including event, date, tx received & physician involved.
Bec. an older pt has been typically treated by many physicians,
asking for physicians’ names, conditions treated & date of tx’s
can yeild impt clues.
10. Pay special attention to the patient’s medication
hx bec he probably routinely takes medication.
Find out what over-the-counter & prescription
medications he has taken in the past, with
dosages.
11. REVIEW OF SYSTEMS
• Skin, hair & nails
• Eyes
• Ears & hearing
• Respiratory system
• Cardiovascular system
• GI system
• Genitourinary system
• Neurologic system
• Musculoskeletal system
• Hematologic & immune systems
• Psychosocial assessment
• ADL’s assessment
