Assessment of older people

Question 1

History from older people

Answer 1

As normal but increased focus on social history and living arrangement – where is home?, are there stairs? Do they feel comfortable? Do they feel safe? who is with them? Do they have any carers? How often and for what? Social activities. ADLs

Question 2

Practical considerations when taking a history from an older person

Answer 2

Ensure you have the time & Show interest
Ensure your and their comfort
Consider their hearing, sight and cognition before you begin
Consider getting a collateral history from relative or carer

Question 3

Barthel ADL SCALE (out of

Answer 3

Transfers Grooming Use of toilet Bathing
Bowels Bladder Dressing Mobility
Stairs Feeding

Question 4

Points to consider when assessing the psychological state of an older person

Answer 4

Depression, Anxiety Bereavement, Social Isolation

Impairment, disability and handicap

Question 5

Points to consider when assessing the physical state of an older person

Answer 5

General appearance, grooming, clothes (dressing/ undressing), standing/walking/transfering ability
Aids and appliances, cognitive state and mood

Question 6

Things to look for on General inspection

Answer 6

Anaemia, Hypothyroidism
pressure sores (feet etc)
Breasts

Question 7

Things to look for on CVS/Respiratory exam

Answer 7

Postural BP, Cyanosis, Skin temperature, RR, Chest shape

Operation scars

Question 8

Things to look for on Abdominal exam

Answer 8

Scars
Catheters
Signs of constipation (do a PR)

Question 9

Things to look for on Nervous exam

Answer 9

Eye movements and fields Speech pattern
Cerebellar function Movement disorders
Hand function

Question 10

Always remember

Answer 10

Collateral history, Mental state, Drug and social history

ADLs, Vision, hearing, nutrition, skin and feet

Question 11

When assessing mental state in older people

Answer 11

Beware but take note of lay terms (bored, confused, lonely)
Consider the baseline and variablity (change of environment may cause decompensation)
Judge insight and functional impairment (falls)

Question 12

Cognitive testing in older adults

Answer 12

Present it as routine and be positive
MMSE is screening not diagnostic - consider pattern of deficit (memory vs concentration)
Consider premorbid functioning

Question 13

AMTS (Abbreviated mental test score)

Answer 13

Out of 10 (7 or better): Age Name 2 people
DoB Name of hospital Their Address Date of WWI/WWII
Year Who is queen/PM Time of year (season) Count 20-1

Question 14

Other cognitive tests

Answer 14

MMSE – revise from old notes
MOCA - includes frontal lobe tests
Clock drawing test - non-threatening and can be assessed over time

Question 15

Bamford criteria (AKA oxford community stroke project classification)

Answer 15

1 - Total anterior
2 - Partial anterior
3 - Lacunar 
4 - Posterior 
I for Infarct, H for haemorrhage, S for syndrome.

Question 16

London Handicap scale

Answer 16

Measures six dimensions:
Mobility, physical independence, occupation, social integration, orientation, economic self-sufficiency. Each measure has six levels of increasing disadvantage.