Assessment of the non-coping elderly patient Flashcards
Assessment of and the establishment of rapport with the elderly patient is a
a special skill.
Age-associated deterioration of health and function occurs especially with:
- hearing
- vision
- glucose tolerance
- systolic blood pressure
- kidney
- pulmonary and cardiac function
- immune function
- bone density
- cognitive function
- mastication and bowel and bladder function.
The ‘rules of 7’
If your elderly pt presents with:
- non-specific symptoms
- unexpected deterioration in health and/or
- an inability to cope with the activities of daily living,
consider the following:
Mental state
Confusion/dementia, depression, bereavement (incl. pets), elderly abuse/bullying
Eyes
Visual acuity, cataracts, glaucoma
Ears
Deafness (e.g. wax), tinnitus
Mouth
Dentition, xerostomia, malnutrition
Medication
Polypharmacy, adverse reactions
Bladder and bowels
Incontinence, retention, urinary infection
Locomotion, Gait
- —antalgic, movement disorder (esp. Parkinson disease), arthritis
- —hips/knees, back/sciatica, feet
- —nails, neuropathy, circulation, leg ulcers
Symptoms
Apart from confusion, other non-specific symptoms include:
- drowsiness
- poor concentration
- apathy
- fatigue/weakness/tiredness/lethargy
- anorexia
- nausea
- weight loss
- dyspnoea
- immobility, ‘stuck in bed or chair’
- stumbles or falls.
It is also important to consider infections including pneumonia and the masquerades.
The mini-mental state examination
Evidence of memory difficulty remains the best single indication of dementia and should always be evaluated by formal memory testing.
A number of screening tests are available but:
- the mini-mental state examination (MMSE),
- particularly the Folstein MMSE
- is commonly used and recommended.
Consider behavioural changes using the following checklist
DEMENTIA
D: drugs and alcohol, depression
E: ears, eyes
M: metabolic (e.g. hyponatraemia, diabetes mellitus, hypothyroidism)
E: emotional problems (e.g. loneliness)
N: nutrition: diet (e.g. vitamin B group deficiency, teeth problems)
T: tumours, trauma (of CNS)
I: infection
A: atherosclerotic disease → cerebral insufficiency
