Careful medical evaluation of elderly people is very important because it is mandatory to distinguish disease-related disability from age-related disability among these people. This evaluation can not only help in recognition of health and disability related problems but also is quite useful in solving these problems. Following is an account of how to proceed about physical and medical assessment of these people.
Undernourishment among elderly results from a host of factors starting from inability to prepare food, chew it, swallow it to its digestion and assimilation. To assess their nourishment status their body mass index should be calculated, which will give a fair idea about their level of nourishment. Loose skin folds can be looked for to watch out for recent weight loss. Their dental and oral hygiene status will make their ability to chew obvious.
2. Hydration And Skin:
Level of their hydration can be fairly assessed by checking for status of skin turgor and edema. Loose skin, which is also slow to reduce creases after pinching is a hallmark of dehydration. Edema is suggestive of poor heart, kidney or liver function and excessive fluid retention by the body.
Skin should also be checked thoroughly for other signs such as infections (resulting from low immunity in the elderly), purpura (senile purpura resulting from increased bleeding tendency, which in turn originates from impaired vital organ functions and as a side effect of various medications that are required in this age group). Venous ulceration is also common in this age group, which results from inefficient pumping of blood back to heart by the muscles of lower leg resulting in pooling of blood around ankles and around lower legs, which if longstanding can lead to ulceration of ankles and lower legs.
Pulse reveals a lot of useful information regarding health-related problems. One should especially watch out for atrial fibrillation among elderly while checking their pulse, which will be fast, feeble and irregular in this case.
4. Blood Pressure:
Blood pressure must be checked both in supine and erect positions. A fall of 20 millimeter of mercury in blood pressure in erect position as compared to that in supine is indicative of postural hypotension and a high risk for falls.
A subjective assessment of hearing is done automatically while conversing with the patient. Doctor can very easily make out whether patient can hear a whisper, low voice, loud voice or shouting. Among hard of hearing it must also be determined whether they have wax in ears or not and whether using hearing aid or not.
Important things to be looked for while examining vision of this patient population include cataract, visual acuity and whether wearing glasses or not.
Cognitive/higher mental functions can be assessed by using mini-mental state examination.
Muscles should be examined for any wasting and graded for strength in these patients.
9. Per Rectum Examination:
Per rectum examination should be done to determine any fecal impaction and anal tone. While in men prostate size and its consistency should also be determined.
10. Joints, Gait and Balance:
Joints should be examined for deformities, tenderness, swelling and range of motion. While gait and balance can be determined by get up and go test. It should also be determined whether patient uses any gait aid or not.