OMED 1401 - Advanced Patient Assessment (OLDER PERSON ASSESSMENT) Flashcards
What are the Physical Changes associated with Old Age?
- Aching Joints, Stiffness and Slowness
- Weak Muscles
- Brittle Bones
- Dry, Wrinkled Skin
- Greying and Whitening of Hair
- Marked Bony Prominences due to Loss of Subcutaneous Fat.
What are the Sensory Changes associated with Old Age?
- Deafness
- Loss of Sight
- Disturbance of Balance
- Deterioration of Senses of Small and Taste
- Impaired Memory/Forgetfulness
- Reduced Learning Capability
What are Common Medical Conditions Associated with Older Person?
- Cognitive Impairment = Alzheimer’s, Dementia
- Stroke
- Rheumatoid Arthritis/Osteoarthritis
- Respiratory Disorders e.g. COPD
- Cardiac Condtions e.g. Congestive Cardiac Failure
- Renal Failure
- Diabetes
- Obesity
- Cancer
- Urinary Tract Infections.
What is the GEMS Framework?
Geriatric Patient (Geriatric Giants)
Environmental Assessment
Medical Assessment
Social Assessment
What is Associated with Geriatric Giants?
Frailty - Vunerability in Movement Short of Disability
Sacropenia - Degenerative Loss of Skeletal Muscle Mass, Wasting.
Anorexia of Ageing - Unintended Weight Loss
Cognitive Impairment - A Decline in Memory and Thinking Skills.
What is Involved in Environment Assessment for the Older Person?
Conditions of House and Garden (Smells)
Ambient Temperature
Living in Whole Property or One Room
Food (Condition)
Medications (Adherence, in Date)
Hand Rails, Walking Frames, Commode etc.
Hazards
IF OUTDOORS CONSIDER:
- Weather
- Clothing
- Mental State
What Occurs in Hypothermia for the Older Person?
Elderly people are more Prone to Hypothermia because their Heat Generation and Retention is Less Efficient compared with Younger People.
Consider Contributing Factors:
- Poor Diet
- Poor Clothing
- Poor Heating
- Poor Housing
What is the Medical Assessment including the Primary and Secondary Survey for the Older Person?
Danger
Response (Is Confusion Normal?)
Airway (False Teeth, Kyphosis - Forward Rounding of the Upper Back)
Breathing (COPD)
Circulation (Pulse, Hypotension, Medication)
Disability (GCS, FAST, PEARLA, Gait and Mobility)
Exposure and Examine
SECONDARY SURVEY
- Presenting Complaint
- History of Presenting Complaint
- Past Medical History
- Drug / Medication History
- Social / Family Medical History
- Activities of Daily Living
- Review of Systems
What is Involved in the Enhanced Patient Assessment?
- Skin
- Hands
- Face
- Lymph Nodes
- Neck
- Chest (IPPA)
- Oedema
- Mini Mental Test
- Mobility
- Social Assessment
- Other Considerations E.g. Safeguarding/Welfare
How to Assess Mobility in an Older Person?
IF APPROPRIATE ASK THE PT TO WALK A SHORT DISTANCE AS THEY NORMALLY WOULD.
Check for:
- Motor Performance and Gait
- Normal Range of Movement
- Joint Deformity
- Pain when Moving
- Loss of Muscle Mass
- Kyphosis, Scoliosis
- Any aids used, Including Grabbing onto Furniture
- Abnormal Findings: Increased RR, Dizziness, etc.
What is Social Assessment for the Older Person?
Activities of Daily Living:
- Does the Patient Cook/Clean? Does the Patient go out?
Assess Independence/Dependency”
- Care Package? How Often? What for? Family Contact?
Assess Diet, and Medication Adherence/Overdose?
Are they Complaint with Taking Meds? When was the Last Medication Review? Do have food in the Fridge? Is it in Date?
Level/Type of Social Network:
Social Contact? Loneliness/Depression? Contact with Other People?
What are Other Considerations for the Assessment of the Older Person?
Helpful Contacts:
- Age Concern
- Silverline
- Friends of the Elderly
What are the Common Causes of Falls?
DAME
Drugs and Alcohol
Age Related Physiological Changes
Medical
Environment
How to Assess a Fall?
How did you Fall?
Did you have any Dizziness/SOB/Palpitations/LOC?
What did you Slip/Trip on?
Were you able to get up off the Floor?
Any Previous History of Falls?
Medical and Drug History
THERE IS NO SUCH THING AS A MECHANICAL FALL.
Falls are not Said to be Medical/Mechanical any more, better to Determine if they are Related to Intrinsic/Extrinsic Factors.
Intrinsic Factors - Decline in Pathology Affecting Balance.
Extrinsic Factors - Environmental Hazards
Long Lies - Falls which leave the Patient lying and unable to get up for a long time.
How to Examine a Patient in an Older Assessment?
- Check BP Standing and Lying (Postural Drop)
- Watch the Person get out of the Chair and Walk
- Consider a Multi-System Examination Based on History.
