Initial assessment of elderly people

1. K. PUVIYARASI
MSN dept
MNC
Geriatrics Assessment

2. Geriatrics
• Geriatrics is the branch of medicine dealing with
the problem of the ageing and the diseases of the
elderly and management of the diseases of older
adults.
• The branch of medicine dealing with the health and
care of old people

3. Geriatric Nursing
• It is the field of nursing that specializes in the care
of the elderly.
• Gerontological nursing is the specialty of nursing
pertaining to older adults.

4. ASSESSMENT OF ELDERLY
• The geriatric assessment is a multidimensional,
multidisciplinary diagnostic instrument designed to
collect data on the medical, psychosocial and
functional capabilities and limitations of elderly
patients.

5. COMPONENTS OF GERIATRIC ASSESSMENT
• 1.History
• 2.The Physical Examination
• 3.Neuropsychiatric Examination
• 4.Functional Examination

6. 1- HISTORY
• The geriatric assessment incorporates all aspects of
a conventional medical history including
demographic data, chief complaint, present illness,
past and current medical problems, family and
social history

7. A) DEMOGRAPHIC DATA
It includes the following
•Full name
•Age, sex and birth date
•Marital status
•Source of history and reliability of historian

8. B) CHIEF COMPLAINT AND PRESENT ILLNESS
• Elderly patients are famous for presenting with any
combination of non-specific, apparently unrelated
and seemingly trivial complaints.
• Sometimes they have no complaint at all.
• Chief complains includes -
• Primary reason for visit, ideally in patient's own
words
• Duration of presenting symptoms

9. C) PAST MEDICAL HISTORY
• This includes the assessment of the following things
• Previous medical history.
• General state of health
• Childhood diseases
• Immunizations (Tetanus-diphtheria, pertussis,
measles, mumps, rubella, hepatitis
• A&B, influenza, varicella, h. flu., polio)

10. • Chronological list of adult medical diseases, injuries
• Hospitalizations
• Allergies
• Medications, including dosage, duration and
indication
• Diet

11. D) NUTRITIONAL ASSESSMENT
• Nutritional assessment involves the evaluation of :
• Current weight in comparison to ideal body weight,
with determination of BMI to evaluate for
underweight or obesity.
• Recent changes in body weight.
• Current medications and their potential to affect
the patient's nutritional status.

12. • Functional status to determine if the patient can
purchase and prepare food for Himself, plus mental
status with regard to their interest in food.
• Food intake by food groups for a quick estimation
of adequacy of diet.
• Vitamin/mineral supplementation

13. • E) SOCIAL HISTORY
• It address familial, occupational, and recreational
aspects of the patient's personal life.

14. The components of social history are
• Substances (Alcohol, Tobacco, illicit drugs)
• occupation
• sexual preference
• Travel & transportation,
• exercise
• Living arrangements,
• financial security,
• access to medical services
• Recreational Activity,

15. F) SOCIAL NETWORKS
• The assessment of social networks involves
• collecting information on
• (1) marital status,
• (2) number of children and the frequency of
• their visits,
• (3) existence and involvement of other close
• relatives or close friends, and
• (4) frequency of attendance at religious and
• secular meetings or events.
• (5)Caregivers

16. 2- PHYSICAL EXAMINATION
• The physical examination includes physical
assessment of patient from head to toe and the
systemic evaluation. It is a major tool for the
diagnosis of elderly problems.
• It includes
• 1- General Appearance
• Apparent age, state of health, nutritional status,
alertness, and evidence of discomfort.
• 2- Vital Signs
• Temperature, blood pressure, pulse rate and

17. • 4- Lymph nodes
• Size, consistency, mobility and tenderness in occipital,
• cervical, post-auricular, submandibular, supra-clavicular,
• axillary and inguinal regions.
• 5- Head
• Size, symmetry, evidence of trauma, tenderness (including
• sinuses), masses, and condition of scalp.
• 6- Eyes
• Eyebrows, lids, conjunctival inflammation and scleral icterus;
• corneal opacities and abrasions; pupillary size, equality and
• reaction to light and accommodation; extraocular movements
• and exophthalmos; fundi for discs, vessels, macula, exudates
• and hemorrhages; gross visual acuity and fields.
• 7- Ears
• Auricles, auditory canals, tympanic membranes and gross

18. • 8- Nose
• Deformities and septal deviation; obstruction, mucous
• membrane inflammation, polyps, bleeding and discharge.
• 9- Mouth
• Lip color, lesions and pigmentations; condition of teeth;
• gingival color, inflammation, and bleeding; tongue color,
• moisture, tremor and coating; buccal mucosa inflammation
• and eruptions; soft palate; odor of breath. If patient wears
• dentures, remove them.
• 10- Throat
• Mucosal color, exudates and lesions; tonsil size, symmetry
• and exudates; post-nasal discharge.
• 11- Neck
• Range of motion; pain and tenderness; tracheal position,
• thyroid size, symmetry and consistency; carotid impulse

19. • 12- Back
• Range of motion; pain and tenderness over spine, muscles
• and costovertebral angle; symmetry.
• 13- Thorax
• Shape and symmetry in excursion; intercostal retractions; rib
• tenderness and chest wall masses.
• 14- Lungs
• Percussion, auscultation, bronchophony, egophony,
• pectoriloquy and fremitus.
• 15- Breasts
• Size, shape, symmetry, tenderness and masses.
• 16- Heart
• Precordial movement, apical impulse, rate and rhythm; heart
• sounds, murmurs, rubs and gallops.

20. • 17- Abdomen
• Shape, tenderness, bowel sounds and bruits; size of liver,
• spleen, and kidneys; masses
• 18- Extremities
• Deformities, tenderness, localized swelling, peripheral
• pulses and edema, cyanosis, clubbing, temperature,
• varicose veins, and hair loss.
• 19- Musculoskeletal
• Joint mobility, tenderness, effusion, erythema and
• deformity.
• 20- Neurologic
• Screening exam in non-neurologic cases, otherwise full
• exam. Mental status; cranial nerves; peripheral strength,
• tone and sensation; deep tendon reflexes; Rhomberg

21. • 21- Female Pelvic and Rectal
• External genitalia; speculum exam for vaginal
• mucosa and cervix, bimanual exam for uterus,
• masses and tenderness; digital rectal.
• 22- Male Pelvic and Rectal
• Inguinal hernias; scrotal and testicular masses
• and tenderness; digital rectal, with prostate
• exam.

22. • 3- NEUROPSYCHIATRIC
• EXAMINATION
• Neurological and psychiatric examinations
• comprise a significant portion of the Geriatric
• Assessment.
• This is because illnesses such as dementia and
• delirium are common among elderly patients.
• It includes (Mini-Mental State Examination)
• 1. Cognitive Assessment
• 2. Mood Assessment
• 3. Substance Abuse
• 4. Competency

23. • 4- FUNCTIONAL
• ASSESSMENT
• Functional impairment is defined as difficulty
• performing, or requiring the assistance of another
• person to perform, one or more of the following
• Activities of Daily Living (ADL)