This document provides guidance on patient assessment for geriatric patients. It emphasizes establishing rapport, gaining consent, maintaining privacy and dignity. A comprehensive assessment involves evaluating medical, cognitive, psychological, sensory and functional status. The assessment should obtain a thorough history, including personal details, primary complaints, past medical history, medications, social circumstances and functional abilities. A systematic approach is important to make an accurate diagnosis in 80% of cases based on history alone.

1. Clinical Assessment
part 1
Dr Doha Rasheedy
Lecturer of Geriatric Medicine
Department of Geriatric and Gerontology
Ain Shams University

2. Key Principles of Patient
Assessment
• It is estimated that 80% of diagnoses are
based on history taking alone.
• Use a systematic approach.
• Establish a rapport with the patient.
• Ensure the patient is as comfortable as
possible.
• Listen to what the patient says.
2
(Scott 2013, Talley and O’Connor 2010, Jevon 2009)

3. Key Principles of Patient
Assessment
• Ensure consent has been gained.
• Maintain privacy and dignity.
• Summarise each stage of the history taking
process.
• Involve the patient in the history taking
process.
• Maintain an objective approach.
• Ensure that your documentation (of the
assessment) is clear, accurate and legible.
3
(Scott 2013, Talley and O’Connor 2010, Jevon
2009)

4. Domains of Comprehensive Geriatric
Assessment
 Medical assessment
 Cognitive dysfunction
 Affective Disorders
 Visual Impairment
 Hearing Impairment
 Dental Health
 Functional Status
 Nutritional Status
 Sleep
 Gait and Balance Impairment
 Social history
 Environment
 Advance directives

5. History taking
• Personal history
• 1ry health problem from patient/ caregiver perspectives.
• Past history:
• Medical
• Geriatric giants
• Surgical
• Sleep
• Leisure
• Exercise
• Nutritional status
• Health promotion
• Sensory deprivation
• Accidents and trauma
• Previous hospitalization
• Medications review
• Social history, advance directives

6. • Description of major health problems.
• Assessment tools

7. Personal history
• Patient identification:
– Name, age, sex, caregiver, contact method(telephone number,
address).
– Education
• Special habits, Menstrual history, handedness
• Social:
– occupation, marital status, children
– Living arrangement (where, with whom, appropriateness for
patient)
– Finances(aids, pension/ satisfaction), retirement (cause, effect)
– Caregiver issues (caregiver stress, elderly abuse)
– Community resources
– Hobbies, Social life
– Significant life experiences

8. 1ry health problem from patient/ caregiver
perspectives.
• The rule: Multiple complaints
• Select the bothering one
• The recently changing one
• The new one
• The backache for last 10 y with same ccc isn’t
worrisome but increasing severity is
• Patient/ caregiver perspectives
• Onset
• Course
• Duration

9. Types of Onset
1-Acute onset
Dramatic: within seconds or minutes e.g. cerebral
hemorrhage or embolism
Sudden onset: within hours e.g. cerebral thrombosis
Rapid onset :within days e.g inflammation
2-Gradual onset:
(Within weeks, months or years ) e.g. degenerative diseases
and tumors
3-Accidental onset:
(Discovered by the patient by chance)
e.g. breast mass , mass in inaccessible site as back

10. Types Of The Course
1. Regressive: as inflammation , vascular
, trauma
2. Progressive: as malignancy and
degenerative diseases
3. Stationary: emphysema, chronic
bronchitis
4. Remission and exacerbation: as
autoimmune diseases (SLE,
rheumatoid arthritis), disseminated
sclerosis.

11. Past history
1. Baseline functional, medical and cognitive
status.
2. Each condition: analyze cause,
complications, treatment, follow up, effect on
function
3. Confirmed by which investigations

12. A
• Anemia: history of blood transfusion iron therapy,
erythropoietin injection, laboratory diagnosis.
• Asthma: dyspnea, wheezes, intermittent free in
between if not overlap disease, precipitating factors,
season, history of other allergies, frequency of attacks
• Arthritis: which joint, what is the cause,character,
signs of inflammation, stiffness duration, gelling, ROM,
deformity, effect on function, Analgesic use
• Allergies: anaphylaxis, angioedema, asthma, allergic
rhinitis, contact dermatitis

13. B
• Bilharziasis:
1) complications
• Colonic polyposis with bloody diarrhea (Schistosoma mansoni mostly)
• Portal hypertension with hematemesis and splenomegaly (S. mansoni,
S. japonicum)
• Cystitis and ureteritis (S. haematobium) with hematuria, which can progress
to bladder cancer;
• Pulmonary hypertension (S. mansoni, S. japonicum, more rarely
S. haematobium)
• Glomerulonephritis
• and central nervous system lesions.
2) Tartar emetic injection, Praziquantel tablets
3) Exposure to infected water with snails

14. • Blood transfusion: when, amount, cause, if
repeated why
• Behavioral disturbance: Anxiety, agitation,
verbal and physical aggression, self
neglect, why(depressed, delirious,
demented)

15. C
• Cancer: where/ when / chemotherapy radiotherapy/ their
complication/ surgery therapeutic or palliative.
• Cataract: which eye, operation, with IOL, post operative visual
acuity.(GLUCOMA)
• COPD: chronic cough, productive, small amount, whitish,
morning, exacerbations, O2 therapy, previous hospitalization,
ICU, ventilation
dd: supporative lung disease, emphysema, IPF, asthma.
• Constipation: usual habits, Alteration of bowel habits,
frequency, flatulence, associated abdominal pain, anal pain
on defecation or rectal bleeding, possible cause
Don’t forget Medications: Calcium channel blockers,
antidepressants, anticholinergics, opioid agonists, iron
supplements
Don’t forget diet

16. D
• Diabetes mellitus: Duration, therapy , complications, follow up
• Depression: not only depressed mood + rest of DSM V ± diagnosis made by
physician ± antidepressant treatment
• Dementia:
• Memory (recent and remote) and learning
• Language (word-finding problems, difficulty expressing self)
• Visuospatial skills (getting lost)
• Executive functioning (calculations, planning, carrying out multistep tasks)
• Apraxia (not able to do previously learned motor tasks, eg, slicing a loaf of bread)
• Behavior or personality changes
• Psychiatric symptoms (apathy, hallucinations, delusions)

17. F
Falls: when, indoors or outdoors, once or
repeated,
1) Pre-fall history: activities before falling, e.g.
standing rapidly, palpitation- environmental
hazards
2) During the fall: fits, loss of consciousness
3) Post-fall history: physical (fractures, contusion,
wounds), psychic (phobia, anxiety,
depression, fear)

18. G
• Glucoma:
Visual impairment, IOP measurement,
Pharmacological therapy, surgery

19. H
• Heart disease: IHD, HF, arrythmia,
anticoagulant use.
• Hypertension
• Hepatitis, cirrhosis (hematemsis, melena,
jaundice,splenomegaly, ascites)

20. I
• Incontinence:
1. Urinary: acute, chronic, character, volume,
activity during attack, associated symptoms,
causes mainly drugs.
2. Fecal: acute, chronic, diarrhea, constipation
(stool impaction) , mucus blood, dietary and
toilet habits, immobility, and chronic laxative
abuse
• Impotence:

21. K
• Kidney disease:
– Renal colic, stones
– CKD, RRT

22. P
• PU, Gastritis: Dyspepsia, epigastric pain,
UGI endoscopy, hematemsis, therapy.
• Prostatism (LUTs):
– Obstructive: weak stream, bifid stream,
straining during micturation, hesitancy, sense
of incomplete emptying, impaction, dribbling.
– Irritative: nocturia, dysuria, urgency,
frequency, incontince

23. S
• Seizure
• Syncope
• Stroke/ TIA

25. Surgical history
• Type
• When
• Where
• GA/LA
• Complications
• Blood transfusion

26. Accidents trauma
1. Ask about any accidents or falls number
and timing
2. Circumstances before the event
3. Complications after the event
4. Comment possible causes and
consequences.

27. Other hospitalization
• When
• Why
• Similar attacks
• Management done

28. Medication review
• Type
• Dose
• Duration
• Indication
• Side effects
• Herbal medicine, vitamin supplements

29. Sensory impairement
• Hearing, visual impairment:
– Unilateral/ bilateral
– Cause
– Corrected
– Aids
– Effect on function, QOL

30. Sleep
• Duration of night, daytime sleep
• Sleep latency
• Interrupted sleep
• Inverted sleep rhythm
• Arousal time
• Satisfaction
• Sleep apnea

31. exercise
• Type
• Duration
• Frequency
• If stopped when why

32. leisure
• Activity
• Duration
• Frequency
• With whom
• where

33. Health promotion
• Regular clinic visit
• Life style: healthy diet, exercise, smoking
cessation, dental care
• Chemoprohylaxis (aspirin, vitamin D,
calcium, omega 3, multivitamins)
• Vaccination
• Screening (malignancy, common
diseases)

34. Description of major health
problems.
• Complete analysis of each symptom:
• o Onset
• o Course
• o Duration
• o Associated symptoms
• o Investigations
• o Treatment
• Review for the other systems

35. Thank you