Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Evaluation of the elderly usually differs from a standard medical evaluation. For elderly patients, especially those who are very old or frail, history-taking and physical examination may have to be done at different times, and physical examination may require 2 sessions because patients become fatigued.
Diagnosis may be complicated, resulting in delays or missed diagnoses, and sometimes drugs are used inappropriately. Early detection of problems results in early intervention, which can prevent deterioration and improve quality of life often through relatively minor, inexpensive interventions (eg, lifestyle changes).
Gait Speed Test
Assessment of frailty
Timed Up and Go Test
Evaluation tool for frailty, gait and balance
Clock Drawing Test
Quick screening test for cognitive dysfunction secondary to dementia, delirium, or a range of neurological and psychiatric illnesses
Older people, particularly those with frailty, may find the clinical examination challenging or tiring.
A thorough assessment may have to be split into more than one session or deferred, so initial prioritisation of the most relevant issues is important.
Within a single examination session, the patient with limitations of mobility, exertion or posture requires an adaptive approach, and acceptance of less than ideal conditions for examination.
The clinician may need to group examinations by position and opportunity rather than organ system or diagnosis. For example, a kyphosis or severe heart failure may limit the ability to lie flat and so examination of the abdomen and screening neurological examination of the legs could be done with the patient semi recumbent and consecutively to avoid having to return to this position later.
Assessment of the non-concordant patient :
Patients with dementia, delirium, or psychiatric illness may not give consent or participate with examination.
Consideration must be given to whether the patient has capacity to agree or refuse examination and, if not, assessment should be performed bearing in mind the best interests of the patient.
This is likely to be the case for most aspects of clinical examination which are unlikely to be burdensome, harmful or limiting to the person’s liberty – however if they have previously refused interventions and assessments it should not be assumed that a change in their ability to consent or refuse means that examination is now acceptable.
Discussion with the patient’s advocate(s) or healthcare power of attorney may be required, and should be recorded, before proceeding with selected aspects of the examination.
Opportunistic assessment :
Examination is a continuous process and information can be gleaned even when not formally examining – the walk into the examination room may give significant clues about gait & balance, while visual cues such as choice and fit of clothing (eg elasticated waistbands) can suggest functional difficulties with dressing, or recent weight change.
Non-corcodant patients examined under their best interests may be challenging to assess but with assistance, reassurance, and careful observation (eg a variety of purposeful movements in lieu of formal neurological testing of each muscle group) a large amount of information may be gleaned.
The Physical Examination is one of 5 sub-domains of the Medical Assessment
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The Medical Assessment is one of 8 domains of the Comprehensive Geriatric Assessment (CGA)
Back To : Comprehensive Geriatric Assessment
The Annual Physical in Proactive Care
GoTo :The Annual Physical in Proactive Care