Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly

Physical Examination

stethoscope

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).

BMI calculator

Body Mass Index calculator

Calculator embedded into this CGA Toolkit Plus for accurate BMI determination.

5 min.

 Chair Stand Test - 30 sec.

Timed Chair Stand Test

Strength and endurance test in the assessment of sarcopenia (risk of falls)

3 min.

4 Stage Balance Test

4 Stage Balance Test

Assessment of static balance in the assessment of sarcopenia (risk of falls)

3 min.

TUG Test

Timed Up and Go Test

Assessment of mobility, balance, walking ability, and fall risk in older adults

10 min.

GST-4

Gait Speed Test (4 metre)

Simple assessment of functional mobility

5 min.

Participation :

 

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.

 

 

Posture :

 

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.

medical assessment blood pressure measurement medication pills

The Physical Examination is one of 5 sub-domains of the Medical Assessment

Back To : Medical Assessment

doctor and patient

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

ECG with PVCs

GoTo :The Annual Physical in Proactive Care