Assessment Of Elderly Patients

The geriatric assessment is a multidimensional process, which was developed to assess the functioning of the (physical, cognitive and mental) health and social situation of older people.

Older people also have different, often complicated health problems such. B. Mulitmorbidität that may require (sometimes called polypharmacy) the use of many drugs, and therefore more likely to prescribe a drug at high risk (see Table: Potentially inappropriate drug in the elderly (after American Geriatrics Society 2012 Beers Criteria Update)) , The diagnosis can be complicated, resulting in delayed or missed diagnosis leads erroneous positions, and thus inappropriate use of drugs.

In general, the assessment of elderly people from a medical standard check is different. In the elderly, especially very old or infirm, history taking and physical examination at different times can be carried out, and the physical examination may require two sessions because patients are tired. Older people also have different, often complicated health problems such. B. Mulitmorbidität that may require (sometimes called polypharmacy) the use of many drugs, and therefore more likely to prescribe a drug at high risk (see Table: Potentially inappropriate drug in the elderly (after American Geriatrics Society 2012 Beers Criteria Update)) , The diagnosis can be complicated, resulting in delayed or missed diagnosis leads erroneous positions, and thus inappropriate use of drugs. Early uncovering of problems leads to early intervention, sometimes by relatively simple, inexpensive measures (such. As the change of habits) prevent deterioration and improve the quality of life. So let some older patients, especially frail or chronically ill, the best judge through a comprehensive geriatric assessment, which examines the functioning and quality of life; best guided by an interdisciplinary team. Mulitmorbidität The average elderly patient has six diagnosable disorders, some of which are not recognized by the family doctor often. A malfunction in an organ system can drag another affected, resulting in both worsen and lead to loss of function or need for help and without intervention death. Mulitmorbidität complicated diagnosis and treatment, and the effects of the disease are exacerbated by social disadvantage (eg. As insulation) and poverty (as patients live longer when their resources are sufficient, or because they survive their social environment) and by functional and financial difficulties. Some general geriatric symptoms (eg. As delirium, dizziness, syncope, fall, mobility problems, weight loss and loss of appetite, urinary incontinence) must be given special attention by the doctors, because they can be caused by diseases of several organ systems. In multi-morbid patients the treatments (. Eg bed rest, surgery, medication) must be well matched; a disease isolated and without treating the associated disorders that frailty can accelerate. In addition, careful monitoring is necessary in order to avoid iatrogenic consequences. In complete bed rest for can. As older patients per day 1-3% of their muscle mass and lose -power (which is a cause sarcopenia), and only the effects of bed rest can lead to death. Missed or delayed diagnosis disorders, which are common in older people are often overlooked, or the diagnosis is delayed. The Ärztes hould on the basis of medical history, clinical examination, and simple laboratory tests older patients with actively look for diseases that occur exclusively or often in the elderly (see table: Frequent disorders in the elderly); these diseases can be diagnosed early treatment often lighter. In many cases, early diagnosis depends on whether the doctor is with the behavior and the history of his patient, incl. Of his mental status, familiar. Usually the first sign of a physical illness behavioral disorders, mental or emotional disorders. the doctor this possibility is not aware and he holds these characters for an expression of dementia, diagnosis and treatment can be delayed. Frequent disorders in the elderly Frequency Interference Nearly exclusively in the elderly Accidental hypothermia NPH urinary incontinence Diastolic heart failure Alzheimer’s disease More common in the elderly than in other age groups atrial fibrillation basal cell chronic lymphocytic leukemia Degenerative osteoarthritis dementia Hyperosmolar nichtketotisches diabetic coma falls herpes zoster hip fracture Monoclonal gammopathy osteoporosis parkinsonism polymyalgia rheumatica Druckulzer a prostate stroke temporal arteritis (giant cell arteritis) often in the elderly and treatable depression diabetes foot diseases that affect mobility Gastrointestinal bleeding hearing and vision problems heart failure hypothyroidism iron deficiency anemia in the mouth that interfere with eating vitamin B12 deficiency polypharmacy, the use of both prescription be and nonprescription medicines should, especially with regard to drug interactions and on inadequate for elderly patients medication checked frequently (K CATEGORIES concern drug in the elderly). When multiple drugs are used, the more efficient handling with an electronic medicator. Problems with nurses occasionally hang problems of older patients with neglect or abuse by their caregiver together (elder abuse). Let the circumstances and findings suggest that doctors should be allowed by patient abuse and drug abuse checked by the caregiver. Certain injury patterns or behaviors of patients have specific indication in character, comprising Frequent bruising, v. a. in hard to reach areas (eg. as center back) Handle bruises of the upper arms bruising the genitalia Strange burns Unexplained anxiety of the patient before a caregiver history is often for the medical history and assessment of older patients require more time, in part because it features may have that may interfere with it: the following points should be considered: Sensory deficits: will normally dentures, eyeglasses or hearing aids are used, they should be worn to facilitate communication during the conversation. Adequate lighting and eliminating visual or auditory distractions are also useful. “Underreporting” of symptoms: Elderly patients may not mention symptoms because they believe they are part of the normal aging process (eg, dyspnea, impaired hearing or eyesight, memory problems, incontinence, gait disturbances, constipation, dizziness, falls.). However, no symptom should be attributed to the normal aging unless a thorough investigation is not done and other possible causes have been eliminated. Unusual manifestations of a disorder: In elderly people, typical symptoms of a disease are missing (unusual disease entities in the elderly). Instead, older people with non-specific symptoms can imagine (z. B. fatigue, confusion, weight loss). Functional degradation as the only manifestation: disease can manifest itself only in the form of functional degradation. In such cases, standard questions can not be valid. When asked about joint problems it can for. his example, that patients experience with severe arthritis do not have pain, swelling or stiffness, but they are asking for changes in their activities, they can be,. B. tell that they no longer walk or volunteer work at the hospital. Questions to the duration of functional decline (z. B. “How long can you no longer even do your shopping?”) Can elicit useful information. then identify individuals when their difficulties in performing the basic activities of daily living (ADL) and instrumental ADL (IADL) have just started, can open up more opportunities for interventions that restore the operability or prevent a further decline, and thus to remain independent. Memory problems: patients can not remember exactly, previous illnesses, hospitalization, surgery and medication use,; The doctors then elsewhere must obtain this information (eg. as by family members, a home employee or patient records). Fear: Elderly patients may report their symptoms are reluctant because they are afraid of a hospital stay, they may connect to the dying. Age-related diseases and problems: depression (often in the elderly who are vulnerable and sick), the cumulative loss in old age and ailments due to illness result in older people provide less adequate health information doctors. For patients with impaired cognition it can be difficult to describe problems, making it difficult for a medical assessment. White conversation a doctor about the everyday concerns, the social circumstances, mental health, emotional state and subjective well-being of elderly patients notice, so this hilt to stukturieren the conversation and lead. If the patient asked to describe a typical day, it produces information about their quality of life and their mental and physical condition. This approach is particularly useful when you first meet. Patients should be given time to talk about things with personal meaning. Physicians should also ask whether patients have specific concerns, such as fear of falling. The resulting harmonic ratio can contribute to better communication with patients and their families. A survey of mental status may be necessary in early talks to determine the reliability of the information provided by the patient; this study should be done tactfully so that the patient will not be embarrassed or offended or feels attacked. Routine screening to physical and mental disorders (see Table: screening recommendations for older patients) should be starting at the age of 70 years, carried out annually. Often verbal and nonverbal cues (. Eg how a story is told, rate of speech, tone of voice, eye contact) information can provide include: Depression: Elderly patients may pass or deny symptoms of anxiety or depression, but they give themselves away by a small voice , muted enthusiasm or even tears. Physical and mental health: what patients say about sleep and appetite, may be instructive. Weight gain or loss: Any change in the fit of clothes or dentures should be noted by the doctor. If the mental status is not affected, a patient should be interviewed alone, to promote conversation about personal matters. It may also be necessary that doctors perform a relative or a caregiver conversation. These people often have a different view of the functioning, mental status and emotional state. These discussions can take place with or without the patient. The physician should obtain the consent of the patient before he invites a relative or a caregiver, and should explain to him that such discussions take place routinely. If the caregiver interviewed alone, the patient should be always busy sense (eg. As by completing a standardized questionnaire or another member of the interdisciplinary team is talking to him). If indicated, physicians should have the opportunity of drug abuse by the patient and patient abuse by the caregiver into account ziehen.Medizinische history are patients asked about their medical history, the doctor rheumatic for diseases that time were more frequent (eg. As fever should inquire, polio), and after obsolete treatments (eg. B. pneumothorax therapy for tuberculosis, syphilis mercury). What is needed is a history of vaccination (z. B. tetanus, influenza, pneumococci), unwanted side effects and results of TB skin tests. Patients can indeed reminiscent of an operation, but know nothing more about the procedure or its purpose, should be obtained whenever possible operation protocols. Doctors should ask questions that are designed to systematically review every body part or organ system review of the system) and thus detect other diseases and common problems that the patient had forgotten may be mentioned (see table: references to disturbances in elderly patients). Signs of anomalies in the elderly area or organ system symptom Possible causes skin itching allergic reaction, cancer, dry skin, hyperthyroidism, jaundice, lice, scabies, uremia head headache anxiety, cervical osteoarthritis, depression, giant cell arteritis, subdural hematoma, tumors eyes glare from lights the N eight cataract, glaucoma, central visual acuity loss macular degeneration loss of near vision (presbyopia) Decreased accommodation of the lens Peripheral vision loss glaucoma, retinal detachment, stroke pain giant cell arteritis, glaucoma Ear hearing loss acoustic neuroma, ear wax, foreign body in the external auditory canal, eye toxicity (by drugs such. As aminoglycosides, aspirin, furosemide), Paget’s disease, presbycusis, acoustic trauma, tumor of the cerebellopontine angle, viral infection loss of the high frequency range presbycusis (usually caused by age-related changes in the cochlea) mouth burning in the mouth Pernicious anemia, stomatitis pain caused by dentures Poor dentures, oral cancer Mundtro (Ckenheit (xerostomia) autoimmune diseases z. As rheumatoid arthritis, Sjögren’s syndrome, SLE), dehydration, drugs (eg. As antidepressants, incl. Tricyclic antidepressants, antihistamines, antihypertensives, diuretics, psychiatric drugs), damage to the salivary glands due to infection or radiotherapy for head and neck tumors limited movement of the tongue oral cancer, stroke loss of taste adrenal insufficiency, medications (eg. as antihistamines, antidepressants), infection in the mouth or nose, nasopharyngeal tumor, radiation therapy, smoking, dry mouth throat Dysphagia fear cancer, esophageal stricture, foreign bodies, insult in Schatzki ring, Zenker’s diverticulum voice changes hypothyroidism, rezidiveriende dysfunction laryngeal nerve, vocal cord tumor sore throat Cervical arthritis, carotid or vertebral artery dissection, polymyalgia rheumatica chest shortness of breath on exertion cancer, COPD, functional loss, heart failure, infection Paroxysmal nocturnal dyspnea Gastroesophageal reflux disease pain angina, anxiety, aortic dissection, costochondritis, motility disorders of the esophagus, gastroesophageal reflux, herpes zoster, myocardial infarction, myocarditis, pericarditis, pleural effusion, pleurisy, pneumonia, pneumothorax gastrointestinal constipation (without other symptoms Colorectal cancer, dehydration, drugs z. As aluminum-containing antacids, anticholinergics, iron supplements, opioids, antidepressants), hypercalcemia (z. B. due to hyperparathyroidism), hypokalemia, hypothyroidism, insufficient exercise, abuse of laxatives, fiber diet constipation with pain, vomiting, intermittent diarrhea Stuhleinklemmung bowel obstruction fecal incontinence cerebral dysfunction, fecal impaction, rectal cancer, spinal cord lesions abdominal pain (cramping, suddenly) Diverticulitis, gastroenteritis, ischemic colitis, abdominal pain Postprandial closure (2-3 h after eating, duration 1-3 h) Chronic intestinal ischemia Rectal bleeding colonic angiodysplasia, colon cancer, diverticular disease, hemorrhoids, ischemic colitis urogenital tract frequency of rain, hesitation, weak river benign prostatic hyperplasia, constipation, medications (eg. As antihistamines, opioids), prostate cancer, urinary retention, urinary tract infection dysuria with or without fever prostatitis, urinary tract infection polyuria Diabetes insipidus (decrease in ADH activity), diabetes mellitus, diuretics incontinence bladder infection, functional loss, normal pressure hydrocephalus, spinal cord dysfunction, stroke, urinary retention or – overflow, urinary tract infection musculoskeletal system Backache abdominal aortic aneurysm, compression fractures, infection, metastatic tumor, multiple myeloma, osteoarthritis, Paget’s disease, pyelonephritis, spinal stenosis proximal muscle pain myopathies, polymyalgia rheumatica, statin intake limb pain in the legs claudication, nocturnal muscle cramps, osteoarthritis, radiculopathy (eg. B. disc herniation, lumbar stenosis), restless legs syndrome Swollen ankles heart failure (when beidseitieger swelling), hypoalbuminemia, renal failure, venous insufficiency Neurological alteration in mental status with fever delirium, encephalitis, meningitis, sepsis change in mental status without fever Acute disease cognitive dysfunction, constipation, delirium, depression, drugs, paranoia, urinary retention Clumsiness in tasks that require fine motor coordination (eg. B. buttoned a shirt) arthritis, Parkinson’s disease, spondylotic cervical myelopathy, intention tremor Excessive sweating while eating Autonomic neuropathy fall without loss of consciousness bradycardia, “Fall attack”, neuropathy, orthostatic hypotension, postural instability, tachycardia, transient ischemic attack, blurred vision hesitant response with intention tremor Parkinson’s disease Numbness with tingling in the fingers carpal tunnel syndrome, peripheral neuropathy, spondylotic cervical myelopathy sleep anxiety, disorders of the circadian rhythm, depression, medications, pain, Parkinsonism, Periodic Limb Movement Disorder, sleep apnea, urinary frequency syncope aortic stenosis, karidale arrhythmia, hypoglycemia, orthostatic hypotension (especially drug-dependent), seizure ago passing over interference with speech, muscle, sensor or visual acuity Transient ischemic attack tremor alcohol abuse, CNS disease (e.g.. B. disorders of the cerebellum, Z. n. Stroke), essential tremor, hyperthyroidism, Parkinsonism, drug history, the drug history should be detected, and the patient or their caregiver should receive a copy. You should drug used dose regimen Prescribing physician reason for prescribing the drugs specifically OTC drugs (which may have serious consequences include information about any drug allergies all used drugs should be included, including topical medications (which can be absorbed systemically) when overdosed and they can with prescription drugs interact) nutritional supplements medicinal herb preparations (because many can interact negatively with prescription and OTC medicines) patients or relatives should be asked to all of the above Drugs and supplements during the first visit and then bring on a regular basis. Doctors can ensure that patients receive the prescribed medication, but simply being in possession of these drugs does not guarantee adherence. It may be necessary to count the number of tablets in each pack at the first and subsequent visits to the doctor. Administered a person other than the patient’s medications, this is questioned. Patients should be asked to demonstrate that they labels (which are often printed in small type) read container (especially those with child protection) open and recognize the drugs. Patients should be instructed their drugs do not respect in a single container to tun.Vorgeschichte. Alcohol, tobacco and recreational drugs patients who smoke should be advised to stop, and if they continue to smoke, not to do so in bed because asleep elderly people tend to it. Patients should be checked for signs of alcohol consumption related disorders that are under-diagnosed in the elderly. Such symptoms include confusion, anger, hostility, alcohol odor on the breath, balance and gait disturbances, tremor, peripheral neuropathy, and nutritional deficiencies. Screening questionnaires (eg AUDIT – see table. Screening recommendations for older patients and see table: Screening levels for alcohol problems), and questions about the amount and frequency of alcohol consumption may be helpful. The four CAGE questions must be answered quickly and easily; the doctor asks if the patient ever had the feeling that they have to reduce drinking (cut down) that the environment has made remarks about drinking (Annoyed) to feel guilty about drinking (Guilty) the need for a morning pick-me ( “Eye -opener “) Two or more positive responses to the CAGE questions point to a possible alcohol abuse. Fragen zum Gebrauch von anderen Freizeitdrogen oder Suchtmitteln sind ebenfalls angemessen.Vorgeschichte bzgl. Ernährung Art, Menge und Häufigkeit der verzehrten Lebensmittel werden bestimmt. Bei Patienten, die ? 2 Mahlzeiten pro Tag einnehmen, besteht die Gefahr von Unterernährung. Ärzte sollten nach Folgendem fragen: Etwaige spezielle Diäten (z. B. salzarm, kohlenhydratarm) oder selbstverordnete Modediäten Verzehr von Ballaststoffen und verschriebenen oder freiverkäuflichen Vitaminen Gewichtsabhame und veränderte Passform der Kleidung Geldbetrag, den die Patienten für Lebensmittel ausgeben müssen Erreichbarkeit von Lebensmittelgeschäften und geeigneten Küchen Vielfalt und Frische der Lebensmittel Die Fähigkeit zu essen (z. B. zu kauen und zu schlucken) wird beurteilt. Sie kann durch Mundtrockenheit und/oder dentale Probleme, die bei älteren Menschen häufig vorkommen, beeinträchtigt sein. Eine verminderte Geschmacks- oder Geruchswahrnehmung kann die Freude am Essen verringern, sodass die Patienten vielleicht weniger essen. Patienten mit verminderter Sehfähigkeit, Arthritis, Immobilität oder Tremores können Schwierigkeiten mit der Zubereitung von Mahlzeiten haben und sich beim Kochen verletzen oder verbrennen. Patienten, die wegen Harninkontinenz besorgt sind, reduzieren möglicherweise ihre Flüssigkeitszufuhr; infolgedessen können sie evtl. auch weniger essen.

Health Life Media Team

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