(2)

• Approach to the Older Adult Patient

  • Adjusting the office environment
  • Shaping the content and pace of the visit
  • Eliciting symptoms
  • Responsiveness to the cultural dimensions of aging
• Adjusting the Office Environment

  1. Regard changes in temperature regulation

  2. Brighter lighting

  3. Allows older adult to see your facial expressions and gestures

  4. Face patient directly

  5. Quiet room, free of distraction or noise

  6. Adopt low-speaking tone of voice

  7. Patient with quadriceps weakness may require higher seating and a wide stool with a handrail
• Shaping the Content and Pace of the Visit

  1. Listen to the process of life review

  2. Balance the need to assess complex problems with the patient's endurance and possible fatigue

  3. Ample use of brief screening tools

  4. Schedule 2 or more shorter visits

  5. Older person need more time to respond to questions
• Eliciting Symptoms in the Older Adult

  • Older adults may accidentally or purposefully underreport symptoms
  • Presentation of acute illness may be different
  • Common symptoms may mask a geriatric syndrome
  • Cognitive impairment
• Eliciting Symptoms in the Older Adult

  1. Start the visit with an open-ended question like "How can I help you today?"

  2. Adopt a more directed questions or health screening tools

  3. Consult with family members and care givers
• Students must be knowledgeable about how cognitive impairment affects the patient's history
• Learn to recognize and avoid stereotypes that distort your appreciation of each patient as unique with a treasure of life experiences
• Tips for Communicating Effectively with Older Adult

  • Provide a well lit-moderately warm setting with minimal background noise and safe chairs and access to examining table
  • Face the patient and speak in low tones; make sure the patient is using glasses, hearing devices, and dentures if needed
  • Adjust the pace and content of the interview to the stamina of the patient; consider two visits for initial evaluations when indicated
  • Allow time for open open-ended questions and reminiscing; include family caregivers needed, especially if patient has cognitive impairment
  • Carefully assess symptoms, especially fatigue, loss of appetite, dizziness, and pain for clues to underlying disorders
  • Make sure written instructions are in large print and easy to read
• Addressing Cultural Dimensions of Aging

  • Clinicians must acquire new knowledge and awareness about the health beliefs and culture that shape the older adult's response to illness and the health care system
• Special Areas of Concern

  • Activities of daily living
  • Instrumental activities of daily living
  • Medications
  • Nutrition
  • Acute and chronic pain
  • Smoking and alcohol
  • Advance directives and palliative care
• Activities of Daily Living (ADLs)

  Consist of basic self-care abilities
• Instrumental Activities of Daily Living (IADLs)

  Higher level functions
• Questions on ADLs


  Can the patient perform these activities independently, does he or she need help, or is the patient entirely dependent on others?
• Physical Activities of Daily Living

  • Bathing
  • Dressing
  • Toileting
  • Transferring
  • Continence
  • Feeding
• Instrumental Activities of Daily Living

  • Managing Money
  • Using the telephone
  • Shopping
  • Preparing food
  • Housekeeping
  • Laundry
  • Transportation
  • Taking Medicine
• Medications


  • Take a thorough medication history, including name, dose, frequency, and indication of each drug
  • Explore all components of polypharmacy
  • Use of over-the-counter medications
• Nutrition


  Rapid Screen for Dietary Intake and Nutrition Screening Checklist
• Acute Pain


  Distinct Onset, Short duration, Can fluctuate in intensity over time, Common causes: postsurgical, trauma, headache
• Persistent Pain


  Lasts more than 3 months, Often associated with psychological or functional impairment, Common causes: arthritis, claudication, leg cramps, radiculopathy
• The CAGE Questionnaire


  • Have you felt the need to CUT DOWN on drinking?
  • Have you ever felt ANNOYED by criticism of your drinking?
  • Have you ever felt GUILTY about drinking?
  • Have you ever taken a drink first thing in the morning (EYE-OPENER) to steady your nerves or get rid of a hangover?
• Advance Directives and Palliative Care

  • Wishes about end-of life decisions
  • Advance care planning: Provide information, Invoke patient's preferences, Identify proxy decision-makers, Convey empathy and support
• Health Promotion and Counseling

  • When to screen
  • Vision and hearing
  • Exercise
  • Immunizations
  • Household safety
  • Cancer screening
  • Depression
  • Dementia and mild cognitive impairment
  • Elder mistreatment
• When to Screen


  • Base screening decisions on each older person's particular circumstances, rather than age alone
  • Consider deferring screening if it places added burdens on the older adult
• Exercise


  • Recommend regular aerobic exercise
  • Physically active lifestyle
  • Perform moderate intensity aerobic activities for at least 30 mins. 5 days a week
  • Vigorous intensity activity for at least 20 mins 3 days each week
• Vision and Hearing


  1. Needed to maintain optimal function

  2. Includes the 10 minute geriatric screener

  3. Test vision objectively through the use of EYE CHART

  4. Ask about hearing loss

  5. Follow up with whisper test and more formal testing if indicated
• Immunizations


  • Influenza vaccine- each year for people 50 yrs and above
  • Pneumococcal vaccine- every 5 years to adult 65 yrs and older
  • Zoster vaccine- 60 years
• Household Safety Tips


  • Handrails on both sides of any stairway
  • Well-lit stair ways, paths and walk-ways
  • Rugs secured by non-slip backing or adhesive tape
  • Grab bars and non-slip mat or safety strips in the bath or shower
  • Smoke alarms and plan for escaping fire
• Depression


  Screening and management