Topics

• History
• Functional Assessment
• Immunizations, Screenings and Health Promotion
• Physical Exam

NDNP 819: Advanced Health Assessment Across the Lifespan

Module: Geriatrics

History

The components of a comprehensive geriatric assessment include medical status, functional capabilities, and psychosocial status. There can be challenges in taking a health history with an older adult. These include sensory impairment (hearing, vision, etc.), restricted mobility, slowed response time/communication difficulties (aphasia), cognitive impairment, and tendency to underreport or minimize symptoms, lengthy medical histories and disease presentation in an atypical fashion.

Strategies to help in getting information include scheduling more than one session for the initial patient history.  By having patients bring their medications and supplements in a brown bag and getting collateral history from family/caregivers provides a lot of information. It helps to minimize the impact of sensory deficits (adequate lighting, minimize ambient noise, interruptions) and structure the interview to overcome patients’ disability (ex. yes or no questions for an aphasic patient, attention to non-verbal cues). BE OBSERVANT!!!  You can integrate a functional assessment into the exam (see Subtopic 2 for more information).

Just like any patient, you would introduce yourself and address the patient respectfully. It is important to face the patient directly (as oppose to typing in a computer without direct eye contact). Speak slowly and allow the patient time to answer the questions. Using other tools, such as writing in large print and be aware of possible low health literacy to improve self management skills, adherence, and use of preventative services.

PMH includes: previous surgical procedures, major illnesses and hospitalizations, previous transfusions, and TB history and testing

Medications: “What are you taking? How often? Why are you taking them?” Watch for CNS depressants in older adults due to fall risks!

FH may be difficult to collect especially if asking about grandparents in older adults. Doesn’t mean you don’t ask, but recognize you may have more success with asking about siblings and parents

SH includes home/living arrangements, relationship with family & friends, expectations of family/caregivers, economic status, ability to perform ADLs, social activities/hobbies/past occupation, spiritual/religious, transportation and advanced directives. Assessment of elder abuse using these SAFE questions:

ROS questions that are key for older adults include: