Heberden nodes. Pedal edema. Dorsal kyphosis, vertebral tenderness, back pain. Gait disturbances. Adverse effects from medication, arthritis, deconditioning, foot abnormalities, Parkinson disease, stroke. Leg pain. Intermittent claudication, neuropathy, osteoarthritis, radiculopathy, venous insufficiency. Muscle wasting. Proximal muscle pain and weakness.
Premalignant or malignant lesions. Actinic keratoses, basal cell carcinoma, malignant melanoma, pressure ulcer, squamous cell carcinoma. In the normal aging process, there is often a decline in physiologic function that is usually not disease-related. However, treatment of diabetes mellitus, hypertension, and glaucoma can prevent significant future morbidity. Screening for malignancies may allow for early detection, and some are curable if treated early.
It is important that physicians weigh the potential harms of screening before screening older patients. It is essential to consider family preferences regarding treatment if a disease is detected, and the patient's functional status, comorbid conditions, and predicted life expectancy.
If an asymptomatic patient has an expected survival of more than five years, screening is generally medically warranted, assuming that the patient is at risk of the disease and would accept treatment if early disease was detected. It can assist physicians in identifying age-appropriate screening measures. A nutritional assessment is important because inadequate micronutrient intake is common in older persons. Several age-related medical conditions may predispose patients to vitamin and mineral deficiencies.
Studies have shown that vitamins A, C, D, and B 12 ; calcium; iron; zinc; and other trace minerals are often deficient in the older population, even in the absence of conditions such as pernicious anemia or malabsorption. One simple screening tool for nutrition in older persons is the Nutritional Health Checklist Table 4.
I have an illness or condition that made me change the kind or amount of food I eat. Add up the circled numbers to get your nutritional score. Recheck your nutritional score in six months. Recheck your nutritional score in three months. Talk with any of these professionals about the problems you may have.
Ask for help to improve your nutritional status. Adapted with permission from The clinical and cost-effectiveness of medical nutrition therapies: evidence and estimates of potential medical savings from the use of selected nutritional intervention. June The most common causes of vision impairment in older persons include presbyopia, glaucoma, diabetic retinopathy, cataracts, and age-related macular degeneration. Additionally, the task force advised that patients at high risk of glaucoma, including black persons and those with a positive family history, diabetes, or severe myopia, undergo periodic assessment by an ophthalmologist.
Presbycusis is the third most common chronic condition in older Americans, after hypertension and arthritis. The whispered voice test is performed by standing approximately 3 ft behind the patient and whispering a series of letters and numbers after exhaling to assure a quiet whisper.
Failure to repeat most of the letters and numbers indicates hearing impairment. Additionally, patients' medications should be examined for potentially ototoxic drugs. Patients with chronic otitis media or sudden hearing loss, or who fail any screening tests should be referred to an otolaryngologist. Does a hearing problem cause you to feel frustrated when talking to members of your family?
Does a hearing problem cause you difficulty when visiting friends, relatives, or neighbors? Does a hearing problem cause you to attend religious services less often than you would like? Does a hearing problem cause you difficulty when listening to the television or radio? Do you feel that any difficulty with your hearing limits or hampers your personal or social life? Does a hearing problem cause you difficulty when in a restaurant with relatives or friends? Raw score sum of the points assigned to each of the items.
Identification of elderly people with hearing problems. Urinary incontinence, the unintentional leakage of urine, affects approximately 15 million persons in the United States, most of whom are older. Psychosocial implications of incontinence include loss of self-esteem, restriction of social and sexual activities, and depression. Additionally, incontinence is often a key deciding factor for nursing home placement.
Impaired balance in older persons often manifests as falls and fall-related injuries. Approximately one-third of community-living older persons fall at least once per year, with many falling multiple times.
The Tinetti Balance and Gait Evaluation is a useful tool to assess a patient's fall risk. This entire process should take less than 16 seconds.
Those patients who have difficulty performing this test have an increased risk of falling and need further evaluation. Older persons can decrease their fall risk with exercise, physical therapy, a home hazard assessment, and withdrawal of psychotropic medications. Guidelines addressing fall prevention in older persons living in nursing homes have been published by the American Medical Directors Association and the American Geriatrics Society.
Osteoporosis may result in low-impact or spontaneous fragility fractures, which can lead to a fall. Polypharmacy, which is the use of multiple medications or the administration of more medications than clinically indicated, is common in older persons. Among older adults, 30 percent of hospital admissions and many preventable problems, such as falls and confusion, are believed to be related to adverse drug effects.
Early diagnosis of dementia allows patients timely access to medications and helps families to make preparations for the future.
It can also help in the management of other symptoms that often accompany the early stages of dementia, such as depression and irritability. As few as 50 percent of dementia cases are diagnosed by physicians. Step 1. Step 2. Ask the patient to draw a simple clock set to 10 minutes after eleven o'clock A correct response is drawing of a circle with the numbers placed in approximately the correct positions, with the hands pointing to the 11 and 2.
Step 3. Ask the patient to recall the three words from Step 1. One point is given for each item that is recalled correctly. Adapted with permission from Ebell MH. Brief screening instruments for dementia in primary care. Am Fam Physician. According to the U. Census Bureau, approximately 70 percent of noninstitutionalized adults 65 years and older live with their spouses or extended family, and 30 percent live alone.
Although options for housing for older persons vary widely, there are three basic types: private homes in the community, assisted living residences, and skilled nursing facilities e. Factors affecting the patient's socioenvironmental circumstances include their social interaction network, available support resources, special needs, and environmental safety. As assessment data are obtained, they need to be recorded to allow all members of the health care team to easily access the information.
The family physician can generate a problem list that includes any condition or event requiring new or ongoing care; the medical, nutritional, functional, and social implications; and proposed interventions. This type of assessment allows older patients to benefit from an interdisciplinary team that is effectively assessing and actively managing their health care.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. He is also medical director at several long-term care and hospice facilities in Dallas. KIM E. Wheatland Rd. Reprints are not available from the authors. Xakellis GC. Who provides care to Medicare beneficiaries and what settings do they use?
J Am Board Fam Pract. American Academy of Family Physicians. Facts about family medicine. Accessed May 3, Department of Health and Human Services; The importance of geriatrics to family medicine: a position paper by the Group on Geriatric Education of the Society of Teachers of Family Medicine.
Fam Med. Diagnosis and treatment of Alzheimer disease and related disorders. Knopman DS. The initial recognition and diagnosis of dementia. Am J Med. Landefeld CS. Improving health care for older persons. Ann Intern Med. American Geriatrics Society Ethics Committee.
Health screening decisions for older adults: AGS position paper. J Am Geriatr Soc. Cancer screening in elderly patients: a framework for individualized decision making.
Basic nutrition for successful aging: part II. Clin Geriatr. The clinical and cost-effectiveness of medical nutrition therapies: evidence and estimates of potential medical savings from the use of selected nutritional intervention. The geriatric patient: a systematic approach to maintaining health [published correction appears in Am Fam Physician. Preventive Services Task Force. Baltimore, Md. Periodic health examination, update: 3. Screening for visual problems among elderly patients.
Prevalence of hearing loss in older adults in Beaver Dam, Wisconsin. The Epidemiology of Hearing Loss Study. Am J Epidemiol. Screening for hearing impairment in older adults. In: Guide to Clinical Preventive Services. Washington, DC: U. As we age, living alone becomes increasingly difficult, and often becomes worrisome for everyone involved. Fill in the blanks, and email the document back to us at [email protected].
We will email you back personally with the best senior home care service providers in your area, who offer the right services for your senior loved one or, for yourself! When it comes to senior care, the most effective approach is to have an accurate picture of what areas are lacking, and would therefore benefit from home care assistance.
Also known as an in-home care assessment, these evaluations are essential prior to hiring home care services for seniors. A senior care needs assessment should be performed before determining the best plan of action. Based on interviews, below are two most commonly used standardized assessments that practitioners use for Rebuilding Together:. Description: Using interview and observation of client participating in activity, assesses 75 items around the home divided into 12 categories; level of safety risk is rated on a 4-point 0—3 scale Asher, Purpose: Measures in-home activity performance and change in fit of the older adult and his or her environment before and after home modification interventions.
Web-based training can be arranged to learn how to conduct and interpret the I-HOPE, how to customize the assessment for Rebuilding Together homes, and how to develop treatment plans in accordance with Rebuilding Together funding and procedures. Contact the Stark Lab at peplab wustl. Asher, I. Chiu, T. Letts, L. Fisher, G. Cougar Home Safety Assessment- Version 4. Misericordia University, Dallas, PA. Law, M. The Canadian Occupational Performance Measure 4th ed.
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