Human ageing is defined physiologically by the gradual constriction of each organ system's homeostatic reserve. This loss, known as homeostasis, is visible by the third decade and is steady and progressive, albeit the rate and amount of decline vary. Each organ system appears to deteriorate independently of changes in the other organ systems. In psychology, assessing a patient remains the same in all age groups. However, the evaluation and interpretation of clinical information techniques used in older patients differ from those used in younger patients.
The majority of the older population suffers from various ailments and substantial disabilities. They have a high level of medical intricacy and susceptibility. The symptoms are unusual and cryptic, and many suffer from significant cognitive, emotional, and functional issues. Health practitioners require an extensive array of clinically relevant knowledge to cope with the exceedingly challenging healthcare concerns related to the elderly. The geriatric assessment in the home will assist you in doing a complete examination in which the many difficulties of older people may be analysed, and the persons' resources and strengths are recorded. It is necessary to analyse the demand for health services and create a thorough plan for focusing on solutions for the elderly's problems.
The comprehensive geriatric assessment generally includes evaluation of the patient in several domains. These have been divided into
A significant component of the complete geriatric evaluation is functional assessment, which focuses on the patient's capacity to conduct activities of daily life. In this chapter, you will learn about the components of the complete geriatric evaluation, the methodology, and how to do it. The elderly's physical evaluation includes obtaining their history and counting their symptoms. This examination aims to discover illnesses and conditions that can be effectively controlled or cured. Some of these may be managed to enhance the functional condition of the elderly
Taking a Geriatric History − Because of the various illnesses, differences in presentation, and features of an aged person, the history taking and examination of a geriatric patient varies significantly from those of a younger person. Elderly patients may require more time to interview and evaluate than younger ones. The elderly may appear with various vague symptoms, making it difficult to concentrate on the interview. Sensory limitations (such as hearing or vision loss), frequent among the elderly, can significantly impede the interview process. Elderly individuals may underreport symptoms (e.g., dyspnea, hearing or vision loss, memory issues, incontinence, gait disruption, constipation, dizziness, and falls) that they believe are regular with age. No symptom, however, should be attributed to natural ageing. Due to cognitive deterioration, older people may have trouble recalling all previous diseases, hospitalisations, procedures, and drug usage; you may need to gather this information from another source (e.g. family member or medical records). The patient's principal complaint may differ from what the family considers to be the main issue.
Past Medical History − One must take a brief medical history. However, this topic must focus on the aim of your visit. Inquire about diseases the old may have had in the past (e.g., rheumatic fever, poliomyelitis) and chronic ailments that he may still have, such as hypertension, diabetes, and so on. A history of vaccines (e.g., tetanus, influenza, pneumococcus), adverse immunisation responses, and TB skin test results must be collected. Inquire about any serious illnesses, surgery, hospitalisation, or transfusions. Surgical records can be obtained if the patient remembers having surgery but cannot recollect the operation or its purpose.
Drug History − Keep a record of your drug history. Determine which pharmaceuticals are used, at what dosage, how frequently they are used, who prescribed them, and why. Topical medications must be mentioned; for example, glaucoma eyedrops are systemically absorbed, generating cardiovascular, pulmonary, or central nervous system effects that may equal IV doses. Over-the-counter medications must be included since excessive usage might have dangerous implications (e.g. constipation from laxative use, salicylism from aspirin use). Any medication allergies should be thoroughly investigated. It is a good idea to request that the patient or family members bring in all pills, ointments, or liquids from the patient's medication cabinet. Mental state, sensory/deficit (vision), financial condition, health beliefs and attitudes, and caregiver's attitude are all examples.
Nutritional History − Determine the number of hot meals he may be consuming. The availability of cooking facilities or the caregiver's meal preparation is critical. The amount of money the elderly must spend on meals is also increasing. The use of alcohol, fibre, and over-the-counter vitamins should be investigated. Try to evaluate any observable (clothing loss) or documented weight changes. Inquire about hunger and eating habits as well. Reduced taste or odour may reduce the enjoyment of eating, causing the patient to eat less. Identifying chewing, swallowing, or digesting issues is also critical. Many elderly persons might require or use dentures. Determine any issues that have arisen as a result of their utilisation.
Psychiatric History − Psychiatric issues in elderly adults may be more challenging to identify than in younger patients. Insomnia, alterations in sleep patterns, constipation, impaired cognition, anorexia, weight loss, exhaustion, obsession with physiological functions, and increased alcohol intake are all prevalent symptoms. as well as a physical ailment. Please inquire about the patient's delusions and hallucinations, as well as his or her previous psychiatric care, such as psychotherapy, hospitalisation, electroconvulsive therapy, and the use of psychoactive medicines or antidepressants. Sadness, despair, and weeping fits can all be symptoms of depression. Many factors can lead to depression, including the recent death of a loved one, pets, and hearing loss. There are several approved screening measures for depression, but a two-question instrument is just as valuable. The primary affective symptom might be irritability.
Family History − Inquire about any family history or later-life problems known to have hereditary patterns (e.g., Alzheimer's disease, cancer, diabetes). In family members, the age of onset is indicated.
Physical Examination − Make the older adult feel at ease before the exam. You examine the patient on a rough bed. A portion of the examination may be more pleasant if the patient sits. During the examination, the patient may like to have a relative present. Examine the patient's hygiene to see how well he or she is functioning. Describe the patient's overall look (e.g., relaxed, restless, starved, drowsy, pale, dyspneic, cyanotic).
The functional evaluation of the elderly is a critical component of assessing the elderly in the home. Several fundamental tasks are required for human survival with autonomy and freedom. These activities, known as activities of daily living (ADL), are not affected by gender, education, socioeconomic situation, or culture. Feeding, continence, toileting, bathing, dressing, and transferring are some activities. Inquire about self-care, hygiene, and housekeeping skills. Patients unable to execute these tasks or acquire enough nourishment typically require carer assistance 12 to 24 hours per day.
Behavioural and social activities, which demand more cognitive and judgement than physical activities, are also components of functional well-being. Meal preparation, shopping, light housework, financial administration, prescription management, transportation, and telephone usage are instrumental activities of daily living (IADL). IADLs are activities that allow someone to live independently in their own home or apartment.
Many elderly persons use and utilise assistive technology to improve their functioning capacity. Typical assistive devices include spectacles, hearing aids, dentures, and walking aids. However, the utilisation of assistance is influenced by affordability, the patient's and caregiver's attitude, and awareness. Deficits in ADLs and IADLs imply that further information about the patient's socio-environmental status is required. When an aged person needs assistance with these activities, their risk of becoming more reliant increases. Direct observation of the patient in the house or a simulated homelike setting by family or health professionals is the most accurate way to assess functional status (ADL and IADL). However, standardised questionnaires or self-reports can provide surprisingly accurate information.
Factors influencing a patient's social surroundings are complicated to define. They include the social contact network, social support resources accessible, and specific requirements. Identifying current and future carers and rating their competency, willingness to provide care, and acceptability to the older person are all part of evaluating the social support network. This information can be gathered through questionnaires, interviews, or other means. The level of carer stress and the caregiver's support network is also considered. Evaluate the older adult's financial resources, determine their access to medical and personal care, and impact possibilities for living arrangements.
The majority of older people have various illnesses and ailments. They may avoid visiting a health centre for various physical and social reasons. As a result, it is critical to pay home visits to the elderly. A comprehensive history and examination are required to uncover any illnesses that may necessitate medical intervention.
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