History and Physical Examination of the Older Adult

Noel A. DeBacker, M.D., F.A.C.P.

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The history and physical examination is the foundation of the medical treatment plan. The interplay between the physiology of aging and pathologic conditions more common in the aged complicates and delays diagnosis and appropriate intervention, often with disastrous consequences. This chapter assumes that practitioners will perform the thorough history and physical examination that is expected of an excellent general internist. It highlights the special considerations required for the older adult.

History

General considerations

The history may take more time because of sensory or cognitive impairment or simply because an older patient has had time to accrue numerous details. Several sessions may be required.

The patient should be recognized as the primary source of information. If doubts arise about accuracy, other sources should be contacted with due respect paid to the sensitivities and confidentiality of the patient. When interviewing the patient and caregiver together, ask questions first to the patient, then to the caregiver.

If the patient's responses to initial questions are clearly inappropriate, turn to the mental status exam immediately.

The patient should be dressed and seated. The physician should also be seated and facing the patient at eye level, speaking clearly with good lip movement. If the patient is severely hearing impaired and an amplifier is not available, write questions in large print.

Use honorifics (i.e., Mr., Mrs., Miss, or Ms.) unless the patient specifically requests you to do otherwise.

Areas requiring special emphasis

Physical Examination

General considerations

Limit the time the patient is in the supine position as this may cause back pain for persons with osteoarthritis or kyphoscoliosis and shortness of breath for those with cardiopulmonary disease--having several pillows on hand for these patients will be greatly appreciated.

Multiple sessions may be required for a complete physical exam due to patient fatigue. While they are important, the rectal and pelvic exams may be deferred to a later session, if not urgently required.

Areas requiring special emphasis

When physicians have a high index of suspicion with knowledge of the subleties of physical assessment in the older adult, an adequate information base can guide timely intervention.




Copyright ©1999. Northwestern University. All Rights Reserved.
Edited by the Buehler Center on Aging, McGaw Medical Center.
For information regarding content contact:
James R. Webster, j-webster@northwestern.edu

Published electronically by the Galter Health Sciences Library.
For information regarding publication contact:
James Shedlock, j-shedlock@northwestern.edu

Last Updated: June 9, 1999