Fn Aa ea ‘Areas of Emphasis When Conducting a Review of Systems with an Older Adult 1. How would do you <2 Constitutional + Changes inthe level of energy ge in vision, in hearing acuity, and in the stuations or complaints of others related to these «Increase in dental caries; changes in taste, bleeding gums, or level of curent dental care * Changes in smell Respiratory * Shortness of breath and, it so, under what circumstances ‘+ Frequency of respiratory problems * Need to sleep in chair or elevated on pillows Cardiac *+ Chest, shoulder, or jaw pain and under what circumstances * If already taking antianginal medication such as nitroghcerin, whether there is a need for more than usual dosage ‘* Sense of heart palpitations * fusing anticoagulants, and evidence of bruising or bleeding Vascular * Cramping of extremities, decreased sensation (see also neurological ‘edema, what time of the day and how much ** Change of color to the skin, especially increased pigment to the lower ‘extremities, cyanosis, or any other change in color Urinary ‘+ Changes in urine stream and for how long, ditficlty starting stream ‘* Incontinence and, it so, under what circumstances and degree Sexual ‘+ Desire and ability to continue physical sexual activity ‘© Ability to express other forms of intimacy © Changes with aging that may affect sexuality leg. vaginal dryness, erectile dysfunction) Musculoskelet «© Pain in joints, back, or muscles ‘+ Changes in gait and sense of safety in ambulation * 1 titfness is present, when isit the worst and is it relieved by activity? + limited, effect on day-to-day life Neurological ‘+ Changes in sensation, especialy in extremities ‘© Changes in memory other than very minimal ‘Absit to contiwe usual cognitive acttios ‘Changes in sense of balance or episodes of diziness History offal trips, sips Gastrointestinal ‘+ Continence, constipation, bloating, anorexia integument ‘Dryness, frequency of injury, and spved of healing a. Who a. Why has it hace b.What dt 5. What are the 6.Whet do you think will eit th receive and what are che most imonrart Tutt x a.if specific tests, medicanans: 7. Agart from me, wha aise dt you thine ar mae Are there therapies “rat make wou es in another diseiclire” Modified from Kleinman 3. an expleratan of ina Psychiatry Berkeley The mnemonic FAN. Nutrition, Communication". "ay, ‘ching, dryness, history of skin cancer Socialization. The gunde ..S*, (2008) im her work 382 penge, jospital i Asli. Nort « ayags myTIPS FOR BE: cas ae Considerations of Common Changes Specific to Late Life during the Physical Assesament [Height and Weight | + sorter for changes in mete |] * Sea one especity important the person hat any hear Saeae, te | for early sins cheat flue + (Me os beaten for exieaton of malas fom sera cana, de: presser. cancer Check for mouth leans from iting deveces, Thos > creased rate of maraity for rap weight ssn penne wid tomeres | Temperature + Evin alow grade eer could be an inseaton of» senna | wesasows 00 Cray neat peng aps ines Tongans | eco rss new Se pane tg tut | Sect crn pcan aa ne | sapphesteneug ttc ton 2 oe | Seseratnacy gates ene ee | sun | Sete ne ea eg re autos ee sy climates Due ong, ee wedcator of hydration status. Examine bruises. oe * AS a resut of ying cerumen,impactons ae comeren. These mu ‘moved before hearing can be adequately assessed, Hearing * Hh requney hearing loss presbycusis is common Wager tet oie iy The parson often complains that he or she can hear but ot urderare because sore. bute al sounds re lost such as consents, The person wth eve at \erecoppied hearng loss may be correct tous a have Sener, | | | | | | | Eves * Reduced pupillary responsiveness (mioss| Normal 4 equal bilaterally Gray "ng around the ii arcus seni) Sagging of le. Positon of ids * Increased glare sensitivity, decreased contrast sensitivity, and reed tor rare Sight to see and read. Ensure that waiting roams, hallways, 2rd exam txers ae adequately it * Decreased color discrimination may affect ability to set administer mesica ‘ons safely | | Mouth, | + Excessive dryness common and exacerbated by many medications. Carnat | 38e mouth moisture to estimate hydration status. Periodontal ease com- |__tmon Decreased sense of taste. Tooth surface abraded Neck + Because of loss of suextanecus fat it may appear that cacti arenes a2 laced when thay ae Chest + Any eycrons wil altar the location ofthe lobes, making careful assessment ‘nore mgertant Crackies i ower les may clear with cough ‘+ ak tor anpraton preuonia increased and therefore the importance ofthe iateral exam and measurement of oxygen Saturation. Heart * Listen carey for third and fourth heart sounds. Fourth heart sounds oreran. Ostermine i ths ha been found tobe present inthe pastoris new Up to 50% of persons have heant murmu Extremities * Darvals padis and posterior nial pulses very difcult or impossible palpate Must look for other indications of vascular integrity. Edema comenen Abdomen * Because of deposition of fat inthe abdomen, auscultation a bowel tnes may be aitheut Musculoskeletal * Ostesartes very common and pain often underteated. Ask about pain and fron n joes. Conduct very gentle passive range-a-mation exercises it ‘tive rage: of mation exercises nat possible. Do ot push past comfort level tsar for gat cisorders. Observe the person gat in and out of chair in order ‘a assets independent function and fall isk. Neurological * Although there is a gradual decrease in muscle strength. it stil should ‘sain equal laterally Greatly diminished or absent ankle jek (Achilles) ‘tendon refx is common and normal, Decreased ot absent vibratory sense ofthe lower extremities, testing unnecessary. Slowed reflexes. Coherence, ‘memory Verbal fuency should be intact. Genitourinary: Male * Fendulous scrotum with less rugae; smaller penis. thin and graying pie haie Genitourinary: Female * Seal to nonpalpable ovanes, shor, dryer vagina; decreased sizeof labia and (itor. sparse pubic haw Use utmost care with exam to avod trauma to the