History-Taking from an Elderly Patient

Good history taking from an elderly patient is the foundation for geriatric assessment.
The purpose of geriatric assessment is to determine whether or not the patient is at risk
for imminent morbidity or mortality. The questions asked are unique to this age group;
often, more than one visit will be needed to attain all the information needed.
Injury Prevention:
Ask the patient about:
- Safety habits
o If they bike ride, do they wear a helmet?
o Are there smoke detectors/carbon monoxide detectors in the house?
o Do they have a good water heater?
- Fall Assessment:
o Certain medications are associated with an increased risk of falls in the
elderly:
▪ Antiarrhythmics – example: digoxin
▪ Antihistamines – Benadryl
▪ Antihypertensives
▪ Antipsychotics
▪ Diuretics
▪ Laxatives (patient is in a rush to use the bathroom, or may have
taken to many and is now dehydrated/hypotensive)
▪ Tricyclic antidepressants
o Osteoporosis
o External factors at home – slippery floors, no grab-bars or railings at the
stairs, too many rugs (these can cause the elderly person to trip)
o Mobility and Dexterity: this is more important in the physical exam of the
elderly patient
▪ The ability to stand on one leg for five seconds
▪ “Get up and GO” – patient is observed as he or she rises from a
sitting position, walks 3meters, turns, and returns to the chair to sit
o If you feel your patient may be at risk for falls, it is important to try and
educate the patient on ways to be careful.
▪ Example: if the patient is taking medications that may cause
orthostatic hypotension, tell the patient to rise from a
supine/sitting position slowly; advise the patient to use a cane or
walker
- Sensory Perception: changes in vision and hearing occur as patients age; regular
vision and hearing screening is recommended for patients 65 years of age and
older
o Vision:
▪ As the patient if he/she has noticed in changes in vision
▪ Ask about the last eye exam
▪ Remember: poor vision can also lead to an increased risk for falls
 ▪Is the patient at high risk for glaucoma? Risk factors include:
● Black patients over the age of 40 (white patients over 65)
● Diabetes mellitus
● Occular hypertension
● Family history of glaucoma
o Hearing:
▪ As the patient if he/she notices any change in hearing?
● Is it only difficulty in hearing, or is the patient having trouble
understanding words?
Nutrition: malnutrition and under-nutrition are common, yet frequently overlooked
problems, in the geriatric population. It is important to assess whether the patient is
receiving the proper nutrition as those with compromised nutritional states spend more
time in the hospital and can develop more complications
o Nutrition Health Screen – ask the patient these questions:
▪ Do you have any illness or condition that has caused you to change
the amount of food, or the type of food, that you eat?
▪ Do you eat less than 2 meals per day?
▪ Do you eat FEW fruits, vegetables, or milk products?
▪ Do you have more than 3 alcoholic beverages per day?
▪ Do you have any dental problems that limit your ability to eat?
▪ Do you have financial problems that limit your ability to buy food?
▪ Do you often eat alone?
▪ Are you physically able to shop for groceries and cook for yourself?
▪ Are you physically able to feed yourself?
▪ Without wanting to, have you noticed that you have lost or gained
5kg (10 pounds) in the past six months?
Immunizations: because elderly patients are more susceptible to infections, being up-to-
date on immunizations is one way to prevent illness
o It is recommended that an annual influenza vaccination in the fall is
recommended for all elderly patients
o Patients over 65 should also receive at least one pneumococcal
vaccination in their lifetime
o Tetanus-diphtheria toxoid should be given every 10 years
Sexuality:
o Ask the patient if he/she is still sexually active?
o How many partners?
o If it is a male patient, ask about erectile dysfunction
Continence:
o Do you ever lose urine when you don’t want to?
o Have you lost urine on at least 6 separate days?
 o Do you ever lose urine when you cough, exercise, lift, sneeze, or laugh?
o Are you drinking more water than usual? Could this account for your
frequent trips to the bathroom?
MENTAL STATUS:
- Cognition:
o Dementia is chronic and progressive → characterized by gradual onset of
impaired memory and deficits in TWO OR MORE AREAS OF
COGNISTION
o It is helpful to do a quick mini-mental status exam. Ask the patient the
following questions:
▪ What year is it?
▪ What season is it?
▪ What is today’s date?
▪ What country are we in?
▪ What city are we in?
▪ What is the name of this hospital?
▪ What floor are we on?
▪ Name three objects – take 1 second to say each. Then ask the
patient to repeat the name of all three objects
▪ Attenuation and calculation: 100 minus 7, minus 7, minus 7…
▪ Language: point to certain objects and ask the patient to name
them:
● Pen
● Watch
▪ Tell the patient to fold a piece of paper in half and put the paper on
the floor (this is to assess the ability to understand language)
- DEPRESSION: depression can significantly increase morbidity and mortality.
There is a GERIATRIC DEPRESSION SCALE that is used as a screening tool:
o Are you satisfied with your life?
o Have you dropped many of your activities and interests?
o Do you often get bored?
o Do you feel happy most of the time?
o Are you afraid that something bad is going to happen to you?
o Do you often feel helpless – that you cannot do something on your own?
o Do you prefer staying at home, instead of going out and doing things?
o Do you feel that your memory problems are worse than most?
o Do you feel energetic during the day or always fatigued?
SOCIAL ISSUES: remaining as independent as possible, for as long as possible, is a
primary concern for most elderly patients. The level of supportive assistance that is
needed can quickly be determined by asking the patient about his/her ACTIVITIES OF
DAILY LIVING (ADLs) and INSTRUMENTAL ACTIVITIES OF DAILY LIVING
(IADLs):
- Ask the patient if he/she can do the following activities on his own, with some
help, or completely unable to do the activity
o Use the telephone
o Go to places that are out of walking distance
o Go shopping for groceries
o Prepare your own meals
o Do your own housework
o Do your own laundry
o Take your medications on your own
o Manage money
CHECKLIST: