• Age Discrimination –it goes
 IMPORTANT FACTORS in
understanding Geriatric Population
1. Societal attitudes and beliefs
 As a group, older adults in our
society are stereotyped.
 Aging-is a natural process, but
the changes associated with it
are rarely viewed as natural or
positive.
 Health care professional
commonly described it as a
"LOSSES" such as floss of fissue
elasticity or a decrease in blood
flow.)
 General, our society regards
aging as:
• a series of inevitable,
negative events that a
person must tolerate.
• Health care professional
often mentioned age
related changes and
disease conditions in the
same breath.
 Some myths, misconceptions, &
negative stereotypes about older
people stem from our culture's
values and beliefs.
 Many people perceived older
adults as senile, sick, and
incapable of making worthwhile
contributions to society.
2. Fear of Aging
 Most people don’t know enough about
the realities of aging; they fear death
and, therefore, fear of growing older.
 GERONTOPHOBIA  -refers to this fear
& the refusal to accept older people into
the mainstream of society.
 2 extreme forms of Gerontophobia
• Ageism- the negative
stereotyping of aging and older  (note: not all individuals of the same
       persons, I a belief that aging
makes people  level.)
       unattractive, unintelligent, and
unproductive, it’s  of the older population.
      an emotional prejudice.
beyond emotion; it’s the 
o practice of treating people
differently simply because 
o of their age. (eg. Hiring,
limited amount of health
care 
o provided.)
What is aging?
 The word “aging and old
age are highly subjective. 
 It is defined as having lived
for a long time and is
commonly synonymous with
negative terms, such as
“ancient”, “antiquated”, and
“timeworn”.
 Its process is complex: it
can be described :
 Chronologically
 Physiologically
 and functionally.
CHRONOLOGICAL AGE
-refers to the number of years a
person has lived.
- age 65 became the maximum
age of eligibility for
retirement benefits
-65 is the accepted age for
status as a senior citizen
- THERE 3 CHRONOLOGICAL
CATEGORIES
Young- old (age 65 to 74)
Middle-old (age 75 to 84)
Old-old (ages 85 and older)
PHYSIOLOGIC AGE
-refers to the determination of
age by body function.
 
FUNCTIONAL AGE
-refers to a person’s   ability to
contribute to society and
benefit others  and himself.
- those who require help are
called – FRAIL ELDERLY
 
chronological age function at the same
-age 75 is the fastest growing segment
-age 75to 84 – about 25% need help
with ADL
-age 85 and older – nearly ½ need help
with ADL.
 
@ CHARACTERISTIC COMMON TO
THE FRAIL ELDERLY
 Poor mental and physical health
 Low socioeconomic status
 Female gender (predominantly)
 Isolated living conditions
(possibly)
 More & longer hospital stays with
more money spent on health care
& drugs
 More frequent visit to the doctors
 More use of nursing home beds
than hospital beds.
 
  THEORIES OF AGING
BIOLOGICAL THEORIES
1.CROSS-LINK THEORY
- Strong chemical bonding between
organic molecules in the body causes
increase stiffness, chemical
instability, and insolubility of
connective tissues deoxyribonucleic acid
• SOURCES
-Lipids, proteins,
carbohydrates, and nucleic acid.
• RETARDANTS
-Restricting calories
and lathyrogens (anti-link agents)
2. FREE RADICAL-THEORY
-Increased unstable free radical
produced harmful to biological system,
such as chromosomal
changes, payment to accumulation
• SOURCES
-Environmental
pollutants, oxidation of dietary
fat, protein, carbohydrates.
• RETARDANTS
-Improving
environmental monitoring;
decreasing of free- radical
stimulating foods; increase intake
of vitamin of A & C
Mecarplans and vitamin E
3. IMMUNOLOGIC THEORY
-An aging immune system is less able to
distinguish body cells from foreign
cells; as a result, it begins to attack and
destroy body cells as if they were
foreign. This may explain the adult onset
of such conditions as diabetes mellitus,
rheumatic heart disease, and
arthritis. Theorists have
speculated about several erratic
cellular mechanisms capable
of precipitating attack on various tissues
through auto aggression
or immunodeficiencies
• SOURCES
-Alteration of B and T cells of the
humoral ad cellular system.
• RETARDANTS
-Considering and immuno-
engineering-selective alteration
replenishment or rejuvenation of
the immune system.
4.WEAR AND TEAR THEORY
 -Body cells, structures, and functions
wear out or are overused through
exposure to internal and
external stressors. Effects from residual
damage accumulate, the body can
longer resist stress and death occurs.
• SOURCES
-Repeat injury or
overuse; internal and external
stressors (Physical,
Psychological, social, and
environmental, including trauma,
chemicals, and buildup of
naturally occurring wastes
• RETARDANTS
-Reevaluating and
possibly adjusting lifestyle
A. PSYCHOSOCIAL THEORIES
1.ACTIVITY THEORY
- Successful aging and
life satisfaction depend
on maintaining a high level
of activity.
• SOURCES
 -Quality and meaningfulness over
quantity of activities;
life satisfaction related
to involvement in life.
• RETARDANTS
-Increasing activities in other
areas when activities in one
area decrease.
2. CONTINUITY THEORY
- An individual remains essentially the
same, despite life changes. This
theory focuses more on personality and
individual behavior over time.
• SOURCES
-Assumed stability of
individual patterns or orientation
over time.
• RETARDANTS
-Taking into account the
impact major societal changes,
which can alter individual
expectations and behavior.
3. DISENGAGEMENT THEORY
- Progressive social disengagement
occurs with age.
• SOURCES
-Decrease participation in society
resulting from age-
related changes in
health, energy, income,
and social roles.
• RETARDANTS
-Taking into account diversity of
individual outlook and lifestyle
and social structure variables,
such as economy and
social organizations.
4. SOCIAL EXCHANGE THEORY
-Social behavior involves doing
what’s valued and rewarded by society.
• SOURCES
-Diminished resources and
increase dependency leading
to unequal contribution to society
and reduced power and
value; decreased number of roles
available in society.
• RETARDANTS
-Assuming new roles
and friendship with other older
adults to help socialize the
person and help the person
adjust to age-related norms.
BIOLOGICAL THEORIES
Attempt to explain physical aging as
an involuntary process, which eventually
leads to cumulative changes in cells,
tissues, and fluids. 
• Intrinsic biological
theory maintains that aging
changes arise from
internal, predetermined causes. 
• Extrinsic biological
theory maintains that
environmental factors leads to
structural alterations which, in
turn, cause degenerative
changes.
PSYCHOLOGICAL THEORIES
Attempts to explain age-related
changes in cognitive function, such as
intelligence, memory, learning, and
problem solving.
SOCIOLOGIC THEORIES
-Attempts to explain changes that
affects socialization and life satisfaction.
It maintains that a social expectation
change, people assume new roles,
which leads to changes in identity.
DEVELOPEMENTAL THEORIES
-Describe specific life stages and
tasks associated with each stage
Physiologic Changes of Aging
1) Aging is characterized by the loss
of some body cells and
related metabolism in other cells.
 This process results in a decline
in bodily function and changes in
body composition.  •
2) It’s important for you to recognize
the gradual changes in body
function that normally accompany
aging so that you can adjust your
assessment techniques
accordingly.
3) It’s equally important for you to
recognize that even laboratory
test values will change to reflect
the aging process.
4) Values considered abnormal in
younger adults may be normal in
older adults. Understanding the
normal aging process can help
you understand why a person’s
risk of developing certain disease
and sustaining injuries increase
over time.
NUTRITION
-A person’s protein, vitamin, and mineral
requirements usually remain the
same as he/she ages, but caloric need
decrease. Diminished activity may
lower energy requirements by about;
MEN & WOMEN - 200 Calories /day
ages 51 to 75
Men - 500 Calories/day age over 75    in   the family
Women - 400 calories/day age over 75
Other physiologic changes that can
affect nutrition in an older patient.
• Decrease renal function an,
causing greater susceptibility to
dehydration and formation of
renal calculi
• Loss of calcium and nitrogen
(patient isn’t ambulatory)
• Diminished enzyme activity and
gastric secretions
• Reduced pepsin and hydrochloric
acid secretions, which tends to
diminish the absorption of
calcium and vitamins B1 and B2.
• Decrease salivary flow and
diminish sense of taste which
may reduce the person’s appetite
and increase his consumption of
sweet, salty, and spicy foods.
• Diminished intestinal motility and
peristalsis of the large intestine
Thinning of tooth enamel, causing
teeth to become more brittle
• Decrease biting force
• Diminish gag reflex. 
Some common condition found in
older people can affect nutritional
status:
1) Limiting patient’s mobility
2) Diminished intestinal motility -
may cause GI disorders
like constipation &
fecal incontinence
3) Suffer constipation – cause
by nutritionally inadequate diet
of soft, refined foods low
in dietary fiber, physical
inactivity, emotional stress or
certain medications.
4) Laxative abuse -cause
rapid transport of food through
GI tract, decreasing digestion and
absorption.
Socioeconomic & psychological
factors that affect nutritional status:
1) Loneliness
2) Decline of role & importance
3) Lack of money
4) Transportation to buy
nutritious foods.
ILLNESS AND INJURY: WHY THE
RISK INCREASE WITH AGE
• Decreased cerebral blood flow
increases the risk of stroke.
• An older person’s spinal cord is
tightly encased in vertebrae that may
studded with bony spurs or shrunken
around the cord. Even minor fall can
cause sever cord damage.
• In older women, osteoporosis cause
compression fractures even without
a history of trauma
• Brittle bones make an older person
especially prone to fractures. Falling
on an outstretched arm or hand or
experiencing a direct blow to the arm
 or shoulder and is likely to fracture
the shoulder or humerus.
• Diminished heart rate and stroke
volume place an older person at risk
for developing heart failure,
hypertensive crisis, arterial
occlusion, and myocardial infarction.
• Weakened chest musculature re
person’s reduces an older ability to
clear lung secretions and increase
high risk of developing pneumonia,
tuberculosis, and other respiratory
diseases.
• In older men, prostatic hypertrophy is
a common cause of urinary
tract obstruction and acute urine
retention.
• A weakened immune system
increases an older debilitated
person’s risk of Acquiring almost any
infection to which he’s exposed.
DIFFERENT BODY SYSTEMS
INVOLVE IN THE PROCESS OF
CHANGES
Age related adjustment and
transitions
The aging process is accompanied by
role changes and transitions:
Factors;
• Family role
• Age, sex, beliefs, attitudes,
income, health, and past
experience
• Culture (illness,
dependence/interdependence,
roles changes, losses an death
in a context that’s unique to
their culture)
• ROLE CHANGES - depends on
the situation where in and
varies.
• RETIREMENT
• MULTIPLE LOSSES
• LONELINESS
• DEPRESSION AND SUICIDE
• thin, by age 70  it’s baby fine
Clinical Alert!
• Suicidal rate in older adult men is
seven times that of women, an is
rarely an impulsive act, most
suicide attempts aren’t gestures
or threats
Risk factors include;
• Alcoholism
• Bereavement
• Loss of health, loss of role
• Living alone
• And children who have married
and moved away.
LESSON 1B: BODY SYSTEMS /
DIFFERENT BODY ORGAN
A. Integumentary System
SKIN, HAIR & NAILS              
S/symptoms:
SKIN- Facial lines around the
eyes (crow’s feet), mouth, & nose
resulting in subcutaneous fat
loss.
Dermal thinning, decrease
collagen & elastin & a 50%
decline in cell replacement –
resulting slow healing of wounds
which is more susceptible to
infection.
Women’s skin shows sign of
aging about 10 yrs earlier than
men because it’s thinner & drier.
Loss of elasticity to the point
where it may seem almost
transparent.
The supra clavicular and axillary
regions, the knuckles and the
hand tendons and vessels are
more prominent, as are fat pads
over bony prominence.
Mucous membranes become dry
Decrease output of sweet glands
due to decline number of active
sweet glands.
 Body temperature is more
difficult to regulate..
The appearance of (senile
lentigo) brown spots on the skin,
specially in areas exposed to the
sun.
HAIR-hair pigment decrease with
age, it may turn to gray/ white,
again.
Pubic hair loss due to hormonal
changes
 Facial hair increases in
postmenopausal women and
decrease in aging men.
grow at different rates,
longitudinal ridges, flaking,
brittleness and malformation may
increase.
NAILS - grow at different rates,
longitudinal ridges, flaking,
brittleness and malformation may
increase.
Discoloration of toenails
OTHER COMMON HYPERPLASTIC
SKIN CONDITION  in elderly;
 Senile keratosis- refers to dry,
harsh skin) and
 Senile angioma – refers to a
benign tumor of dilated
blood vessels caused by
weakened capillary walls.
B. Eye and Vision
Eye structure and visual acuity
changes with age.
Sign/ Symptoms:
The eye sit deeper sockets, the
eyelids lose their elasticity- becoming
baggy and wrinkled.
Conjunctiva become thinner and
yellow retina
Older adults need about 3x  as much
light as a younger person to see
objects clearly.
Diminishes night vision and
depth perception.
Sclerae become thick and rigid and
fat deposits cause yellowing
Vitreous degenerate over the time
causing opacities and
floating vitreous debris and can also
detach retina.
Through ophthalmoscope-the
vitreous detach from the area of
the optic disk looks like a dark ring in
front of the disk.
Lens enlarges and
loses transparency
Accommodation decreases because
of impaired lens
elasticity (PRESBYOPIA)
Impaired color vision specially in the
color blue and green ranges- due to
cones in the retina deteriorate.
There is decrease reabsorption of
intraocular fluid which predisposes
them to glaucoma.
C. Auditory System
EARS AND HEARING
S/symptoms:
 Loses some degree of hearing –due
to…
These are called as…
PRESBYCUSIS / SENILE
DEAFNESS.  This is irreversible,
bilateral, sensorineural hearing loss
usually starts during middle age,
slowly worsens and affects men
more than women.
PRESBYCUSIS appear in 4 forms
Sensory Presbycusis- it is the most
common form. It is caused
by atrophy of the organ of Corti
The accompanying hearing loss
occurs mostly in the high
pitch ranges. 
Age 60, most adults have difficulty
hearing above 4,000 Hz
(the normal range for speech
recognition is 500 to 2,000Hz)
The older adults can’t easily
distinguish the high –
pitched consonants- s, z, t, f, & g.
D. Respiratory System
Age-related anatomic changes in the
upper airways Includes:
Nose enlargement from continued
cartilage growth
General atrophy of the tonsils
Tracheal deviations from changes in
the aging spine
 Thoracic changes increased
anteroposterior chest diameter, as a
result of altered calcium metabolism,
and calcification of costal cartilages
which reduces mobility of the chest
wall.
KYPHOSIS advances with age
because of such factors as
osteoporosis and
vertebral collapse.
Diminishes ventilatory capacity for
the following reasons: 1. Lungs
diffusing capacity declines
Decreases Inspiratory and expiratory
muscle strength diminishes vital
capacity
2. Lung tissue degeneration causes a
decrease in the lung's volume. thus
aging alone can cause EMPHYSEMA.
Closing of some airways causing
poor ventilation of the basal areas,
resulting in both a decreased surface
area for gas exchange and reduced
partial pressure of oxygen (PO2)
Normal partial pressure of a
capacity, arterial oxygen (PaO2)
decreases to 70 to 85 mm Hg.
Oxygen saturation decrease by 5%.
Lung becomes more rigid, and the
number and size f alveoli decline
with age.
A30% reduction in respiratory fluids
heightens the risk of pulmonary
infection and mucus plugs.
Maximum breathing capacity, forced
vital capacity, vital capacity, and
inspiratory reserve volume
diminished with age. leaving the
patient with lowered tolerance for
oxygen debt.
E. Cardiovascular system
Heart usually becomes slightly
smaller and loses its
contractile strength and
efficiency.
(Exceptions occur with people
with hypertension or
heart disease.)
By age 70, cardiac output at rest
diminished by about 30% to 35%
in many people.
Fibrotic and sclerotic changes
thicken heart valves and reduce
flexibility, leading to rigidity and
incomplete closure of the heart
valves, which may result in
systolic murmurs.
Thickness of the left ventricular
wall increase by 25% between
age 30 and 80
Develop obstructive coronary
disease and fibrosis of the
cardiac skeleton.
Hearts become irritable, extra
systoles may occur, along with
sinus arrythmias and sinus
bradycardias.
Increase fibrous tissue infiltrates
the sinoatrial node and internodal
atrial tracts, which may cause
atrial fibrillation and flutter.
Vein dilates and stretch
Coronary artery blood flow
decreases by 35 % between age
20 and 60.
Aorta becomes more rigid,
causing systolic blood pressure to
rise disproportionately higher
than the diastolic, resulting in a
widened pulse pressure.
ECG (electrocardiogram)changes
include increase PR, QRS, and
QT intervals
Decrease amplitude of the QRS
complex, and shift of the QRS
axis to the left.
Decrease ability to respond to
physical and emotional stress. 
Heart rate takes longer to return
to normal after exercise.
Arterial and venous insufficiency
as the strength and elasticity of
blood vessel decrease.
 
This contributes older people increased
incidence of cardiovascular disease,
particularly coronary disease.
F. Gastrointestinal System
Aging are usually less debilitating to
the GI system than the other system.
This include the ff:
Diminished mucosal elasticity and
reduced GI secretions, which in turn
modify same process like digestion
and absorption.
Decrease in GI tract motility, bowel
wall and anal sphincter tone &
abdominal muscle strength- may
cause complaints in ranging from
loss of appetite to constipation that
may increase too as related to use of
multiple medications-common to
older people.
Decrease in liver weight, reduced
regenerative capacity
Decreased blood flow to the liver-
because hepatic enzymes involved
in oxidation and reduction markedly
decline with age.
Liver metabolizes drugs and
detoxifies substances becomes
less efficient.
G. Renal System
Renal function diminishes after age
40. If the person lives to age 90
it may have decreased by as much
as 50% - this due to the decline in
the glomerular filtration rate.
Decrease renal blood flow by 53%
from reduced cardiac output
and age-related atherosclerotic
changes.
Bladder muscles weaken- may
results in incomplete bladder
emptying
Chronic urine retention- predisposing
the bladder to infection.
Diminished kidney size
Impaired renal clearance of drugs
Reduced bladder size and capacity
Decreased renal ability to respond to
variations in sodium intake
By age 70, blood urea nitrogen levels
rise by 21%
Residual urine, frequency and
nocturia also increase with age.
H. Male Reproductive system
Reduced testosterone production
– which in turn may cause the ff:
decrease in libido, testes become
atrophy, soften&
decreases sperm production by
48 % to 67% between age 60 and
80.
Prostate glands enlarge with age
and its secretion diminish.
Decrease in seminal fluid, volume
and less viscous.
I. Female reproductive system
Declining estrogen and progesterone
levels cause a number of physical
changes.
o It includes emotional &
physical changes
o Transition from childbearing
years to infertility.
o As estrogen level decrease,
menopausal
period approaches about age
50.
OVARIES
-Ovulation usually stops 1 to 2 years
before menopause.
-They become unresponsive to
gonadotropic simulation.
-Ovaries become atrophy, thicker
and smaller.
VULVA
o The vulva atrophies with age.
o Pubic hair loss and flattening
of labia majora
o vulva tissue shrinks- thus
exposing the sensitive area
around the urethra and
o vagina to abrasions and
irritation (e.g. Undergarments)
o introitus constricts
o tissues lose their elasticity and
epidermis thin from 20 layers
to about 5.
VAGINA
o -The vagina shortens and the
mucous lining to become thin,
dry, less elastic
o and pale as a results of decrease
vascularity – due to atrophy.
o -susceptible to abrasion
o -pH of vaginal secretions
increase, making the vagina
environment moreAlkaline.
o -Flora changes causing increase
in vaginal infections.
UTERUS
o After menopause, the uterus
shrinks rapidly to one-half its
premenstrual weight
o to approximately one-fourth its
premenstrual size.
o -Atrophy of the cervix and no
longer produces mucus for
lubrication
-Endometrium and myometrium
become thinner
BREAST
o -Atrophy of glandular, supporting,
and fatty tissues
 o -Cooper’s ligament lose their
elasticity
o -Pendulous breast
o -decrease in nipple size and
becomes flat
o -Fibrocystic disease present at
menopause diminishes
o Inframammary ridges become
more pronounced.
PELVIC SUPPORT STRUCTURES
-(Relaxation of structures commonly
occurs among post reproductive women.
Initially occurs during labor &
delivery, but clinical effects go unnoticed
until the process accelerates with
menopausal estrogen depletion and loss
of connective elasticity and tone.)
Signs and Symptoms:
o Pressure and pulling in the area
above the inguinal ligaments
o Low backache
o A feeling of pelvic heaviness
o Difficulty in rising from a chair
o Urinary stress incontinence occurs -
if ureterovesical ligaments weaken.
J. Neurologic system
Neurons of the central and peripheral
nervous systems undergo
degenerative changes.
Nerve transmission slows down-
causing the older people to react
more slowly to external stimuli.
After about age 50, the number of
brain cells decreases at a rate of
about 1% per year.
(note: Clinical effects usually aren’t
noticeable until aging is considerably
more advanced)
Hypothalamus becomes less
effective at regulating body
temperature.
Cerebral cortex undergoes 20%
neuron loss
Corneal reflex becomes slower, and
the pain threshold increases
Experiences a decrease in stages III
and IV sleep- causing frequent
awakening; 
Rapid eye-movement sleep
decreases – results in increased
need for rest during the day.
K. Musculoskeletal system
Increase adipose tissue
Diminish lean mass and bone
mineral contents
Height decrease – may results in
exaggerated spinal curvatures
and narrowing intervertebral
spaces, which shorten the trunk
and make the arms appear
relatively long.
Decrease bone and muscle mass
causing muscle weakness 
And collagen formation causing
loss of resilience and elasticity
in joints and supporting structures
Synovial fluid more viscous and
synovial membranes become
more fibrotic
Difficulty in tandem walking
Walks in shorter steps and wider
leg stance to achieve
better balance and stable weight
distribution.
L. Immune system
Immune function starts declining at
sexual maturity and
continue declining with age.
Start to losing its ability to
differentiate between self
and nonself and the incidence of
autoimmune disease increase.
Also start losing its ability to
recognize and destroy mutant
cells, which probably accounts for
the increase in cancer among
older people.
Decrease antibody response, makes
older people susceptible to infection.
Tonsillar atrophy and
lymphadenopathy commonly occur.

LESSON 2: ASSESSMENT OF THE
OLDER ADULT
 Another thing is that, there are variables
that affects the assessment in older
adult the followings are:
1. Setting / place
2. Time
3. Energy level and the
environment.
4. Consent
5. Language or communications
deficits
6. Your very own Attitude
A. VARIABLE
1. Attitude
-Refers to your personal feelings &
prejudices/ biases towards the
patient.
2. Patient's Attitude
-Refers to the patient's own
perception or attitudes toward his/her
body and health.
3. Language
-Refers to the way how you
communicate. The language you use
when you assess an older patient
should be tailored/ fit to that individual.
Like the educational level, culture, and
the languages he/she may speak.
4. Deficits
- Refers to the problems/ deficits
(sensory, neurologic and
musculoskeletal) that might interfere
with accurate data collection such as
misinterpretation of a questions due to
hearing and vison impairments,
destructions due to discomfort or pain.
5. Consent
-Refers to when one person agrees
to or gives permission to another person
to do something.
- means agreeing to an action based
on your knowledge of what that action
involves, its likely consequences and
having the option of saying no. The
absence of no does not mean yes.
- is an essential element for all
patients to ask before doing anything
(like procedures) or something to agree
upon.
Elements of consent: what are they?
 The right to know why you’re
doing the assessment
 What procedure it involves.
 What kind of information you
need
 The right to refuse to answer
question or to participate in any
aspect of the assessment.
6. Time and Energy level
-Refers to the allotted time and
energy you give for your
assessment. Considering that there
some factors that might hinder or
interfere during assessment such
fatigue & discomfort of the patient ‘s
side.
7. Environment
-Refers to the place where you do
an assessment. It should
be comfortable, quiet and well-lit
most specially to the elderly patient.
A. Performing the HEALTH
ASSESSMENT
-A comprehensive health
assessment of an older adult involves
taking a thorough health history and
performing a complete physical
examination
 1. Obtaining the Health History
-The heath history and interview, is
the first phase of the health assessment,
provide a subjective account of the older
adult's present and past health status.
-Initiate relationship and establish the
patient's well-being as your primary
concern.
-Key areas of focus for physical
examination.
Preparing for the Interview
A. Timing
 – a plan to talk with older patients early
in the  day, when they likely to be most
alert.
“SUNDOWN SYNDROME “– a condition
by which the older people experience,
the capacity for clear thinking diminishes
by late afternoon or early evening. Or
even disoriented /confused later in the
day.
S/S of Sundown Syndrome during the
assessment
 Fatigue, sighing, grimacing
 Head & shoulder drooping
 Irritability, slouching
 Leaning against something for
support
-schedule additional times and
take advantage of other interactions
to elicit additional data & validate
known data
-clarify inconsistencies and possible
inaccuracies by assessing the patient
more than once and at different times of
the day.
B. Environment
 What to prepare?
 area that’s private, comfortable,
warm enough & draft free and ample
space for if the person uses assistive
devices.
 Avoid bright fluorescent lighting/
direct sunlight instead use diffused
lighting.
 Keep water /other fluids on hands
 Patients is closed to the bathroom
 Have comfortable chair available 
 Encourage to change position in the
chair and to move around as much
as he/she wants to during the
interview.
C. Deficits
 Problem of Vision
 If the wear glass make sure he
has them before the interview.
 Pull shades and block light from
the patient’s view
 Reduced visual acuity or
environmentally induced
blindness from bright lights, shiny
floors or direct sunlight – can
cause squinting /poor eye contact
to patient.
 Face the patient closely at eye
level.
 Hearing Impairment 
 Close the door in the room—this
minimizes noises of any sorts and
Destructions.
 Speak distinctively, clearly, slowly
and don’t shout- but in mellow
tone voice.
 Make sure the room is well- lit, so
the patient can read your lips
 If the patient wears hearing aid,
make sure it’s in place and
working properly.
 Repeat if necessary, during the
interview.

D. Communication
 Always address an older patient
appropriately (Mr./Mrs. followed 
 by the surname)
 As per recommendation used
body language, touch, shake 
 hand, and eye contact to
encourage participation.
 Talk to the person concerned and
not at him-unless otherwise 
 necessary or needs interpreter.
 Early in the interview try to
evaluate the patient’s ability and
reliability as a Historian. Unless
necessary to aid or to elicit more
information from the patient. For
this may hinder the patient to
speak freely.
  Provide carefully structured
questions to elicit significant
information.

E. Consent
 Initial contact should focus on
ensuring that patient knows the
assessment’s purpose and how
he can help during the history
taking-an impotent step in
establishing a
trusting relationship.  
2.   Performing the PHYSICAL  
ASSESSMENT
 The Physical examination is the
second component of the health
assessment.
 Together with the health history, it
helps you identify and evaluate
the patient’s strengths,
weaknesses, capabilities, and
limitations.
 Use inspection, palpation,
percussion, and
auscultation together objective
patient data, which provide
new information and help you
validate the subjective data you
obtained during the health
history.
Consider these things for older
adults:
Because they become easily fatigued
during P.E.
 Prepare all necessary
equipment within easy reach and
proper working order
 Anticipate the patient’s needs for
modifications and additional
comfort measures as necessary.
Keep the following points in mind:
 Respect the patient’s need for
modesty. As to patient’s privacy
during examination.
 Ensure patient’s comfort during
examination.
Anticipate any problems with mobility
/strength that might assistance from
another person.