The

Elderly
Client

Assessment of Special Populations

 GENERAL ASSESSMENT
GUIDELINES
• Provide a room with a comfortable (warmer)
temperature, without air drafts and close to the rest
room.

• Conduct assessment in an area with ample space

to accommodate wheel chairs and other supportive
devices (e.g. cane, walker)

• Eliminate background noise as much as possible

(e.g. turning off television)
The Elderly Client
 GENERAL ASSESSMENT
GUIDELINES
• Introduce yourself. Wear a name tag since some
clients may soon forget your name.

• Begin by addressing the client as “Mr.,” “Mrs.” or

“Ms.” or with an appropriate title such as “Reverend”
or “Doctor.” Don’t address client by his/her first name
unless permitted to. Remember that it is better to be
more formal than informal.

The Elderly Client

 GENERAL ASSESSMENT
GUIDELINES
• Assess hearing acuity. Speak clearly & at
a moderate pace. Face the client when
speaking with him or her . Keep your voice
volume down even if you anticipate the
client has difficulty hearing.
• Avoid elderspeak (the manner of talking
to the client as if he/she is a baby or child).
The Elderly Client
 GENERAL ASSESSMENT
GUIDELINES
• Do not assume that the client cannot
answer questions if he or she has a cognitive
impairment.

• Collect no more information than is

absolutely necessary. Many older people
hesitate to give out personal information
(e.g. finances, personal likes & dislikes).
The Elderly Client
 GENERAL ASSESSMENT
GUIDELINES
• If you need to question caregivers or collateral
sources to validate or clarify information, avoid
consulting them in the presence of the client.

• Before the P.E., instruct to empty bladder. Assist as

needed in changing to exam gown.

• Be sensitive to the client’s need for privacy. Ask if he

or she wishes for a caregiver to remain in the room.

The Elderly Client

 GENERAL ASSESSMENT
GUIDELINES
• Give only one-step directions. Allow time to
respond to directions and change positions.

• Provide adequate rest periods.

• Limit the length of the examination. A

complete assessment may require several
sessions over a period of time.
The Elderly Client
FUNCTIONAL ASSESSMENT
TOOLS
1. Katz Activities of Daily Living
2. Lawton Scale for Instrumental
Activities of Daily Living (IADL)

The Elderly Client

 KATZ ACTIVITIES OF DAILY
LIVING (also refer to p. 816 of textbook)
• Bathing  1 point is given if client
performs the ADL independently
• Dressing or without supervision, direction
or personal assistance
• Toileting  0 point is given if client
• Transferring performs the ADL with
supervision, etc. or total care
• Continence  total pts.: 6 = high (patient
• Feeding independent); 0 = low (patient
very dependent)

The Elderly Client

 LAWTON SCALE FOR I.A.D.L.
(also refer to p. 817 of textbook)

• Ability to telephone • Mode of Transportation

• Shopping • Responsibility for Own
• Food preparation Medication
• Housekeeping • Ability to Handle
• Laundry Finances

 Certain points are given for each domain.

 The total score can range from 8 to 28. The lower
the score, the more the independence.
UNIT 4-B : The Elderly Client
PSYCHOSOCIAL ASSESSMENT
TOOLS
1. Geriatric Depression Scale
- (refer to p. 824 of textbook)
 Client is made to answer 30 questions with a yes
or no response
 Corresponding points are given for each number
 Total Score:
- 0 to 10 = within normal range
- 11 or higher = possible indication of
depression
The Elderly Client
PHYSICAL ASSESSMENT &
AGE-RELATED CHANGES
 PHYSICAL ASSESSMENT & AGE-
RELATED CHANGES
SKIN, HAIR and NAILS

Physical Assessment The Elderly Client

 Normal Variation:

LENTIGINES
 Hyperpigmentation in sun-exposed areas; appear as
brown, pigmented, round or rectangular patches
The Elderly Client Skin, Hair & Nail Assessment
Normal Variation:

VENOUS LAKES
 Vascular lesions on ears or other facial areas
due to dilation of small blood vessels
The Elderly Client Skin, Hair & Nail Assessment
Normal Variation:

CUTANEOUS TAGS/SKIN TAGS

 flesh-colored pedunculated lesions

The Elderly Client Skin, Hair & Nail Assessment

 Normal Variation:

SEBORRHEIC KERATOSES
 Tan, brown or reddish flat lesions commonly found
on fair-skinned persons in sun-exposed areas.
The Elderly Client Skin, Hair & Nail Assessment
Normal Variation:

CHERRY ANGIOMA
 Small, round, red spots

The Elderly Client Skin, Hair & Nail Assessment

 Normal Variation:

SENILE PURPURA
 Vivid purple patches; do not blanch when
touched
The Elderly Client Skin, Hair & Nail Assessment
 Normal Variation:

SENILE TURGOR
 Skin wrinkles or tents when pinched
The Elderly Client Skin, Hair & Nail Assessment
 Normal Variation:

GRAY HAIR
 May also occur in facial, axillary & pubic hair.
The Elderly Client Skin, Hair & Nail Assessment
 PHYSICAL ASSESSMENT & AGE-
RELATED CHANGES
EYES and VISION

Physical Assessment The Elderly Client

 EYES & VISION:
AGE-RELATED CHANGES
•  tear production
• Poorer night vision
•  tolerance to glare
• Presbyopia
•  peripheral vision
• Blue-green colorblindness

The Elderly Client Eye Assessment

 Normal Variation:

ARCUS SENILIS
The Elderly Client Eye Assessment
Abnormal Finding:

CATARACT
The Elderly Client Eye Assessment
Abnormal Finding:

PTERYGIUM
The Elderly Client Eye Assessment
 PHYSICAL ASSESSMENT

EARS and HEARING

Physical Assessment The Elderly Client

 EARS & HEARING:
AGE-RELATED CHANGES
•  cerumen
• Presbycusis
•  ability to hear high-frequency
sounds

The Elderly Client Ear Assessment

 PHYSICAL ASSESSMENT

NOSE and SINUSES

Physical Assessment The Elderly Client

 NOSE & SINUSES:
AGE-RELATED CHANGES
•  sense of smell

The Elderly Client Nose & Sinuses Assessment

 PHYSICAL ASSESSMENT

MOUTH and PHARYNX

 Swallow
test
Physical Assessment The Elderly Client
 MOUTH & PHARYNX:
AGE-RELATED CHANGES
•  saliva
• Mild  in swallowing ability

The Elderly Client Mouth & Pharynx Assessment

 PHYSICAL ASSESSMENT

NECK

Physical Assessment The Elderly Client

 PHYSICAL ASSESSMENT
BREASTS

Physical Assessment The Elderly Client

 PHYSICAL ASSESSMENT

CHEST and LUNGS

Physical Assessment The Elderly Client

 CHEST & LUNGS:
AGE-RELATED CHANGES
• N° RR = 16 to 25 cpm
•  lung expansion

The Elderly Client Chest & Lung Assessment

 PHYSICAL ASSESSMENT

HEART and PERIPHERAL VASCULATURE

Physical Assessment The Elderly Client

 HEART & PERIPHERAL
VASCULATURE:
AGE-RELATED CHANGES
• Prominent, bulging veins
• S4 heart sound & low-intensity
systolic murmur
• Absent dorsalis pedis pulse
•  BP,  blood vessel elasticity

The Elderly Client Heart & Peripheral Vascular Assessment

 PHYSICAL ASSESSMENT

HEART and PERIPHERAL VASCULATURE

 Assessing for orthostatic hypotension.

Physical Assessment The Elderly Client
 PHYSICAL ASSESSMENT

ABDOMEN & RECTUM

Physical Assessment The Elderly Client

 MALE & FEMALE GENITALIA:
AGE-RELATED CHANGES
• Sparse pubic hair
•  penis & testicular size
• Prostate enlarges (urinary
problems)
•  clitoris size, labia flattens
•  vaginal lubrication

The Elderly Client Genitalia Assessment

 PHYSICAL ASSESSMENT

BACK & EXTREMITIES (Musculoskeletal)

 Testing ROM

Physical Assessment The Elderly Client

“GET UP & GO” TEST

 Test should be
completed w/in
10 seconds
 Normal Variation:

HEBERDEN’S NODES
The Elderly Client Musculoskeletal Assessment
Abnormal Finding:

KYPHOSIS
 Seen in osteoporosis; also called, “Dowager’s
hump”
The Elderly Client Musculoskeletal Assessment
 PHYSICAL ASSESSMENT

NEUROLOGIC ASSESSMENT

Physical Assessment The Elderly Client

 NEUROLOGIC:
AGE-RELATED CHANGES
• Slight decline in short-term
memory
• Resting tremors (in the absence
of a disease)
•  touch & vibratory sensations

The Elderly Client Neurologic Assessment