Chapter 17: Geriatric Exam

INTRODUCTION

The number of adults age 65 years and older in the United States is growing rapidly. For the first time in US history, older adults are projected to outnumber children by 2034, with nearly 1 in 4 Americans aged over 65 years old by 2060. This chapter focuses on the assessment of older adults, a population that holds a unique set of healthcare needs due to several factors:

• Higher presence of multiple chronic conditions

• Larger number of medications used

• Increased frequency of certain syndromes

• Wide variation in the level of function

• Particular focus on providing goal-aligned care

Geriatrics care benefits older adults based on their needs rather than when they reach a specific age. Geriatrics specialty care is generally most valuable when an older adult:

• Experiences conditions that cause considerable impairment or frailty (this tends to happen after age 75 or when someone starts managing a number of health conditions)

• Has family, friends, or other caregivers who start feeling considerable stress related to care

• Themselves or their family start having trouble following complex treatments or working with many different healthcare professionals for multiple health needs

The Age-Friendly Health Systems (AFHS) movement, known as 4 Ms care, is one framework that addresses the core domains of high-quality geriatrics care (Figure 17-1). All older adults benefit from age-friendly healthcare. The 4 Ms are:

• What Matters

• Medications

• Mentation

• Mobility

In this chapter, we review elements of history taking and the physical exam that are unique to older adults as well as strategies for incorporating the 4 Ms of age-friendly healthcare.

HISTORY TAKING IN THE OLDER PATIENT

This is done in the same fashion as with other patients and includes the history of present illness (HPI), past medical history, past surgical history, review of systems (ROS), social history, family history, and medication review (see dedicated chapters on HPI [Chapter 1] and ROS [Chapter 2] for details). We highlight the following areas that require a distinctive approach for the older adult:

• Consideration of sensory impairments

• Involvement of family members or caregivers when appropriate

• Eliciting what matters most for the patient

• Asking about functional status and mobility

• Asking about cognition and mentation

• Consideration of common geriatric syndromes

• Recognizing the complexity of medication review for older adults

Consideration of Sensory Impairments

Sensory impairments, such as with vision and hearing, are common in the older adult population. The potential barriers in communication from sensory impairments can be minimized by the following measures:

• Ensuring that the patient is wearing glasses ...