adapting physical assessment to different age groups: elderly clients and vulnerable groups

a.a

more likely to have strokes than other races

osteoporosis

more common in elderly women who are caucasian or northern european descent

a.a males

higher risk for prostate cancer

a.a and ashkenazi jews

higher risk for colon cancer

for health history

allow more time bcs have lived a longer life

dementia

not a normal thing of aging

what is a normal finding of aging

decreased function of all 5 senses

elderly and vision

age 65 only abt 30% of light gets to your eye

medications that affect hearing

furosemide, antibiotics such as vancomycin

intelligence and age

general intelligence does NOT decline with age

elderly and complaints

older people tend to not complain, you have to press them

past medical history considerations w elderly

tend to minimize their symptoms, back when they were little there were no vaccines might have sequelas later in life (chicken pox—>shingles)

diet

24h diet recall, tea and toast syndrome (malnutrition limited diet of simple carbs)

tooth loss/mouth pain in elderly

can make it diff to eat, can be caused by peridontal disease

reduced social contact w elderly

can become depressed= not eat as well

elderly weight change reasons

nutrition, cancer, depression, no resources to make/get food

fatigue in elderly

could be hypothyroidism, cancer

3 main reasons for elderly admissions to nursing homes

falls, incontinence,

visual changes

cataracts, cloudy vision, loss of central vision (but can see in peripheral= could have macular degeneration), last vision test

hearing changes

problems w communication, loud TV to be able to hear, problems w balance

mouth and teeth

do u wear them, how do they fit

changes in sense of smell

things dont taste as good, so not eating as much

cardiovascular

chest pain, orthopnea (sob when laying flat), ankle edema, htn

GI system

slows down, might get constipated (ask what theyre doing to fix it), stool caliver (diameter) if it was big and is now really thin could be colon cancer bcs of tumor obstruction

what happens w systolic bp w age

it increases, can develop strokes

genitourinary

ask if they have incontinence, it is NOT a normal consequence of the aging process, iits a pathology

musculoskeletal/neuro system

have trouble walking?

ask abt sexual activity w elderly

STIs on the rise w elderly bcs they think theyre not going to get pregnant so why use protection

are elderly eyes moist or dry

often dry

lgbtq considerations

use gender neutral language, free of assumptions, emphasize that sexual health discussion is routine for all clients

health issues/preventative care for gay and bisexual men

sexual health, cv health, prostate and anal health, cancer risk, ED & body image (HIVs, STIs, sexual function)

preventative care for lesbians

coronary heart disease (higher rates of smoking and obesity in this community), cancer risk, osteoporosis, exercise and nutrition education, social issues

health issues/ preventative care for transgender patients

hormonal use (can they get them and the care that they need)

household safety for elderly

no throw rugs tripping hazard),railings? (enhance safety)

general inspection of elderly

decrease in stature (6-10 cm of spine lost as u get older)

kyphosis

an excessive outward curve of the upper spine, causing a hunched or rounded back, often appearing as slouching

skin w elderly

increased wrinkles, change in color, skin turgor decreases, lentigines, seborrheic keratosis, actinic keratosis, skin tags

lentigines

old age spots (melanocytes cluster tg), do NOT turn into cancer

seborrheic keratosis

do NOT turn to cancer

actinic keratosis

pre-cancerous lesion

skin tags

do NOT turn to cancer

hair and nails w elderly

decrease in axillary and pubic hair, decrese in hair in both men and women

presbiopia

old seeing, age related loss of the eyes ability to focus on near objects

farsightedness

age 50 and up, trouble seeing close

xanthelasma

fatty tissue in eye, harmless

arcus senilis

a white halo around the eye, a NORMAL consequence of aging

glaucoma

loss of peripheral vision (tunnel vision), can only see central and not surroundings

macular degeneration

loss of central vision

hemianopsia

normal vision in one side, lose vision in the other (can only see ½ of field)

nose w elderly

looks longer, decreased sense of smell

mouth w elderly

dryness of mouth can cause halitosis (bad breath), tongue might look smoother, teeth look longer/yellow, gag reflex is a little sluggish

neck w elderly

neck shortens

respiratory system w elderly

lungs are less elastic, decreased expansion, breathing decreases, diaphragmatic excursion decreases

bp w elderly

increases, htn is common bcs of stiffness of aortic and great vessels

breasts w elderly

in males they increase in size bcs of less testosterone, female breast hang lower, breast cancer risk increases w lifetime

genitourinary w elderly

female= less pubic hair, male= penis and testes decrease in size

abdomen w elderly

female and male= increase of perineal tissue, decreased intestinal mobility= decreased bowel sounds

musculoskeletal system w elderly

ROM limitations, decreased muscle bulk, tone and strength, osteoarthritis= common pathology (degeneration of joint cartilage)

neurological system w elderly

deep tendon reflex=decrease especially in lower extremities, decreased sensation and kinesthesia (bodys awareness of own movement)

if they have eye condition, ask about

cataracts, glaucoma, discharge from eyes, presbyopia, macular degeneration