Geriatric Patient Assessment: Interview and Clinical Techniques

Introduction

Geriatric patients between the ages of 70 and 95 have very different needs from those of their younger counterparts. In part, these differences have clear physiological bases. The structural and physiological changes associated with aging necessitate different assessment and interview techniques. Ensuring that a clinician obtains all correct and up-to-date information from a patient is essential, and in the cases of both children and geriatric adults, this can become particularly challenging.

Cognitive Deficits and Communication Challenges

Cognitive deficits related to dementia are one possible hurdle that must be overcome when interviewing older patients. It is important to recall that not all dementia is Alzheimer's-related, and many cases are a natural result of the aging brain. It is useful for the healthcare professional to note that the original disease diagnosed by Dr. Alzheimer related to pre-senile dementia — that is, a dementia occurring physiologically much earlier than one would expect. As a result, naturally occurring forms of senile, rather than pre-senile, dementia may be expected to become increasingly prevalent within the aging population.

In order to be certain that a patient can hear and understand everything being asked, the clinician must maintain eye contact and speak face-to-face at all times. Careful attention should be paid to the patient's reactions to confirm that they respond appropriately and understand the questions being asked. Because older patients are also more likely to have hearing- and vision-related problems, it can be helpful for them to read the clinician's lips. Regular check-ins to confirm comprehension are strongly advised.

Adapting the Interview Process

Cognitive deficits may also impair memory. For this reason, it can be useful to ask patients to bring all of their pill bottles to the appointment, or to prepare a written list in advance. If asked to recount all medications on the spot, some patients may forget certain ones — an omission that could have serious clinical consequences. Written lists are helpful more broadly, including for health histories. Where possible, clinicians should ask patients to bring a written document describing their health history and current medications.

Physiological and Anatomical Variations in Elderly Patients

In addition to requiring different interview techniques, physiological and anatomical variations in elderly patients are also important to identify during a physical assessment. For example, elderly patients are more likely to have brittle bones and fragile skin. Osteoporosis is a serious condition that should be assessed in elderly patients. Fragile skin is more significant than it may initially appear, because the skin serves as the body's first defensive layer. Skin that bruises and cuts easily can lead to a wide range of infections and secondary conditions. Additionally, diabetes is more prevalent in geriatric patients and carries major implications for immune system function.

Eye-related diseases are very common in older patients. Glaucoma and cataracts are conditions that can lead to serious complications. More commonly, myopia and presbyopia are normal aspects of aging but should be recognized in the clinical setting because of the effects they can have on daily life. As noted previously, they can also create complications during the interview and assessment processes themselves. Hearing loss is likewise a normal aspect of aging and must be assessed carefully. It is important to distinguish between communication difficulties that result from dementia and those that result from conditions involving the inner ear. Although both neurological and ear-related hearing disorders can produce similar effects, the treatments differ, and each can lead to slightly different complications that ought to be anticipated.

Conclusion

With age comes a wide range of possible anatomical and physiological variations. These include everything from basic myopia to glaucoma and cataracts, to osteoporosis, diabetes, and mouth sores. These are important conditions to identify in any physical assessment, and they can also create communication barriers during the interview process. For this reason, it is necessary to take certain precautions and adjust clinical methods — for example, by requesting written health histories or asking patients to bring their pill bottles to appointments. It is also extremely important to remain face-to-face with the patient, speaking directly to them and maintaining eye contact throughout. By adopting these practices, clinicians can help ensure that elderly patients receive the careful, compassionate care they need and deserve.

References

Carey, M. (2011). Geriatric assessment: Essential skills for nurses. American Nurse Today. Retrieved March 11, 2016, from

Comprehensive Geriatric Assessment. (n.d.). Retrieved 2016, from