Geriatric Patient Wellness Exam
Population aging is a victory to commemorate successes in the public health sector and medical developments that have led to a decrease in the mortality of the younger population, with a consequent rise in life expectancy. Advances in medical services and infrastructure, as well as improvements in health preventive and promotion strategies, have resulted in an aging population, giving birth to the subject of gerontology.
According to the United Nations Department of Economic and Social Affairs (2021), there were 703 million older people aged 65 and over in 2019, with a projected increase to 1.5 billion by 2050. Because of the rise in the senior population, a group of care professionals with advanced practice knowledge and abilities is required to provide care to the individuals.
The following discussion will focus on a 75-year-old female client’s physical and developmental milestones, components of a wellness check for the patient, techniques to communicate the findings with the patient and her family members, and a mental health evaluation.
Expectations for Physical and Developmental Milestones
Aging is generally associated with physical decline. The physical decline may be linked to, but is not limited to, the following factors: poor diet, insufficient energy reserves, lack of physical activity, cell breakdown, loss of muscle mass, decreasing immunity, and a decrease in the size and function of certain bodily organs such as the liver and kidney (Flint & Tadi, 2020).
Aging significantly impacts appearance, sensory system, and motor ability. In the case of the 75-year-old patient, wrinkles, dry skin, and perhaps drooping brows below the superior orbital rim are expected. Furthermore, in the late adulthood group (65 and older), the loss of elastic tissue causes the skin to lose its tensile strength and become slack (Flint & Tadi, 2020).
Furthermore, the rupture of tiny blood arteries under the skin causes hypoperfusion of the skin, resulting in skin necrotic characteristics such as age spots, skin tags, and warts. Due to a lack of melanin, the hair becomes thin and grey (Glynn & Drake, 2022). The sensory system also dulls s age advances. Age-related visual impairment results from the breakdown of eye lens proteins, resulting in senile cataracts and impaired eyesight (Nizami & Gulani, 2022). Furthermore, refractive errors grow with age, resulting in greater usage of corrective lenses at the patient’s specified age.
Aging is also associated with hearing deterioration. The patient is likely to suffer hearing loss, particularly the inability to detect high-pitched sounds—a condition known as presbycusis (Cheslock & De Jesus, 2022). Hearing loss is the root of seeming paranoia, which practically all elderly patients experience as a compensatory mechanism for hearing loss.
Furthermore, age-related hearing loss is underpinned by greater usage of hearing aids, especially among late adults. Taste fairly remains intact, while the sense of smell declines markedly (Flint & Tadi, 2020). In terms of motor abilities, persons in their late adulthood have a deterioration in reflexes and lower fine motor abilities, which reduces their reaction time to activities.
Some people grow less mobile and may become physically disabled, necessitating the use of wheelchairs or walkers. The decline in motor skills and performance leads to a reduction in particular areas of functioning, such as driving. People in their late adulthood have trouble driving due to impaired coordination of the hands, legs, and brain, as well as a loss of eyesight.
While adults’ fine motor abilities and performance speed may decline in certain areas, other areas may experience an increase of the same. Pianists and guitarists, for example, have extraordinary finger dexterity at the keyboard and the chords, respectively, as they age. Finally, the population’s sexual activities change.
Females have less lubrication and weakening of the vaginal mucosa (vaginal atrophy), which exposes them to sexual injuries and bleeding abnormalities (Glynn & Drake, 2022). Regardless of the changes, the improved capacity to conserve energy, as well as the increased understanding, patience, experience, and wisdom that comes with age, help the elderly overcome the challenges of aging.
Conducting a Wellness Exam for the Patient (Physical and Functional Assessment)
Due to the predisposition to multiple illnesses, the late adult population must have all bodily systems evaluated. Following a thorough history, the physical wellness examination continues with an evaluation of vital signs, including temperature, pulse, respiration rate, and oxygen saturation. Weight and height, in addition to vital signs, are significant in calculating the body mass index (BMI), which is a clinical indicator of health in aging populations (Dodd, 2020). The following age-related findings may be present in the 75-year-old patient in a head-to-toe format.
Face: Wrinkles, dry skin, a descent of chin, eyebrows that drop below superior orbital rim. The temporal area should also be palpated for tenderness and thickening, which are indications of giant cell arteritis.
Nose: Descent of the nasal tip
Eyes: Loss of orbital fat evidenced by the gradual sinking of the eye back into the orbit, entropion, ectropion. Snellen chart may depict decreased visual acuity. Ophthalmoscopy may reveal findings suggestive of various types of retinopathies.
Ears: Use of hearing aid, cerumen impaction; tuning fork tests may reveal hearing loss
Mouth: Examined for dentures, bad breath, cheilitis, bleeding and swollen gums, loose teeth, signs of premalignant or malignant lesions (leukoplakia, erythroplakia, ulcerations, mass), signs of fungal infections (oral thrush).
Neck: Swelling (thyroid mass), carotid bruits
Chest and Back
Breasts: Changes in size, skin changes (dimpling, ulceration), nipple discharge
Heart: Pulse rate and rhythm, apex palpation (heart may be enlarged, and apex displaced), auscultation may reveal additional heart sounds
Gastrointestinal: Weak abdominal muscles, which may predispose to hernias. An abdominal aortic aneurysm may be felt as a pulsatile lump. Organomegaly may be discovered with palpation.
Female reproductive system: Speculum pelvic examination (vaginal mucosal atrophy, seems dry and lacking rugal folds), ovaries impalpable (ovaries should not be palpable 10 years after menopause, if palpable, ovarian cancer is suspected). A Papanicolaou (Pap) test is used to screen for cervical cancer. There are no advantages to screening for cervical cancer beyond the age of 65 if prior screening was negative (CDC, 2021)
Musculoskeletal: Examined for tenderness, swelling, joint stiffness, subluxation, crepitus, warmth, and redness. Active and passive range of motion are also determined.
Neurologic system: Reduced sensation. Muscle mass, reflexes, tone, and power are all diminished during a motor examination. Tremors, altered gait, and posture may also be discovered.
Nutritional: BMI calculated
The following is an overview of functional assessment criteria and outcomes pertinent to the patient’s age (75-year-old patient)
Activities of daily living (ADL): Evaluate independence in eating, continence, transferring, dressing, toileting, and bathing. Loss of independence might indicate a chronic condition such as heart failure, depression, or dementia.
Mobility: Identify problems with gait, posture, balance, maneuverability, ability to transfer, and joint function
Shoulder function: Inquire about pain, and observe the range of motion
Hand function: Assess the ability to grasp and pinch, which are required for grooming and eating
Vision impairment: Snellen chart, ophthalmoscopy
Hearing impairment: Tuning fork tests, otoscopy, whisper test
Cognitive function: Mental state examination
Bladder incontinence: Simple screening for incontinence is done by asking the patient if they have ever “lost urine or gotten wet.”
Nutrition: Diet diaries provide essential information on food consumption. Changes in weight, appetite, and clothing, together with serial weight assessment, may be the most effective technique to determine nutritional status in the elderly population.
Alcoholism: Utilizes the CAGE questionnaire
Caregiver availability and stress: Assess the availability, willingness, and physical and cognitive abilities, of current and potential current caregivers.
Depression: A question like “do you feel depressed?” helps in the initial screening for depression
Communication is an essential skill in healthcare for both healthcare professionals and patients. Improved patient-care provider relationships, better patient outcomes, and increased organizational performance are all effects of effective communication (Baylor et al., 2022).
Respect is essential while addressing the patient or persons of the same age group. Instead of referring to patients by their names, such as “Jay” or “Edna,” use polite prefixes such as “Mr.”, “Mrs.”, and “Ms.” Also, make the patients feel at ease by assisting them in filling out documents in examination rooms, offices, or reception desks (Baylor et al., 2022).
I would also take a few moments to establish a rapport with the patient by asking about her residence, occupation, and family. Given her declining physical strength and cognitive ability, I would not rush the patient or interrupt her while she expresses herself. Furthermore, when discussing the results of the examination, actively listen to the patient, display empathy, and avoid using complicated medical terminology. Because the senior population is prone to forgetting, I would jot down the key aspects and provide them with my phone numbers in case an issue or a query arose.
To compensate for hearing problems, Baylor et al. (2022) recommend tactics such as getting closer to the patient, talking slowly and loudly, making eye contact, limiting background noises, and keeping a notepad ready to jot down what is said. Additionally, to compensate for visual deficits, provide appropriate lighting, encourage the patient to wear reading glasses, and if the patient has difficulty reading, alternatives such as recording and utilizing visuals may be explored (Baylor et al., 2022).
Finally, when using print materials, the font should be bigger. Because of the research-proven advantages of good communication and the fact that it is a teachable skill, care professionals should get communication training to better their conversations with, assessments of, and relationships with patients.
Mental Health Assessment, Anticipatory Guidance, and Documentation
A mental state exam is an essential psychiatric tool used to examine individuals seeking psychiatric or wellness assessment. The examination starts with an evaluation of the candidate’s appearance and behavior. Speech, emotion, affect, thought content, thought process, and perception are also assessed.
Furthermore, details of the conscious levels, orientation, memory functioning, literacy and arithmetic skills, attention and concentration, visuospatial processing, general knowledge, language, and abstract are obtained. Finally, the mental state test concludes with the patient’s judgment and insight.
Concerning guidance, the patient needs instruction on health promotion and preventive strategies. Such strategies may include healthy food, physical exercise, medication adherence if she is on any drugs, and regular medical checkups. The data will be documented using electronic medical record recording procedures and saved for future use. An example of a mental status exam that is pertinent to the patient is provided below.
The patient is a 75-year-old Caucasian female who appears her age. She is well-groomed, comfortably seated on a chair, and maintains eye contact with the examiner. She is calm, maintains a rapport with the examiner, speaks at a slow, loud, and normal rate, with clearly articulated words, and maintains conversational spontaneity. She claims to be in a good mood, and she appears to be euthymic.
She has a stable and appropriate effect. She has no abnormalities in thought content or process and no abnormalities in perception. She is conscious, oriented to time, place, and person, has intact short and long-term memory, is attentive, and has good general knowledge. She has sound judgment and insight.
Aging is a key predictor of illness and a relevant element in patient evaluation. Multiple causes contribute to the growth in the aging population; nevertheless, the most significant one has been the improvement in medical care. As the population ages, more nurses with advanced knowledge and skills are needed to care for the elderly. Patients 65 and older need special attention due to deteriorating immunity, physical strength, and performance in different facets of life. To make working with patients easier, caregivers must have communication training, which is an essential component in the evaluation and education of the elderly.
Baylor, C., Brown, C., Mroz, T. M., & Burns, M. (2022). Understanding how older adults with communication difficulties access health services: What we can learn from the National Health and Aging Trends Study (NHATS). Seminars in Speech and Language, 43(3), 176–197. https://doi.org/10.1055/s-0042-1749618
Centers for Disease Control and Prevention. (2021, December 15). What should I know about cervical cancer screening? Cdc.gov. https://www.cdc.gov/cancer/cervical/basic_info/screening.htm
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Nizami, A. A., & Gulani, A. C. (2022). Cataract. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539699/
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