6 Assessing Older Adults

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
Normal Variation:
CUTANEOUS TAGS/SKIN TAGS

 flesh-colored pedunculated lesions

Normal Variation:
SEBORRHEIC KERATOSES
 Tan, brown or reddish flat lesions commonly found
on fair-skinned persons in sun-exposed areas.
Normal Variation:
CHERRY ANGIOMA
 Small, round, red spots

Normal Variation:
SENILE PURPURA
 Vivid purple patches; do not blanch when
touched
Normal Variation:
SENILE TURGOR
 Skin wrinkles or tents when pinched
Normal Variation:
GRAY HAIR
 May also occur in facial, axillary & pubic hair.
PHYSICAL ASSESSMENT & AGE-
RELATED CHANGES
EYES and VISION

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
Abnormal Finding:
CATARACT
Abnormal Finding:
PTERYGIUM
PHYSICAL ASSESSMENT
EARS and HEARING

EARS & HEARING:
AGE-RELATED CHANGES
•  cerumen
• Presbycusis
•  ability to hear high-frequency
sounds
The Elderly Client Ear Assessment

PHYSICAL ASSESSMENT
NOSE and SINUSES

NOSE & SINUSES:
AGE-RELATED CHANGES
•  sense of smell
The Elderly Client Nose & Sinuses Assessment

PHYSICAL ASSESSMENT
MOUTH and PHARYNX
 Swallow
test
MOUTH & PHARYNX:
AGE-RELATED CHANGES
•  saliva
• Mild  in swallowing ability
The Elderly Client Mouth & Pharynx Assessment

PHYSICAL ASSESSMENT
NECK

PHYSICAL ASSESSMENT
BREASTS

PHYSICAL ASSESSMENT
CHEST and LUNGS

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

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
ABDOMEN & RECTUM

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

“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

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

6 Assessing Older Adults

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The

Assessment of Special Populations

• Conduct assessment in an area with ample space

• Eliminate background noise as much as possible

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

The Elderly Client

• Collect no more information than is

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

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

The Elderly Client

• Provide adequate rest periods.

• Limit the length of the examination. A

The Elderly Client

The Elderly Client

• Ability to telephone • Mode of Transportation

 Certain points are given for each domain.

Physical Assessment The Elderly Client

CUTANEOUS TAGS/SKIN TAGS

The Elderly Client Skin, Hair & Nail Assessment

The Elderly Client Skin, Hair & Nail Assessment

Physical Assessment The Elderly Client

The Elderly Client Eye Assessment

EARS and HEARING

Physical Assessment The Elderly Client

The Elderly Client Ear Assessment

NOSE and SINUSES

Physical Assessment The Elderly Client

The Elderly Client Nose & Sinuses Assessment

MOUTH and PHARYNX

The Elderly Client Mouth & Pharynx Assessment

Physical Assessment The Elderly Client

Physical Assessment The Elderly Client

CHEST and LUNGS

Physical Assessment The Elderly Client

The Elderly Client Chest & Lung Assessment

HEART and PERIPHERAL VASCULATURE

Physical Assessment The Elderly Client

The Elderly Client Heart & Peripheral Vascular Assessment

HEART and PERIPHERAL VASCULATURE

 Assessing for orthostatic hypotension.

ABDOMEN & RECTUM

Physical Assessment The Elderly Client

The Elderly Client Genitalia Assessment

BACK & EXTREMITIES (Musculoskeletal)

Physical Assessment The Elderly Client

Physical Assessment The Elderly Client

The Elderly Client Neurologic Assessment

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