History - Health Care of the Elderly

Health Care of the Elderly

History

·        History should include:

o   Function of the person before their illness

o   Current function of the person

o   Their aims and aspirations:

§  Where do they anticipate living on discharge from hospital

§  What functional level must they achieve for this to happen

§  Has the availability, ability and opinions of carers and family been taken into account

§  Are there special social or cultural considerations

§  Are the goals of the person and the family reasonable within a realistic timeframe

§  Has there been sufficient consultation

o   What is the physical layout of the home, access to and within it

o   Screen for disorders

Assessment of Functional State

·        Include the following in the social history

·        Basic activities of daily living: 

o   Mobility: can they move in bed, get in and out of bed, in and out of a chair, on and off a toilet, ability to get around the house, to get outside, to get to the shops or visit friends. Can steps and stairs be managed 

o   Urinary & Faecal Continence: is there a problem, how is it managed

o   Bathing, shaving, teeth, dressing: how much assistance in needed, can they reach all body parts

o   Feeding: how much assistance is needed (eg cutting up food)

·        Advanced activities:

o   Handling of finances

o   Shopping

o   Use of public transport

o   Preparation of a hot drink

Screen for Disorders

·        Cognitive impairment: delirium, dementia, focal cognitive impairments (dysphasia, non-dominant hemisphere problems). May need to use an assessment instrument (eg mini-mental state) and/or interview others 

·        Visual and hearing impairment

·        Postural hypotension

·        Malnutrition

·        Faecal impaction

·        Pressure areas

·        Iatrogenic disease, including adverse drug reactions

·        Weakness secondary to immobility

·        Untreated or under-treated pain

Residential Care History

·        Reasons for living in a residential care facility, how long have they lived there

·        Past health problems and current concerns

·        Current medical treatment

·        Current functional state

·        Social network (family and other visitors), and interests and activities

·        General physical examination

·        Screen for common impairments 

·    Formulate a problem list, and management strategies (including preventative) that may be appropriate