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
·
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
· 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
·
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
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