The Elderly Patient

Excerpt

Just as children are not simply tiny adults, the elderly are not simply older versions of young adults. Like children, the elderly require special approaches and an understanding of the physiologic, psychosocial, and physiologic impact of aging. Evaluation of the elderly patient must focus on (1) what the patient can do, relative to what the patient should be able or wishes to do; and (2) identification of recent functional deficits that may be reversible. Since elderly persons are especially vulnerable to loss of functional capacity arising from the interaction of medical problems with adverse economic, psychologic, and social pressures, data must be collected in all these spheres.

The emphasis in providing health care to the elderly should be on maintaining functional capabilities. Most older citizens live in the community and are intellectually intact and fully independent in their daily activities. Nevertheless, many elderly persons who are not institutionalized report major activity limitations resulting from chronic conditions. These limitations include basic activities of daily living (walking, bathing, dressing, using the toilet, transferring from bed to chair, eating, going outside) and in home management activities (shopping, chores, meals, handling money).

Although a complete and precise diagnosis is essential, the functional impact of each diagnosis should also be evaluated. Specific diagnoses often have little relation to functional status, and the length of the diagnosis list provides little insight into the specific needs and capabilities of a given patient. Too often, a long list of diagnoses provides the physician with a bias that the patient is multiply impaired and frail, although this may not be the case at all. Thus, thorough evaluation of the present and likely future clinical importance of each diagnosis is essential.