Question

Directions: Assess an older adult using the Geriatric Assessment Tool Complete all Tables Regarding Table 3: perform a head to toe physical assessment on the client, document positive findings and current medications (if any indicated for the body system)

Answer 1

Region/system

Symptom

Possible Causes

Skin	Itching	Allergic reaction, cancer, dry skin, hyperthyroidism, jaundice, lice, scabies, uremia
Head	Headaches	Anxiety, cervical osteoarthritis, depression, giant cell arteritis, subdural hematoma, tumors
Eyes	Glare from lights at night	Cataracts, glaucoma
	Loss of central vision	Macular degeneration
	Loss of near vision (presbyopia)	Decreased accommodation of the lens
	Loss of peripheral vision	Glaucoma, retinal detachment, stroke
	Pain	Giant cell arteritis, glaucoma
Ears	Hearing loss	Acoustic neuroma, cerumen, foreign body in the external canal, ototoxicity due to use of drugs (eg, aminoglycosides, aspirin, furosemide), Paget disease, presbycusis, trauma due to noise, tumor of the cerebellopontine angle, viral infection
	Loss of high-frequency range	Presbycusis (usually caused by age-related changes in the cochlea)
Mouth	Burning mouth	Pernicious anemia, stomatitis
	Denture pain	Dentures that fit poorly, oral cancer
	Dry mouth (xerostomia)	Autoimmune disorders (eg, rheumatoid arthritis, Sjögren syndrome, systemic lupus erythematosus), dehydration, drugs (eg, antidepressants including tricyclic antidepressants, antihistamines, antihypertensives, diuretics, psychoactive drugs), salivary gland damage due to infection or to radiation therapy for head and neck tumors
	Limited tongue motion	Oral cancer, stroke
	Loss of taste	Adrenal insufficiency, drugs (eg, antihistamines, antidepressants), infection of the mouth or nose, nasopharyngeal tumor, radiation therapy, smoking, xerostomia
Throat	Dysphagia	Anxiety, cancer, esophageal stricture, foreign body, Schatzki ring, stroke, Zenker diverticulum
	Voice changes	Hypothyroidism, recurrent laryngeal nerve dysfunction, vocal cord tumor
Neck	Pain	Cervical arthritis, carotid or vertebral artery dissection, polymyalgia rheumatica
Chest	Dyspnea during exertion	Cancer, COPD, functional decline, heart failure, infection
	Paroxysmal nocturnal dyspnea	Gastroesophageal reflux, heart failure
	Pain	Angina pectoris, anxiety, aortic dissection, costochondritis, esophageal motility disorders, gastroesophageal reflux, herpes zoster, myocardial infarction, myocarditis, pericarditis, pleural effusion, pleuritis, pneumonia, pneumothorax
Gastrointestinal	Constipation with no other symptoms	Colorectal cancer, dehydration, drugs (eg, aluminum-containing antacids, anticholinergic drugs, iron supplements, opioids, tricyclic antidepressants), hypercalcemia (eg, due to hyperparathyroidism), hypokalemia, hypothyroidism, inadequate exercise, laxative abuse, low-fiber diet
	Constipation with pain, vomiting, and intermittent diarrhea	Fecal impaction, bowel obstruction
	Fecal incontinence	Cerebral dysfunction, fecal impaction, rectal cancer, spinal cord lesions
	Lower abdominal pain (crampy, sudden onset)	Diverticulitis, gastroenteritis, ischemic colitis, obstruction
	Postprandial abdominal pain (2–3 hours after eating, lasting 1–3 hours)	Chronic intestinal ischemia
	Rectal bleeding	Colon angiodysplasia, colon cancer, diverticulosis, hemorrhoids, ischemic colitis
Genitourinary	Frequency, dribbling, hesitancy, weak stream	Benign prostatic hyperplasia, constipation, drugs (eg, antihistamines, opioids), prostate cancer, urinary retention, urinary tract infection
	Dysuria with or without fever	Prostatitis, urinary tract infection
	Polyuria	Diabetes insipidus (decrease in antidiuretic hormone action), diabetes mellitus, diuretics
	Incontinence	Cystitis, functional decline, normal-pressure hydrocephalus, spinal cord dysfunction, stroke, urinary retention or overflow, urinary tract infection
Musculoskeletal	Back pain	Abdominal aortic aneurysm, compression fractures, infection, metastatic cancer, multiple myeloma, osteoarthritis, Paget disease, pyelonephritis, spinal stenosis
	Proximal muscle pain	Myopathies, polymyalgia rheumatica, use of statins
Extremities	Leg pain	Intermittent claudication, night cramps, osteoarthritis, radiculopathy (eg, disk herniation, lumbar stenosis), restless legs syndrome
	Swollen ankles	Heart failure (if swelling is bilateral), hypoalbuminemia, renal insufficiency, venous insufficiency
Neurologic	Change in mental status with fever	Delirium, encephalitis, meningitis, sepsis
	Change in mental status without fever	Acute illness, cognitive dysfunction, fecal impaction, delirium, depression, drugs, psychiatric disorders, urinary retention
	Clumsiness in tasks requiring fine motor coordination (eg, buttoning shirt)	Arthritis, parkinsonism, spondylotic cervical myelopathy, intention tremor
	Excessive sweating during meals	Autonomic neuropathy
	Fall without loss of consciousness	Bradycardia, drop attack, neuropathy, orthostatic hypotension, postural instability, tachycardia, transient ischemic attack, vision impairment
	Hesitant gait with intention tremor	Parkinson disease
	Numbness with tingling in fingers	Carpal tunnel syndrome, peripheral neuropathy, spondylotic cervical myelopathy
	Sleep disturbances	Anxiety, circadian rhythm disturbances, depression, drugs, pain, parkinsonism, periodic limb movement disorder, sleep apnea, urinary frequency
	Syncope	Aortic stenosis, cardiac arrhythmia, hypoglycemia, orthostatic hypotension (especially drug-related), seizure
	Transient interference with speech, muscle strength, sensation, or vision	Transient ischemic attack
	Tremor	Alcohol abuse, CNS disorder (eg, cerebellar disorders, poststroke), essential tremor, hyperthyroidism, parkinsonism

The geriatric assessment is a multidimensional, multidisciplinary assessment designed to evaluate an older person's functional ability, physical health, cognition and mental health, and socioenvironmental circumstances. It is usually initiated when the physician identifies a potential problem. Specific elements of physical health that are evaluated include nutrition, vision, hearing, fecal and urinary continence, and balance. The geriatric assessment aids in the diagnosis of medical conditions; development of treatment and follow-up plans; coordination of management of care; and evaluation of long-term care needs and optimal placement. The geriatric assessment differs from a standard medical evaluation by including nonmedical domains; by emphasizing functional capacity and quality of life; and, often, by incorporating a multidisciplinary team. It usually yields a more complete and relevant list of medical problems, functional problems, and psychosocial issues. Well-validated tools and survey instruments for evaluating activities of daily living, hearing, fecal and urinary continence, balance, and cognition are an important part of the geriatric assessment. Because of the demands of a busy clinical practice, most geriatric assessments tend to be less comprehensive and more problem-directed. When multiple concerns are presented, the use of a “rolling” assessment over several visits should be considered.