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Assessment of and the establishment of rapport with the elderly patient is a special skill. Age-associated deterioration of health and function occurs especially with hearing, vision, glucose tolerance, systolic blood pressure, kidney, pulmonary and cardiac function, immune function, bone density, cognitive function, mastication and bowel and bladder function.
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‘RULES OF 7’ FOR ASSESSMENT OF THE NON-COPING ELDERLY PATIENT
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If your elderly patient presents with non-specific symptoms, unexpected deterioration in health and/or an inability to cope with the activities of daily living, consider the following checklist (Table E3) in your assessment.
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Apart from confusion, other non-specific symptoms include drowsiness, poor concentration, apathy, fatigue/weakness/tiredness/lethargy, anorexia, nausea, weight loss, dyspnoea, immobility, ‘stuck in bed or chair’, stumbles or falls. It is also important to consider infections including pneumonia and the masquerades.
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THE MINI-MENTAL STATE EXAMINATION
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Evidence of memory difficulty remains the best single indication of dementia and should always be evaluated by formal memory testing. A number of screening tests are available but the mini-mental state examination (MMSE), particularly the Folstein MMSE (Appendix 2) is commonly used and recommended.
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Consider behavioural changes using the following checklist.
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D: drugs and alcohol, depression
E: ears, eyes
M: metabolic (e.g. hyponatraemia, diabetes mellitus, hypothyroidism)
E: emotional problems (e.g. loneliness)
N: nutrition: diet (e.g. vitamin B group deficiency, teeth problems)
T: tumours, trauma (of CNS)
I: infection
A: atherosclerotic disease → cerebral insufficiency
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Falls are a major problem as at least 5% of falls result in a fracture, particularly Colles and femoral neck. The death rate is significant.
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The most significant clinical risk factors for falls have been shown to be visual impairment, impaired general function, postural hypotension, hearing impairment, low morale/depression, drug usage, especially sedatives, decreased lower limb strength including arthritis, and impaired balance and gait.
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