assessment of the aging patient

assessment of the aging patient

an evaluation of the changes characteristic of advancing years exhibited by an elderly person.
method The patient is measured, weighed, examined, observed, and questioned about physical, functional, and behavioral changes; height normally diminishes 1 to 2 inches with aging, and weight steadily decreases in men over 65 years of age but increases in women. The skin is examined for dryness, wrinkles, sagging, thinning over the back of the hands, areas of vitiligo, keratoses, warts, changes in appearance of freckles and moles, skin tags, and senile telangiectases, and the hair for depigmentation, lack of luster, and thinning or loss on the scalp and in the axillary and pubic areas. Observations are made of enlargement of the nose and ears relative to face size, dryness of the eyes, opacity of the lens, discoloration of the sclera and iris, an opaque ring near the edge of the cornea (arcus senilis), decreased pupil size, and diminished peripheral vision. Tests are performed to determine whether there is hearing loss, especially of high-frequency tones; decreased tidal volume; diminished peripheral perfusion; exertional dyspnea; or deviation of the trachea, especially if scoliosis is present. Examination may reveal gum recession, loss of teeth and taste perception, and diminished salivation. It may also find decreased resting heart rate and cardiac output, increased diastolic and systolic blood pressure, and an easily palpable arterial pulse. The elderly patient may show decreased muscle mass, osteoarthritic joints, Heberden's or Bouchard's nodes at finger joints, contracture of lateral fingers, osteoporosis, a broad-based stance, and slow voluntary movements. The sense of position, of smell, and of touch and the sensitivity to heat and cold may be diminished, and deep tendon reflexes may be decreased. Signs of aging that may be found in women are pendulous, flaccid breasts; vaginal narrowing and shortening and diminished lubrication, causing painful coitus; and effects of long-term estrogen therapy. Signs of aging in men include decrease in the size and firmness of the testes and in the amount and viscosity of seminal fluid, increased diameter of the penis, and prostatic hypertrophy; libido and a sense of sexual satisfaction usually do not diminish.
nursing considerations The health care provider faces the patient during the evaluation, establishes eye contact, repeats questions if necessary, avoids shouting, and addresses the person by name. If the patient's visual perception and tactile sense are diminished, the nurse uses color contrasts and items of marked textural differences in the assessment.
outcome criteria Aging does not progress at a uniform rate, and its effects may vary widely from one individual to the next, but, in many cases, changes once considered normal in elderly patients are disease processes that may respond to treatment. A thorough physical assessment distinguishes the effects of pathological disorders from those of aging and elucidates the care needed by the patient.
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