Geriatrics is the medical care for older adults above 65 years of age. The number of older adults in almost all developed countries has dramatically increased in number. Many of them enjoy excellent healthy while others suffer from disabilities and many different illnesses. There are increased risks in this stage, and therefore there should be a straightforward approach to maintain the health of the elderly. Treatment of diseases and aiming at healthy aging are essential tools in nursing. Geriatric assessment needs a multidisciplinary and multidimensional evaluation that helps assess physical health, functional ability, and mental and cognition health (Assessing Elder Mistreatment). The nurse also evaluates the environmental and social circumstances. Most of the elderly assessments are initiated when a problem manifests in the elderly.
Considerations during the geriatric assessment
The physical examination of the elderly is modified. Much attention should be put in place by the nurse regarding the problems which cause interference in everyday functioning (Besdine, 2018). The multidisciplinary team can apply the information from physical examination to develop a care plan and specific treatments. The health care worker should consider different issues during the assessment, including the financial, physical, spiritual, social, and environmental factors. The considerations that have to be put in place include visual loss, gait disorders, hearing loss, incontinence, and visual loss. While examining the pulmonary and cardiovascular systems, the findings require a particular interpretation since they are different from other age groups.
Delegate your assignment to our experts and they will do the rest.
The examination of the elderly must include various places in the body. Assessment must consist of head and neck examinations. The chest, breasts, back, and abdomen are essential in the evaluation (Jarvis, 2016). The pelvic examination in women and prostate examination in men is also critical. The health care workers should also include skin and extremities examinations. Mental health and cognition status are also essential.
Expected findings in older adult assessment
Skin
During aging, the skin undergoes some regular changes, including thinning, wrinkling, and loss of the elastic tissues and skin turgor. The skin appears very dry and rough on the touch (Assessing Elder Mistreatment). The skin is itchy and may occur with some fissures that appear in a mosaic form, especially in the legs.
Hair
The hair is always grey in almost all the elderly because of the reduced production of melanin. There is thinning and loss of hair (Noel et al., 2018). Some men have baldness, and they experience loss of hair. The hair distribution patterns are altered because of the loss of dermal vascular beds.
Nails
The plate of the nails thins with aging and therefore can cause nail plate fractures. The presence of bands of pigments mainly in black patients. There is ridging in the longitudinal parts of the nails with a thickening.
Eyes and vision
The eyes of the elderly present with some findings which are expected because of their age. The loss of the fat present in orbit is average. It causes the sinking of the eye towards the back into the rotation. The exophthalmos, which is a sign of dehydration, is expected in order adults. And it is accompanied by loss of peripheral vision and deepening of the eyelid fold in the upper side (Jarvis, 2016). The size of the palpebral aperture is also reduced in size. Entropion and ectropion are also evident. They are defined as an inversion in the lower eyelid margins and the lower eyelid margins' eversion respectively. Arcus senilis, which is a white ring located in the limbus, is also evident.
Ears and hearing
The pinna might present with tophi. The elderly might also present with reduced hearing. The balance is also reduced because of improper functioning of the ears (Jarvis, 2016). Presbycusis is an age-related loss of hearing evidence in most older adults.
Mouth
The teeth appear dark because of extrinsic stains and enamel, which is less translucent and occurs mainly with aging. There are varicose veins present in the ventral surface and atrophy papillae in the tongue.
Musculoskeletal system
There is increased loss of the density of bones with reduced size of muscles and loss of strength. The cartilages also degenerate, and the elderly have a significant decrease in height.
Abnormal findings during assessment
Skin
Neoplasms manifest mainly in areas that are exposed to the sun. Pressure ulcers can also be available in sick patients.
Eyes and vision
Cataracts, macular degeneration, which presents with hemorrhages in the macula, and glaucoma are abnormal eye findings.
Ears and earing
Hearing loss and cerumen impaction are abnormal findings. Otosclerosis can also be evident as a result of the growth of the located in the middle ear. Tinnitus can also present with a continuous ringing which is sensed in the head.
Mouth
Xerostomia presents with fissures in the mouth and the tongue, and the tongue sticks in the buccal mucosa. Gingival and periodontal disorders present with gingiva, which easily bleeds and is edematous (Jarvis, 2016). The presence of bad breath indicates periodontitis and other oral diseases. Parotitis is characterized by a parotid artery that is swollen and tender.
Musculoskeletal system
Osteoarthritis presents with bony overgrowths and swellings in the joints. Deviation of the ulnar and metacarpophalangeal joints signifies chronic rheumatoid arthritis. The neck deformity that presents as a swan neck indicates abnormality.
Urinary incontinence causes and management
The possible cause of urinary incontinence in the patient is the existing hypertension disease and the antidiuretics he is taking. It is because the medications work by dilating the blood vessels to reduce blood pressure. The drugs can also alter the bladder's ability to contract and incredibly leads to fewer water amounts that the body can hold. It results in increased production of urine and urinary incontinence. Being geriatric also contributes to increased urinary incontinence levels because of the pelvis's reduced ability and bladder muscles to function normally.
The best way of managing incontinence is through lifestyle changes. The caregivers of the patient, together with him, should be taught the importance of timed voiding (Whitley ,2020). It greatly helps in controlling the proper bladder schedule. It allows control over incontinence because the patient does not have to wait until they feel an urge to urinate to do so.
Environment modification is also essential to ensure it is safe for the patient. There should be increased access to the toilets with close monitoring from the caretakers because he walks using a stick. It indicates that the patient is at a high risk of fall, and therefore support and a safe environment will improve the safety (Assessing Elder Mistreatment). Bladder retraining is also essential. It promotes the lengthening of the period between voids. The patient can learn about the urge to suppress the urine if she does not have cognitive impairment. It is also to educate the importance of restricting caffeine and other irritants that cause bladder irritation, especially when taking light meals.
Conclusion
A timely and systematic examination is essential in the elderly to ensure well-being at all times. It is also necessary to prevent further complications since geriatrics are at high risk of contracting diseases and falls. They are prone to many diseases and problems because of lowered immunity as an individual age. A proper assessment should be done and managed before it is complicated. Therefore, the elderly can be safer when there is adequate support or assistance from the caregivers.
References
Besdine Richard. (2018). Evaluation of the Older Adult . MSD Manual Professional Edition; MSD Manuals.
https://www.msdmanuals.com/professional/geriatrics/approach-to-the-geriatric-patient/evaluation-of-the-older-adult/
Jarvis, C. (2016). Physical Examination and Health Assessment, 7th Edition. Chapters 29-31
Jarvis, C. (2016). Laboratory Manual for Physical Examination & Health Assessment, 7th Edition. Chapters 29-31
Noel A. DeBacker, M.D., F.A.C.P. (2018a, August 24). History and Physical Examination of the Older Adult . Projects.galter.northwestern.edu
Video: “Assessing Elder Mistreatment” (A Case Study) - https://youtu.be/L8jzycu0eTo
http://projects.galter.northwestern.edu/geriatrics/chapters/history_physical_examination.cfm/
Whitley, M. (2020, June 20). Elderly Urinary Incontinence Care . Www.aplaceformom.com.
https://www.aplaceformom.com/caregiver-resources/articles/urinary-incontinence/
