Health Concerns in the Elderly

1. Screening: Common Syndromes in the Elderly
   1. Dementia
   2. Urinary Incontinence
   3. Fall Prevention in the Elderly
   4. Polypharmacy
      1. Also See Medication Use in the Elderly
2. Screening: Common Medical Conditions affecting patients over age 75
   1. Osteoarthritis and other rheumatologic conditions
      1. See Rheumatologic Conditions in the Elderly
   2. Cardiovascular Disease (36%)
      1. Coronary Artery Disease
      2. Congestive Heart Failure
   3. Diabetes Mellitus (20%)
   4. Hypertension (29%)
   5. Cerebrovascular Disease (14%)
   6. COPD (11%)
   7. Decreased Visual Acquity
   8. Hearing
      1. See Hearing Handicap Inventory for the Elderly
   9. Hypothyroidism
   10. References
       1. Van Lankveld (2004) Arthritis Rheum 51:299
3. Screening: Psychosocial Concerns
   1. Geriatric Nutrition Checklist
   2. Activity in the Elderly
      1. Activities of Daily Living
      2. Activities of Daily Living Scale
      3. Instrumental Activities of Daily Living
   3. Long-term care
   4. Advanced Directives
   5. Elder Abuse
4. Exam: Vitals
   1. Weight
      1. Unintentional Weight Loss (Cancer, Major Depression)
      2. Weight gain (CHF)
   2. Blood Pressure
      1. Orthostasis (Autonomic Dysfunction, Beta Blockers, CAD)
   3. Heart Rate
      1. Bradycardia (Beta Blockers, Heart Block)
      2. Atrial Fibrillation
   4. Respiratory Rate increased >24 (COPD, CHF, Pneumonia)
   5. Temperature high or low temperature (Infection, Thyroid disorder)
5. Exam: Head and Neck
   1. Face
      1. Facial asymmetry (e.g. neurovascular disease)
      2. Frontal bossing (Paget's Disease)
   2. Eyes
      1. Vision Loss (Macular Degeneration, Cataracts, Glaucoma)
   3. Ears
      1. Hearing Loss
   4. Mouth
      1. Oral Lesions (denture fit,, Leukoplakia)
      2. Xerostomia (e.g. Diabetes Mellitus, Sjogren's Syndrome, Anticholinergic Medications)
   5. Neck
      1. Carotid Bruit
      2. Thyroid mass
6. Exam: Trunk
   1. Heart Exam
   2. Lung Exam
   3. Abdomen
      1. Abdominal Aortic Aneurysm
      2. Constipation (drug-related, Colon Cancer, dehydration)
      3. Fecal Incontinence (e.g. Fecal Impaction)
      4. Rectal bleeding
   4. Genitourinary
      1. Vaginal atrophy
      2. Prostate enlargement
      3. Urinary Incontinence
7. Exam: Extremity
   1. Feet
      1. Bunions, Callus, and non-healing sores
      2. Peripheral Vascular Disease
      3. Venous Insufficiency
   2. Joints
      1. Painful range of motion
      2. Antalgic Gait
   3. Neurologic
      1. Ataxia
      2. Parkinsonian Tremor
8. Prevention: Counseling for over age 65 years
   1. Tobacco Cessation
      1. Quitting as late as age 65 still increases life expectancy 1-3 years
      2. Taylor (2002) Am J Public Health 92(6): 990-6
   2. Heart Healthy Diet (e.g. Mediterranean Diet)
   3. Exercise in the Elderly
9. Prevention: Screening
   1. Abdominal Aortic Aneurysm Screening with abdominal ultrasound
      1. Screen men between ages 65 to 75 if any history of Tobacco abuse
   2. Breast Cancer Screening with Mammograms
      1. Annually in women up to age 79 (or at least 5 year life expectancy)
   3. Cervical Cancer Screening with Pap Smears
      1. May be discontinued after age 65 unless dysplasia history or inadequate prior screening
   4. Colorectal Cancer Screening
      1. Screen with Colonoscopy at recommended intervals and annual Fecal Occult Blood
         1. See Colon Cancer Screening with Colonoscopy for recommended intervals
      2. Continue screening as long as patient has at least 5 year life expectancy
   5. Osteoporosis Screening
      1. See Osteoporosis Screening
10. Resources
    1. Community Services for the Elderly
11. References
    1. Dial (2003) AAFP Board Review Lecture, Seattle
    2. Elsawy (2011) Am Fam Physician 83:48-56
    3. Spalding (2008) Am Fam Physician 78(2): 206-15