geriatrics
Physical Examination of the Older Adult
Introduction
The physical examination of the older adult should include all major systems but with particular attention to areas of concern identified during the history (see also Overview of Evaluation of the Older Adult and Observing patients and their movements (eg, walking into the examination room, sitting in or rising from a chair, getting on and off an examination table, taking off or putting on socks and shoes) can provide valuable information about their function. Their personal hygiene (eg, state of dress, cleanliness, odor) may provide information about mental status and the ability to care for themselves. If patients become fatigued, the physical examination may need to be stopped and continued at another visit. Older patients may require additional time to undress and transfer to the examining table; they should not be rushed. The examining table should be adjusted to a height that patients can easily access; a footstool facilitates mounting. Frail patients must not be left alone on the table. Portions of the examination may be more comfortable if patients sit in a chair. Clinicians should describe the general appearance of patients (eg, comfortable, restless, undernourished, inattentive, pale, dyspneic, cyanotic). If they are examined at bedside, use of protective padding or a protective mattress, bedside rails (partial or full), restraints, a urinary catheter, or an adult diaper should be noted. 