geriatrics
History Taking in the Older Adult
Introduction
Attention to the medical history is particularly important in older adults because the history is often more complicated than in younger patients, and information may need to be gathered from a variety of sources (see also Overview of Evaluation of the Older Adult ). Often, more time is needed to interview and evaluate older patients, partly because they may have characteristics that interfere with the evaluation. The following should be considered: Sensory deficits:Dentures, eyeglasses, or hearing aids, if normally worn, should be worn to facilitate communication during the interview. Adequate lighting and elimination of visual or auditory distraction also help. Underreporting of symptoms:Older patients may not report symptoms that they may incorrectly consider part of normal aging (eg, dyspnea, hearing or vision deficits, memory problems, incontinence, gait disturbance, constipation, dizziness, falls). However, no symptom should be attributed to normal aging unless a thorough evaluation is done and other possible causes have been eliminated. Unusual manifestations of a disorder:In older adults, typical manifestations of a disorder may be absent. Instead, older patients may present with nonspecific symptoms (eg, fatigue, confusion, weight loss). Disorders may manifest solely as functional decline. In such cases, standard questions may not apply. For example, when asked about joint symptoms, patients with severe arthritis may not report pain, swelling, or stiffness, but if asked about changes in activities, they may, for example, report that they no longer take walks or volunteer at the hospital. Questions about duration of functional decline (eg, “How long have you been unable to do your own shopping?”) can elicit useful information. Identifying people when they have just started to have difficulty doing Occupational Therapy (OT) (ADLs) or Difficulty recalling:Patients may not accurately remember past illnesses, hospitalizations, operations, and drug use; clinicians may have to obtain these data elsewhere (eg, from family members, a home health aide, or medical records). Fear:Older adults may be reluctant to report symptoms because they fear hospitalization, which they may associate with dying. Age-related disorders and problems:Depression (common among older adults who are vulnerable and sick), the cumulative losses of old age, and discomfort due to a disorder may make older adults less apt to provide health-related information to clinicians. Patients with impaired cognition may have difficulty describing problems, impeding the physician’s evaluation. 