geriatrics
Physical Examination of the Older Adult
Skin and Nails
Initial observation includes color (normal rubor, pale, cyanotic). Examination includes a search for premalignant and malignant lesions, tissue ischemia, and Pressure Injuries . In older patients, the following should be considered: Ecchymoses may occur readily when skin is traumatized, often on the forearm, because the dermis thins with aging. Uneven tanning may be normal because melanocytes are progressively lost with aging. Longitudinal ridges on the nails and absence of the crescent-shaped lunula are normal age-related findings. Nail plate fractures may occur because, with aging, the nail plate thins. Black splinter hemorrhages in the middle or distal third of the fingernail are more likely to be due to trauma than to bacteremia. A thickened, yellow toenail indicates, a fungal infection. Toenail borders that curve in and down indicate(onychocryptosis). Whitish nails that scale easily, sometimes with a pitted surface, indicate Psoriasis . Unexplained bruises may indicate Elder Abuse . 