History Taking in Elderly Population PDF

HISTORY TAKING IN ELDERLY POPULATION ICS 2 Dr. Am ber Eker Bakkaloğlu EMU Faculty of Medicine Why elderly need special attention? What might be the challenging features ◦ Welcoming the patient ◦ Age, martial status, occupation, who do they stay with ◦ History of current problem ◦ Past medical histor...

HISTORY TAKING IN ELDERLY POPULATION ICS 2 Dr. Am ber Eker Bakkaloğlu EMU Faculty of Medicine Why elderly need special attention? What might be the challenging features ◦ Welcoming the patient ◦ Age, martial status, occupation, who do they stay with ◦ History of current problem ◦ Past medical history ◦ Habits ◦ Family History ◦ Medications ◦ Daily life ◦ Review of systems ◦ Discuss also end of life decision ◦ Welcoming the patient ◦ Age, martial status, occupation, who do they stay with ◦ History of current problem ◦ Past medical history ◦ Habits ◦ Family History ◦ Medications ◦ Daily life ◦ Review of systems ◦ Discuss also end of life decision Welcoming the patient ◦ Special techniques of communication ◦ Consider cognitive, hearing, visual problems ◦ Introducing yourself ◦ Asking preferenace ◦ You need enough time but not to much time that induce tirenedness ◦ Evaluating with family members/caregivers ◦ Especially the patients with cognitive problems Age, martial status, occupation, Who do they stay with ◦ Occupation ◦ If retired; when, reason ◦ Who do they stay with ◦ Alone, spouse, with relatives/siblings, with caregiver, in nursing home History of current problem ◦ They may have multiple problems Past medical history ◦ May have a long list of disease ◦ Cardivascular disorders ◦ HT ◦ Arrithmias ◦ Cancer ◦ Diabetes ◦ Surgeries ◦ Allergies (Food, drug) ◦ Ask periodic controls Medications ◦ Multidrug usage !!! ◦ Drug-drug interactions ◦ Control the doses, if its suitable ◦ Control if there is any unneeded ones Habits ◦ Tobacco/Alchol ◦ Duration of consumption ◦ Diet ◦ They may live alone ◦ They may not be able to meet their needs easily ◦ Preapearing a good meal may be difficult ◦ Swallowing difficulties, teeth problems may negatively effect the feeding Family History ◦ Ask if someone have similar problems ◦ Then common, important disorders ◦ The family history not only indicates the patient's likelihood of developing some diseases but also provides information on the health of relatives who care for the patient ◦ Knowing the family structure will help you to know what support may be available from family members, if needed. Daily life ◦ For understanding the patient functionality. ◦ It is important especially in dementia patients ◦ Ask questions about the daily life ◦ Basic activities of daily living (ADLs) (Eating, toileting, mobility) ◦ Complex instrumental activities of daily living (IADLs) ( Managing money, communication,transportation) ◦ Consider social status ◦ You may use scales for daily life activities Scales for daily life activities Review of systems ◦ Special attention to common problems of elderly ◦ Hearing problems ◦ Vision problems ◦ Swallowing ◦ Urinary sistem ◦ Gastrointestinal system ◦ Cardiorespiratory system ◦ Neurologic system ◦ Balance, falls ◦ Dementia Challenging features ◦ Easily getting tired ◦ Multiple chief complaints ◦ Hearing, vision problems ◦ Dementia Coping with challenging features ◦ Try to have the patient tell his or her story only once, not to another staff member and then again to you ◦ Special techniques of communication and interviewing skills. ◦ Sit and face the patient at eye level. Use active listening skills, responding with brief comments such as "I see" and "okay.« ◦ Touching also help them for calming ◦ Dementia patients may not understand the speaking language. You can use more then one stimulus. Coping with challenging features ◦ Special techniques of communication and interviewing skills. ◦ Try to use also open-ended questions that encourage a more comprehensive response. If the patient has trouble with responding, be prepared with yes-or-no or simplechoice questions. ◦ If the patient need help for his or her responce always kindly help ◦ Some elderly patient can easly become agitated. If you observe that the patient couldn’t answer your questions, dont ask the same question again and again. Change your method. Coping with challenging features ◦ Even if the patient have dementia talk with your patient not only with family ◦ Using screening instruments help to understand the situation especially about geriatric syndromes ◦ Daily life, depression, risk of fall, cognition, urinary incontinace ◦ Consider possible difficulties in transportation ◦ Reminder system for controls