Geriatric Assessment Pearls

General Guidelines
■ Be mindful that the elderly may be hard of hearing, but never assume that being elderly automatically makes it hard to hear.
■ Approach and speak to elderly Pts as you would any other adult Pt. It is insulting to speak to the elderly like a child. Speaking slowly is sometimes necessary, but does not indicate decreased intelligence.
■ Eye contact helps instill confidence and, in the presence of impaired hearing, it will help the Pt to better understand you.
■ Be aware that decreased tactile sensation and ROM are both normal changes with aging. Care should be taken to avoid unnecessary discomfort or even injury during an assessment.
■ Be aware of generational differences, especially gender differences (e.g., modesty for females, independence for males).
■ Assess for altered mental states. Use your “3-D Vision.”
■ Dementia: Cognitive deficits (memory, reasoning, judgment).
■ Delirium: Confusion/excitement marked by disorientation to time and place, usually accompanied by delusions and/or hallucinations.
■ Depression: Diminished interest or pleasure in most or all activities.

Age-Related Chan Age-Related Changes and Implicationsges and Implications
Decreased skin thickness	Elderly Pts are more prone to skin breakdown and should be assessed more frequently for pressure sores.
Decreased skin vascularity	Altered thermoregulation response can put the elderly at risk for heat stroke.
Loss of subcutaneous tissue	Decreased insulation can put the elderly at risk for hypothermia.
Decreased aortic elasticity	Increased diastolic blood pressure.
Calcification of thoracic wall	Obscured heart and lung sounds and displacement of apical pulse.
Loss of nerve fibers/neurons	Allow for extra time to comprehend, to learn, and to perform certain tasks.
↓ nerve conduction	Response to pain is altered.
Reduced tactile sensation	Puts Pt at risk for injury to self.