Examination of an Older Patient Component What to do/rationale Ask about name Ask about age and date of birth Ask about day and date Ask about present presentation. Geneal inspection If disorientation present Delirium -> acute and reversible Dementia -> chronic and irreversible. Look for pressure sores More important for patients immobile in hospitals or nursing homes. Blood pressure Check for blood pressure Dry mucus Reduced skin elasticity Hydration Status Often reduced in older patients with cognitive dysfunction. Calculate BMI Low weight may also be due to inability to prepare foot, eat (dental or swallowing issue, depression or bowel problems including cancer. Eyes and ear Check vision Vision CN examination Check ears and hearing Hearing CN examination Face These may impair independent living. Mouth Check for dentition Dry mouth May impair eating. Heart rate Heart block Bradycardia Causes syncope and dizziness. Chest Look for signs of pacemaker. Auscultation Heart and lungs If systolic murmur -> could be aortic stenosis. Lungs Look for evidence of COPD: Overinflated lungs Wheeze Hoover’s sign Look for features of interstitial lung disease: Fine basal inspiratory crackles. Breasts Breast examination in women. Palpable abdominal aorta. Thin an elderly patients may be falsely interpreted as an aneurysm. Palpate GIT Patients with constipation from a hard stool may be felt in the LLQ. For patients with acute urinary retention -> may be present in patients with delirium. Perform a DRE. MMSE or Mini-Cog. Check for gait Normal standing Toe standing Nervous System Heel standing Normal walking One foot in front of the other Tip toe walking Heel walking Rheumatological Examine for deformities and functional disabilities. Legs Edema