Tips for Health Assessments
By MJ Henderson
When examining an older adult, especially a frail older adult, in an office setting, it is easier on the patient to evaluate the patient on a low exam table or in a chair. It is best to have a stool on wheels that can move up and down to allow the examiner to be at the patient’s eye level.
Skin Assessment
On morning rounds in the nursing home or hospital setting, when examining the resident’s skin (scalp, hair, ears, back, elbows, buttocks, and heels), consider performing the exam before the resident gets out of bed. It will be less disruptive for the resident, allow a good view of the pressure points on the skin, and will ensure the resident is warm during the exam.
Mouth Exams
Check for food lodged in the cheek pockets and hard palate, especially in patients with dementia or physical challenges who no longer have the ability for self-care. Check the gingiva for erythema and bleeding. Examine the tongue for dryness. As people age the gingiva shrinks and false teeth may not fit as snuggly. Check for loose teeth in residents with false teeth.
Foot Exams
Foot exams should be done on all older adults with diabetes and those with peripheral vascular disease at each exam. Check for sensation, temperature, pulses, and skin/nail integrity. It takes less than 1 minute to take off shoes and socks and what you find may save a foot or a life! Do not abdicate your responsibility to the podiatrist who may not see the patient regularly.
Remember, if an older adult cannot chew and swallow, ambulate, or breathe freely, there could be a cascade of negative events downstream.
MJ Henderson, MS, RN, GNP-BC
Education Committee
mj@mjhsb.com