Assessment > Assessment of Older Patients 

Assessment of Older Patients

Dementia

Delirium

Chronic

Acute

Poor attention is a late event

Poor attention is characteristic

No clouding of consciousness

Consciousness often affected and fluctuating

Hallucinations are a late event

Hallucinations common

  • Often complicated by patients cognitive impairment and health status.

  • Collateral history may be essential.



Differentiating Dementia from Delirium

























Differentiating dementia from pseudo dementia (attention and concentration deficits secondary to depressive disorder)

Dementia

Pseudo dementia

Slow onset

Rapid onset

No personal or family history of mood disorder

Personal or family history of mood disorder

Onset not associated with mood symptoms

Onset associated with  mood symptoms

Higher cortical dysfunction (apraxia, aphasia) present

Higher cortical dysfunction (apraxia, aphasia) usually absent

Memory loss for recent events predominates

Memory loss for recent and remote events

Patient does not report memory problems

Patient will report memory problems

Provides incorrect answers on cognitive assessment

Provides “don’t know” answers on cognitive assessment

History of Presenting Complaint
  • Patient’s view of changes in memory.

  • Patient’s view of changes in social, occupations and self-care functioning.

  • Full exploration of mental state including directed questions on mood and psychotic symptoms.

Cognitive Assessment
  • Cognitive screening test such as mini mental state (MMSE).

  • If cognitive impairment is suspected; a formal assessment should be considered such as neurophysiological testing.

Social History
  • Social supports in community.

  • Support at residence.

  • Activities of daily living- mobility, washing, bathing, cooking etc.

  • If concerns with elder abuse, further investigation for potential safeguarding concerns.

Taking A Collateral History
  • History of changes noted in terms of onset, nature and length of potential decline.

  • Details of any personality change or behavioural difficulties- consider safety such as aggression, wandering.

  • Activities of daily living- safety in terms of falls, traffic etc. 

  • Level of social support- supports at home and in the community.

  • Others view of their needs and risks.