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
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Often complicated by patients cognitive impairment and health status.
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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
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Patient’s view of changes in memory.
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Patient’s view of changes in social, occupations and self-care functioning.
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Full exploration of mental state including directed questions on mood and psychotic symptoms.
Cognitive Assessment
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Cognitive screening test such as mini mental state (MMSE).
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If cognitive impairment is suspected; a formal assessment should be considered such as neurophysiological testing.
Social History
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Social supports in community.
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Support at residence.
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Activities of daily living- mobility, washing, bathing, cooking etc.
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If concerns with elder abuse, further investigation for potential safeguarding concerns.
Taking A Collateral History
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History of changes noted in terms of onset, nature and length of potential decline.
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Details of any personality change or behavioural difficulties- consider safety such as aggression, wandering.
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Activities of daily living- safety in terms of falls, traffic etc.
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Level of social support- supports at home and in the community.
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Others view of their needs and risks.