Role of Physical Examination in Elderly

Introduction:

Physical well-being is the ultimate goal of a healthy lifestyle. However, aging causes several physical and functional changes in the body. As a result, age-related changes in the elderly individuals are evident. That is why physical well-being and functional assessment are important.

What Is the Need for Physical Examination in the Elderly People?

The physical examination involves assessing objective anatomical findings by observing, feeling, tapping, and listening to various parameters. It is crucial to carefully combine this information with the patient's medical history and underlying disease processes. In the elderly people, a lot of physical changes can be seen. These are;

1. In the heart, the cardiac index and the cardiac output are altered. Increased age causes decreased functionality of the cardiac muscles. Also, an increased afterload in the heart is responsible for shape changes. Because of these changes, cardiac diseases are not always present.

2. Aging causes thickening of the walls of arteries and deposition of collagen in the middle layer of the blood vessels. As a result, the elasticity of the blood vessels is altered. This causes hypertension in elderly patients.

3. Age changes in the lungs cause a decrease in lung capacity. Apart from this, a decrease in the total lung volume capacity and ratio of residual volume to total lung capacity are observed in older people. Morphological changes due to aging in the alveolar epithelium cause a mismatch of ventilation and perfusion.

4. Elderly individuals experience neural changes due to degenerative alterations in neurons, leading to decreased nerve impulse conduction speed and fluctuations in neurotransmitter levels. Additionally, a decline in gray and white matter in the brain results in diminished brain functionality.

5. A decrease in kidney weight and volume is observed in the elderly population, which can be attributed to a decline in the number of glomeruli within the kidneys. This alteration in renal function leads to dehydration and ion alliteration in the body.

6. Increasing eye changes cause a reduction in the visual fields. Changes in the curvature of the cornea cause a change in the refraction in the elderly, along with these changes in the corneal luster and corneal sensitivity.

7. Changes in metabolism and physiological changes in the tissue cause muscle mass loss. Also, hormonal changes in the body cause loss of bone strength. As a result, functions like neuromuscular coordination and body balance are lost.

The goal of physical examination is to assess the age-related changes seen in elderly people. Also, physical examination helps to understand physical changes in elderly people. This further aids in the diagnostic processes.

What Are the Different Physical Examination?

Different physical examinations that are used for elderly people are:

1. Vital Signs Assessments: Vital signs are different physical parameters that are indicators of physical well-being. Temperature is one of the first things to be checked under this category with the help of a thermometer. A higher temperature than normal is indicative of fever. Fever is associated with systemic infections like urinary tract infections, pneumonia, and viral infections. Blood pressure and pulse rate are to be checked. Elderly people usually have slightly higher blood pressure due to physiological changes in the blood vessels. However, high blood pressure is observed in patients with hypertension and cardiac diseases. Irregular pulse rate is seen in patients with heart problems. The respiratory rate and the heart rate of elderly individuals are also assessed. The respiratory rate of the elderly is a little higher than that of young individuals. Apart from this, the nature of the respiration and heart rate is also evaluated. The presence of any abnormal sound during respiration or in the heartbeat signifies pathological conditions.

2. Assessment of Different Organs: Different organs like eyes, ears, and skin are assessed to evaluate physical well-being. Eye-related evaluations are done to determine age-related changes such as cataracts, macular degradation, and glaucoma. Examinations like the detection of visual acuity and pupil size are evaluated. Any change in the eyelid margin or palpebral aperture is noted. The evaluation of the cornea is done to evaluate age-related corneal changes. An ear examination is done to determine hearing ability. Initial examination of the ear is done through visualization and palpation. Any changes in the skin, such as erythema or desquamation. An otoscope is used to evaluate the ear canals. In elderly patients, age-related, gradual, bilateral, and symmetric hearing deficits are seen. These are evaluated by different hearing tests like free-field hearing tests or fork tests.

Skin is the largest organ in the human body and may show various changes due to aging. The presence of moles, papules, and rashes in the skin is suggestive of skin disorders due to viral and fungal infections. The presence of small bleeding spots in the skin can be observed due to bleeding disorders or blood problems. The presence of non-healing ulcers in the skin is suggestive of cancerous lesions. Also, nails and nailbeds are evaluated.

1. Musculoskeletal Assessment: Various musculoskeletal assessments are essential to determine neurological well-being and muscle functionality. Gait and the posture of elderly individuals are evaluated for this purpose. Physical functional assessment is done through tests like the handgrip strength test and 400-meter walking test. Factors like walking speed, symmetry during walking, and rhythm are assessed for this purpose. Apart from this, joint mobility and muscle strength tests are done.

2. Neurological Assessment: Elderly persons often suffer from neurological complications due to degeneration of the brain and nerve fibers. Evaluation of all the twelve cranial nerve functions is done through various examinations. Motor functions are detected by the presence of tremors. Assessment of various reflexes is also done. Apart from this, neuromuscular coordination is examined.

3. Assessments of Various Body Parts: Assessments of various body parts are done through inspection and palpation. The shape of the body parts like the chest, abdomen, and breast is done. Abnormal shape of the abdomen is seen in diseases like fatty liver. A change in the shape of the breast and the presence of abnormal mass is observed in patients suffering from breast cancer. Assessment of the prostate gland through digital palpation is done in patients who might suffer from benign prostatic hyperplasia.

Conclusion:

The physical examination aims to determine physical well-being through various examinations. Physical examinations are rapid and non-invasive methods to determine age-related changes in elderly people. Also, these tests are helpful to identify age-related physical and functional changes in the body.