Physical examination
clinical features of disease conditions in senior citizens may not be similar than the young person Generally clinical signs and symptoms in them are non specific and vague. During history taking and in examination, vaidya need to provide special emphasis on physical & mental health conditions apart from functional status, social and economic status and environmental characteristics.
The following activities of daily living (ADL), instrumental activities of daily living (IADL)and advanced activities of daily living (AADL) should be assessed to know the functional status of daily living.
ADL consist Bathing, dressing, toileting, continence, transferring, feeding and alike.
IADL This include Use of telephone, public transport, shopping activity, cooking activities, housekeeping, laundering ,proper medication and management of personal finance.
AADL contains Occupation related activities, traveling, volunteer activities, recreational activities, community tasks,and organizing of events.
Before examining senior citizens following details are required to be recorded in order to get assistance in diagnosis, counseling / management.
Education
Marital status, number of children, present status of family/ care provider
Present and/ or previous occupation
Financial status/ monthly income and age of menopause (in female senior citizen)
Habits - Smoking, alcohol consumption, drug abuse and any other..
Details of present medication, use of over the counter (OTC) drugs if any, previous illness.Home environment, dependency if any.
Details about sleep and appetite
History of recent falls/ injuries
After recording the details following general physical examination are need to be carried out.
Weight, height, BMI, Temperature, Respiratory rate
Blood Pressure at both lying and standing position and in both hands
Pulse - radial and other peripheral pulse
Examination of mouth for bleeding or swollen gums, loose or broken teeth, dental caries, fungal infections and signs of cancer.
Examination of abdomen for weakness of abdominal muscles and also for Hydrocele, Swellings, Growth,Lumps .
The spine is examined for scoliosis and tenderness. low back, hip, and legs.
pain with tenderness in sacral region may indicate spontaneous osteoporotic fractures of the sacrum.
Examination for the voluntary and involuntary movements
Extremities to be checked for any tenderness, swelling, muscle wasting, flexion, 0extension and movement difficulties, deformities, nodules etc.
Any difficulties in sitting, standing and walking, check for upper and lower limbs movement by asking -
To pick up any item like pen/pencil or alike.
To sit on chair and get-up from chair.
To walk for 10-15 feets.
Senior citizens generally complaints pain or difficulty in its movement in shoulder and elbow hence
Examination of joints for any functional impairment including tenderness, swelling, flexion, extension and movement difficulties, stability, deformities is essential.
Status of hydration and dehydrational stage can be examined by presence/ absence of sweating in the axillary regions.
Conventional examination like skin elasticity, oral cavity for dryness, sunken eyes may not be reliable as these may be due to ageing changes.
Mental status and orientation, behavior and emotional status should be assessed and recorded. Depression, dementia and confusion states are common in senior citizens.
After completing the general physical examination, examination of special senses is to be carried out.
Both eyes should be examined for visual acuity using a Snellen chart OR logMAR chart, visual fields. Checking for corneal opacity, ulcers and any growth.Iintra ocular pressure (IOP)need to be recorded in order to rule out glaucoma and ophthalmoscopic examination should be done to check for cataract, optic nerve or macular degeneration and evidence of glaucoma, hypertension and diabetic retinopathy.
Whisper voice test: Hearing test should be done for both ears. To avoid lip-reading,whisper 3 to 6 words or letters into each of the senior citizen ears (12 inches away from testing ear) behind the patient and ask whether it is audible?.
The external auditory canal should be examined for cerumen, especially if a hearing problem is noted during the examination.
Thefollowing mental state in senior citizen also essential to be examined.
Cheerful / sad
Well presented/ disheveled with a neglected appearance
In women, breast and cervical cancers are the common cancers. Hence, breast and cervical examination in female along with cervical Pap smear is also an essential part of examination. Checking for any symptoms due to hormonal imbalance occurring after menopause.Perineal and anal region may also to be examined for presence of hemorrhoids, fissures, fistula or any other ano rectal disorders.
A digital rectal examination (DRE) is vital part in both sexes to detect a mass, stricture,tenderness or fecal impaction and especially in senior citizen males, to rule out the prostatic enlargement and prostatic cancer.
Faecal and urinary incontinence should be recorded by history of bed wetting and urgency in faecal evacuation.
Any difficulties in the following basic activities of daily living should be enquired and evaluated for any pathology for those difficulties.
Bowel movements
Bladder emptying
Toilet use
Feeding
Dressing
Transfer/ movement
Bathing
Climbing stairs/ movement
Once the above examination is completed, systemic examination is to be carried out. Every system is to be examined even if there are no complaints relating to it, because asymptomatic pathology may be discovered which has vital importance.
Management measures in senior citizens
Some important points should be kept in mind before managing for any ailment in elderly.
1. Prognosis and chronicity of disease may not be assessed due to ageing process.
2. There should be clear indication about doses and duration of drug. There are some difficulties to take medicine in elderly. Suitable dosage forms should be choosen considering the palatability, ease of administration like syrup, avaleha, vati, bhasma et
3. Ayurveda recommends less doses of medicine in elderly than the adult dose. This is to be kept in mind while prescribing the medicine to senior citizens.
4. Due to reduction of memory possibilities of over or missed doses in senior citizens can not be ruled out in order to avoid this, proper lebeling should be done and checked by vaidya during subsequent visits.
5. In addition to these things physio-therapy may be advised with treatment to improve the quality of life in in senior citizens if they have some kind of neuro-muscular disorders.
Panchakarma therapy in senior citizens
In view of increased incidence of various disorders attributable to change in life style and environmental conditions globally, it is imperative to adopt safe and effective regimen that could effectively manage such conditions. Panchakarma is indicated in wide range of health conditions for prevention and cure of diseases. It cleanse systems of the human body by expelling out cumulated toxic metabolites (waste products) from the body; maintain normal functioning of tissue, digestion, metabolism, mental function and improve the immune system.
Reference
AYURVEDIC MANAGEMENT OF SELECT GERIATRIC DISEASE CONDITIONS
CENTRAL COUNCIL FOR RESEARCH IN AYURVEDA AND SIDDHA
Department of AYUSH, Ministry of Health & Family Welfare
Government of India, New Delhi - 110 058
