What questions should be asked during an initial assessment of a healthy 80-year-old (octogenarian) new patient?

From the Guidelines

When evaluating a healthy 80-year-old new patient, it is essential to inquire about their medical history, including any previous diagnoses, surgeries, or hospitalizations, as well as their current medication use, such as statins, antihypertensives, and any supplements 1.

Key Questions to Ask

• Current medication use, including dosage and frequency, such as statins (e.g., atorvastatin 20mg daily), antihypertensives (e.g., lisinopril 10mg daily), and any supplements (e.g., vitamin D 1000 IU daily) 1
• Vaccination history, including influenza (annual), pneumococcal (PCV13 and PPSV23), and shingles (Recombinant zoster vaccine, 2 doses, 2-6 months apart) vaccinations 1
• Functional status, including activities of daily living and mobility, using the Geriatric 5Ms framework, which consists of mind, mobility, medications, what matters most, and multicomplexity 1
• History of cardiovascular disease, cerebrovascular disease, and other medical conditions, such as hypertension, hyperlipidemia, diabetes mellitus, and sleep disorders 1
• Social determinants of health, including living situation, social support, and access to healthcare services 1

Additional Considerations

• Assessing the patient's cognitive and psychological domains, including cognitive function, depression, and anxiety 1
• Evaluating the patient's mobility and fall risk, including history of falls, balance, and gait 1
• Reviewing and reconciling medications, particularly high-risk medications, such as anticoagulants and sedatives 1
• Asking what matters most to the patient, including their values, goals, and preferences for care 1
• Assessing multicomplexity, including the intersection of multiple chronic conditions and social determinants of health 1

From the Research

Initial Assessment Questions for an 80-Year-Old Patient

When conducting an initial assessment of a healthy 80-year-old patient, several questions should be asked to gather comprehensive information about their health status. These questions can be categorized into different areas, including:

• Medical history:
  • What are the patient's current medications and dosages?
  • Are there any pre-existing medical conditions, such as hypertension, coronary artery disease, or lung cancer?
  • Have they experienced any recent illnesses or hospitalizations?
• Functional ability and frailty:
  • What is the patient's level of physical activity and mobility?
  • Do they have any difficulties with daily activities, such as bathing, dressing, or managing finances?
  • Have they experienced any recent falls or injuries?
• Cognitive skills:
  • Are there any concerns about the patient's memory or cognitive function?
  • Do they have any difficulties with communication or understanding instructions?
• Social support and patient preferences:
  • Who are the patient's primary caregivers or support systems?
  • What are their preferences for treatment and care, including end-of-life care?
  • Are there any advance directives or living wills in place?
• Laboratory tests and reference values:
  • What are the patient's current laboratory test results, such as blood work or urinalysis?
  • Are there any abnormal results that need to be addressed or monitored?
  • How do their laboratory test results compare to reference values for their age group 2?

Considerations for Older Adults

When assessing an 80-year-old patient, it is essential to consider their unique needs and health status. Older adults may have multiple comorbidities and age-related changes that can impact their health and treatment outcomes 3, 4, 5. They may also have different reference values for laboratory tests compared to younger adults 2. Additionally, older adults may be more susceptible to cardiovascular disease, hypertension, and other age-related conditions, which should be taken into account during the assessment process 6.

Cardiovascular Health

Cardiovascular health is a critical aspect of an 80-year-old patient's overall health. Questions should be asked about their cardiovascular history, including:

• Have they experienced any cardiovascular events, such as heart attacks or strokes?
• Do they have any cardiovascular risk factors, such as high blood pressure, high cholesterol, or diabetes?
• Are they currently taking any medications for cardiovascular conditions, such as beta blockers or statins?
• Have they undergone any cardiovascular procedures, such as angioplasty or bypass surgery? 5

Respiratory Health

Respiratory health is also an essential aspect of an 80-year-old patient's overall health. Questions should be asked about their respiratory history, including:

• Have they experienced any respiratory conditions, such as chronic obstructive pulmonary disease (COPD) or lung cancer?
• Do they have any respiratory symptoms, such as shortness of breath or coughing?
• Are they currently taking any medications for respiratory conditions, such as inhalers or oxygen therapy?
• Have they undergone any respiratory procedures, such as lung surgery or pulmonary rehabilitation? 3