From the Guidelines
When conducting an assessment on an adult, particularly an older adult, healthcare providers should apply the "Geriatric 5Ms" framework, which consists of evaluating the mind, mobility, medications, what matters most to the patient, and multicomplexity, to manage the patient's care effectively. This approach is crucial in older adult care, as emphasized in a recent study published in the Mayo Clinic Proceedings in 2024 1. The study highlights the importance of considering the cognitive and psychological domains of a patient's health, evaluating mobility and fall risk, reviewing and reconciling medications, understanding the patient's priorities, and assessing the intersection of multiple chronic conditions and social determinants of health.
Key components of the assessment include:
- Evaluating the patient's cognitive and psychological health, including screening for dementia, depression, and anxiety
- Assessing mobility and fall risk, including evaluating the patient's ability to perform daily activities and their risk of falling
- Reviewing and reconciling medications, particularly high-risk medications that may exacerbate geriatric syndromes
- Asking what matters most to the patient, including their goals, values, and priorities
- Assessing multicomplexity, including the intersection of multiple chronic conditions, social determinants of health, and other factors that may influence the patient's health care management
By applying the Geriatric 5Ms framework, healthcare providers can develop a comprehensive care plan that addresses the unique needs of older adults, reduces disability, hospitalization, and institutionalization, and improves quality of life, as supported by the study published in the Mayo Clinic Proceedings in 2024 1. This approach is particularly important given the predicted shortage of geriatricians and the growing population of older adults, making it essential for all clinicians to have basic fluency in older adult care.
From the Research
Conducting a Physical Assessment on an Adult
The process of conducting a physical assessment on an adult involves several steps, including:
- Identifying the purpose of the assessment 2
- Taking a health history, which is a crucial step in diagnosing and managing health conditions 3
- Choosing a comprehensive or focused approach, depending on the patient's needs and presentation 2
- Examining the patient using the sequence of inspection, palpation, percussion, and auscultation 2
History Taking
History taking is a structured but flexible process of gathering relevant information from patients to inform diagnosis and treatment 3. Important communication skills for nurses when history taking include:
- Active listening
- Empathetic communication
- Cultural sensitivity By actively engaging the patient in a conversation about their health issues, the nurse facilitates their participation and autonomy 3.
Laboratory Tests and Physical Examination
Laboratory tests, such as a comprehensive metabolic panel, can provide valuable information about a patient's health status 4, 5. A physical examination, including inspection, palpation, percussion, and auscultation, can also help identify abnormalities and inform diagnosis 2. In some cases, a point-of-care test may be used to reduce length of stay in the emergency department 5.
Special Considerations
In older adults, unintentional weight loss can be a significant concern, and a comprehensive evaluation, including laboratory tests and physical examination, may be necessary to identify the underlying cause 6. Social factors, such as isolation and financial constraints, should also be considered as potential contributing factors 6.