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should be done every 2 yrs in women
over 65yrs or earlier in those with
risk factors. Elderly patient in geriatric
homes should be exposed to sunlight
for at least 15 Minutes to get the full
benefit of vitamin D.
Mental State Exam
A patient’s ability to follow instructions
depends on their mental state. The
Folstein Mini Mental state exam is a
simple form, which the patients fills
out. This tests the cognitive function
and a score is given. Done yearly after
the age of 60yrs, it can pick up early
cases of dementia. Approximately 3-
5% of individuals will have dementia
by age 65yrs and 20% by the age of
80yrs.
Vision Screening
All patients over 65yrs should
be evaluated every 1-2yrs for the
presence of cataract (the whitening
of the lens in the eye) also glaucoma
(increase pressure in the eye), which
may cause patients to see halos around
lights, some get eye pain, others may
get no signs at all. With aging, reading
spectacles may be necessary from 45
yrs.
Hearing Testing
Maintaining as much independence
in a patient is important for their
emotional well being and their ability
to listen to instructions. Ear wax can
easily be dissolved by ear drops or
flushed by the physician. A simple
whisper test at to each ear would
determine if to proceed to audio
metric testing and the need for a
hearing aid. Close to 1/3 of persons
over 75yrs have some degree of
hearing loss.
Pelvic Exam
This involves looking at the vulva
to look for changes in pigmentation
(colour of the skin) and dry excoriated
areas that itch, growths and ulcers
(sores). Biopsies are done on all
suspicious areas. The patient is
examined for uterine prolapse, this
usually occurs in post menopausal
women where the pelvic floor muscles
become weak and the uterus (womb)
actually descends down the vagina
and may even protrude outside
the vagina. This may contribute to
incontinence of urine where the
patient cannot hold up her urine The
patient is also checked for bladder
prolapse into the vagina (cystocele).
After menopause the lack of estrogen
causes thinning of the vaginal wall
leading to atrophy and shortening of
the vagina. Dryness of the vagina can
easily be corrected by a hormonal
cream. Insertion of a vaginal ring
and even surgery can relieve uterine
prolapse.
After the physical examination the
doctor usually gives you an overall
assessment of your health. Other test
may be ordered like a chest X Ray,
if you are a smoker or joint X Ray if
arthritis is suspected (33.6% of patients
over 65yrs suffers from osteoarthritis).
An electrocardiogram may be ordered,
if heart disease runs in your family.
Immunization Schedule
Influenza : Given annually in women
>50yrs.
Tetanus-Diphtheria : Booster to be
given every 10 yrs.
Polio( inactivated): Booster every 10
yrs ,especially to those patients who
are exposed to young children who
have been given the live oral polio
vaccine.
Pneumococcal -Given every 5 yrs
in women older than 65yrs.This can
help reduce the risk of developing
pneumonia.
Shingles-Once you have been exposed
to chicken pox, the virus lives in your
system and as your immunity weakens
with age, the painful rash of shingles
can occur (1 in 3 patients). This
vaccine is not yet available in Trinidad
but patients who travel to the U.S.A.
can easily obtain it.
The main goal of the health care giver
is to ensure that the patient can remain
as independent as possible, stay
socially engaged and enjoy a good
quality of life.
