Assessing and interviewing the elderly: interpretation of signs and symptoms

Interviewing the elderly patient, typified by poor memory, often confused and sometimes hard of hearing, requires great patience and perseverance on the part of the physician to extract pertinent information from a complicated history involving past and present illnesses, multiple medications (both prescribed and over-the-counter), and social as well as economic issues. These circumstances may include retirement, death of a spouse and a change of living conditions. Assessment of these issues, followed by a careful physical examination, must lead to a diagnostic programme that is thorough yet practical, with consideration of the benefit of each procedure contemplated. The ultimate goal must be to renew the patient's ability to function as well as to improve the patient's quality of life. Many illnesses characteristic of the aged person are treatable but not curable. The goal is to improve the quality of life and to make the declining years as comfortable as possible. Typical cases illustrating these points are presented and discussed and their resolutions described.