History-taking forms and the care of geriatric patients

Certain historical aspects peculiar to the biology of elderly people may be obscure to the medical observer and need to be fully incorporated in a formulation of a person's state of health. History forms from four acute teaching hospitals and six long-term care facilities were reviewed for the presence of designation of functional assessment, multiple chief complaints, a subjective comment by the patient indicating his degree of health, specifics of home-living arrangement, supporting services received, and dietary history. Ten physical diagnosis course directors were contacted to determine whether their courses emphasize elicitation of multiple chief complaints, the wide spectrum of presentations of acute illnesses in the elderly, specifics of functional assessment, and the need for special techniques of communication and interviewing skills relevant tot he elderly. The study, conducted in the Boston area, indicates that medical students and physicians-in-training are receiving variable and incomplete instruction about the total health care needs of elderly people.