Practice The Competent Novice

A quick ward assessment of older patients by junior doctors

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h607 (Published 19 March 2015) Cite this as: BMJ 2015;350:h607
  1. S E Kurrle, professor in health care of older people,
  2. I D Cameron, professor of rehabilitation medicine,
  3. R B Geeves, consultant geriatrician (retired)
  1. 1Northern Clinical School, Faculty of Medicine, University of Sydney, NSW 2065, Australia
  1. Corresponding author: S E Kurrle kurrle{at}bigpond.com

The bottom line

  • The quick assessment of the unwell older patient can inform more detailed later assessment and appropriate management

  • Collateral information from a family member or other health professional provides useful information on current and background problems and function, and may save time

  • Focus questions on the current problem and identify chronic underlying conditions

  • Check medications

  • Assess daily function, current mobility, vision, and hearing to identify a decline and suitable interventions

  • Assess cognitive function, as people with dementia or delirium are more likely to have adverse events, and delirium is often unrecognised

Case scenario: part 1

Mrs Brown is an 82 year old woman, living alone, who has been brought into the emergency department after her daughter found her “very muddled” at home. She is apparently normally cognitively intact and manages well independently at home. You are asked to assess her for admission.

Older people are core business in most emergency departments and acute hospitals.1 Yet acute hospitals can be dangerous and unfriendly places for older people,2 and the less time they spend in hospital, the less harm is likely to occur to them. Competent assessment and formulation of an accurate problem list can minimise inadequate or incomplete recognition of problems and inappropriate treatment, which can result in poor outcomes for the older person, including decline in function and increased mortality.3 This paper advises how a quick assessment can inform more detailed later assessment and management.

How best to do it?

Ideally the assessment of an older patient should be comprehensive, extending beyond the standard history and clinical examination. Comprehensive geriatric assessment is multidimensional and interdisciplinary, and includes a full review of the patient’s medical and health issues, and physical, psychological, and social functioning. Systematic reviews have shown the benefits of comprehensive geriatric assessment, with a recent Cochrane review concluding that older people who underwent such assessment had …

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