By Atypical Presentation of Disease, we mean all of those “vague complaints” that can make assessment of the complex older patient so time-consuming and challenging in the ED. Weakness, dizziness, confusion, falls, functional decline, “just not right.” These are all real symptoms that are often the only clues of serious life-threatening conditions. The Emergency physician needs a deep understanding of how and why the older person presents with these vague symptoms and strategies for history gathering, physical exam, and diagnosis.
This module accompanies one patient on his midnight arrival in the ED. It uses his case to explore the anatomy, physiology, and pharmacology behind his atypical presentation. It introduces lots of material about history, physical exam, and differential diagnosis that will help you the next time you pick up a chart that says “weakness.”
At the end of this module you should be able to:
- Explain the link between non-specific symptoms (weakness, fatigue, “dizziness,” confusion, increased falls, functional decline) and life-threatening or treatable conditions
- Describe how adverse drug reactions, drug-drug interactions, and drug-disease interactions can present as “new” medical conditions
- Recognize normal age-related changes in anatomy, physiology, and lab investigations that influence symptom presentation
- List reasons that medical diagnoses in older patients can present with atypical symptoms (altered immune response, decreased adrenergic response, polypharmacy (one drug masks symptoms), cognitive impairment (inability to describe symptoms), decreased psycho-social support (no one around to monitor changes).