Age-Related Changes that Affect History Giving
Sometimes the older patient is unable to provide a clear history for several good reasons. As we do with children, we need specific strategies to get a complete history. To the right, there are a list of factors that might affect history giving in the older patient.
Click on the factors to the right to learn more.
Strategies for Getting a More Accurate History
- Look for allies. Listen to the people who know the patient best. It is imperative to turn family members and caregivers and neighbours into your allies in caring for the older patient. What you’re interpreting as “grumpy old man,” reluctant to answer your questions, may actually represent a significant change in mental status for this person. If you don’t hear and listen to the daughter’s comment, “but this is just not like my dad!” then you will not pick up what is probably delirium from a serious infection or new subdural from an unwitnessed fall. (Review the case of Mrs. Sol in the Cognitive Impairment module.)
- Assemble all the family members around the bed and get their version of things;
- Call family members at home;
- See if you can reach the home care nurse or PSW who sees the patient at home;
- Call the nursing home to get a FULL story on what’s been going on (not just “weak” on the transfer note);
- Read the ambulance record carefully — it often contains details that are not available elsewhere;
- Call the family doctor;
- Review old records FIRST (hospital chart, nursing home chart, ambulance record) – even before you see the patient. It’s probably the most efficient way of gathering a complete past medical history.