Medical Investigations In Elderly
General Medical Investigations in the Elderly Population
For medical purposes the segment of the population over the age of 65 years are classified as elderly. Being classified as elderly has numerous implications in the maintenance of health, investigations, and the treatment of health issues.
It is extremely important to have a clear idea of the definition of aging if one wants to care for the elderly with dignity, compassion understanding and empathy.
The aim of care of the elderly is to preserve function with a view to improving it and there by contribute towards an improved Quality of Life (QoL). It is important to appreciate that most elderly will age in a backdrop of ‘Good Health’. These individuals will demonstrate non pathological changes associated with aging. Some others will age in the backdrop of having one or more chronic health conditions. In these individuals it is important to identify and appreciate the changes to the pathological process and contrast it with the inevitable changes of chronological aging.
In the process of assessing the elderly, medical professionals will resort to obtaining a history from the individual and go on to perform a detailed or focused clinical examination (as the situation demands) and inevitably resort to a series of investigations to complete the process of identifying, understanding and managing the health of the elderly individual. Management/investigation of the elderly should be undertaken in a holistic manner and should not target individual systems or organs.. In an article published in the Journal of Palliative Care [9(3), 50-52. 1993] by Honteal and Reddon titled Medical investigation in the elderly: The geriatricians dilemma, conclude that ‘laboratory investigations in asymptomatic patients after the age of 80 to 90 years are generally not justified, because the treatment of asymptomatic conditions in this population may not extend life but may quite worsen their quality of life’.
In this backdrop this article will attempt to shed some light on the basis of use of general investigation in the elderly population.
Common ‘panels’ in laboratory blood testing
1. Complete Blood Count (CBC) / Full Blood Count (FBC) - FBC is a collection of tests related to the cells in your blood. It usually includes: White blood cell count (WBCs): Red blood cell count (RBCs): Hemoglobin (Hb): Hematocrit (Hct)/ Packed Cell Volume (PCV): Mean corpuscular volume (MCV): the average size of red blood cells: Platelet count (Plts): How frequently should it be done: done as baseline test on yearly basis. It may be done more frequently as recommended by your doctor if there is a clinical need.
2. Erythrocyte Sedimentation Rate (ESR) - The rate settling of red blood cells in millimetres in one hour What it is used for : to determine if there is an inflammatory or Infective process Frequency: when the doctor has justification to do so C Reactive Protein- Now many doctors use this to replace the ESR.
3. Blood Glucose levels – Random or Fasting represent the amount of sugar in the blood. What it measures – The Glucose level in the blood. What it is used for – To screen, diagnose and monitor Diabetes mellitus Frequency – As a screening test, once in six months in the elderly. If there is diagnosed problems with metabolism of glucose , then done as per instruction of the doctor In patients with diagnosed diabetes mellitus the HbA1C test is also done along with blood sugar levels to assess the long term (3 month) sugar control.
4. Lipid (cholesterol) panel - These tests measure the different types of cholesterol and related fats in the bloodstream. The panel usually includes: Total cholesterol, High-density lipoprotein (HDL), also known as “good” cholesterol: Triglycerides: Low-density lipoprotein (LDL), also known as “bad” cholesterol What it is used for: to evaluate cardiovascular risk in older adults. Frequency: may be done annually. But In those with diagnosed abnormalities, and on maximum dose of statin therapy it may be done bi-annually.
5. Basic metabolic panel (basic electrolyte panel) - Sodium: Potassium: Chloride: Carbon dioxide / bicarbonate: Blood urea nitrogen (BUN): Creatinine What it is used for: often monitored when people take certain types of medications, such as blood pressure medications, or diuretics, the acidity of blood, and to determine the kidney function. Frequency–decided by doctor based on the existing or anticipated clinical situation.
6. Liver Function Test (LFT) - The functional status of the liver What it contains: Total protein: Albumin and Globulin: Bilirubin (total): Alkaline phosphatase: AST (aspartate aminotransferase):ALT (alanine aminotransferase) What is it often used for: as a base line, screening, diagnostic and special test depending on the clinical status of the individual. Frequency– Should be decided by the clinician.
7. Tests Related to Thyroid Function - These tests can be used to screen for thyroid disorders, or to help calibrate the dosage of thyroid replacement medications. The most commonly used tests are: TSH (Thyroid Stimulating Hormone), T4 (free thyroxine), T3 (triidothyronin) What its used for: Used as a baseline, screening, diagnostic or special test. Frequency– In patients on Thyroxine therapy it should be done 0nce in 8 weeks (particularly if the dose of thyroxine has been changed). Otherwise done annually.
8. Vitamin D levels - Vitamin D, the sunshine vitamin is now recognized as important for health of the elderly- particularly women. It is important to have an idea of one’s vitamin D status The recommendations of routine measurement of Vitamin D levels are still being determined precisely; but it would be prudent to measure it as part of a base line or screening investigative routine annually.
9. Vitamin B12 levels - This Includes measurement of Vit B12 and Methylmalonic acid Vitamin B12 deficiency is quite common in older adults, and can be related to common problems such as fatigue, memory problems, and walking difficulties.It would be prudent to measure it as part of a base line or screening investigative routine annually.
10. Urine Full Report - This is an important but often over looked but simple test which should be done as part of any base line and routine tests in elderly.
Tips to maximise the benefit from your investigations
1. Be sure you understand why a given test is being ordered.
2. Ask your doctor to review the results and explain what they mean for your health.
3. Ask your doctor to explain how your results compare with your prior results.
4. Request copies of your results, and keep them in your own record system.
- Edited from article by Dr R. Haniffa (Consultant Family Physician) for the Sunrise Magazine Elder Care Investigation package available at HLC.
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