Medical Investigations In Elderly
General Medical Investigations in the Elderly Population
Medicine classifies individuals who reach the milestone age of 65 years as ‘elderly’. Society recognises that they have entered a stage of life when physical and mental capacities have begun to decline. A clear understanding of aging and its requirements will help the elderly and their caregivers to maintain their health, manage their medical conditions, and enjoy improved Quality of Life (QoL) well into the last years of life.
Aging in a backdrop of good health will help you to avoid many of the natural changes associated with growing old, and also help you to differentiate these changes from those caused by chronic medical conditions. Assessing the health of an elderly individual begins with a detailed medical profile based on his or her medical history, conducted by a geriatric specialist. Such investigations are often necessary to identify, understand, and manage the health needs of the elderly. Health and medical investigations of the elderly should be undertaken in a holistic manner and should not target individual systems or organs. In an article on medical investigations of the elderly published in the ‘Journal of Palliative Care’, the authors take up the geriatrician’s dilemma and conclude that laboratory investigations of asymptomatic patients aged 80 to 90 years are generally unjustified because such treatments may not extend life but are likely to worsen QoL
In this backdrop, we shed some light on general medical investigation terminology for elderly medical investigations.
1. Complete Blood Count (CBC)/Full Blood Count (FBC)
This is a baseline test that usually includes:
White blood cell count (WBCs);
Red blood cell count (RBCs);
hematocrit (Hct)/Packed Cell Volume (PCV);
mean corpuscular volume (MCV);
average red blood cell size;
platelet count (plts)
Frequency: annual, or more frequently if necessary.
2. Erythrocyte Sedimentation Rate (ESR)
This test determines the rate at which red blood cells in anticoagulated whole blood descend in a standardised tube in one hour. The results determine whether there is an inflammatory or infective process.
Frequency: whenever deemed necessary. C Reactive Protein tests are now replacing ESR.
3. Blood Glucose Levels
These are random or fasting blood tests that reveal glucose levels in the blood. The results are used to screen, diagnose and monitor diabetes mellitus.
Frequency: As a screening test, once in six months for the elderly. If diagnosed with glucose metabolism problems, as instructed by doctor. In patients with diagnosed diabetes mellitus, the HbA1C test is also done alongside to assess long-term (3-month) sugar control.
4. Lipid (Cholesterol) Panel
This test measures the different types of cholesterol and related fats in the bloodstream and includes:
HDL - high-density lipoprotein (‘good’ cholesterol);
triglycerides - low-density lipoprotein (LDL), also known as ‘bad’ cholesterol to evaluate cardiovascular risk in older adults.
Frequency: annual for healthy seniors, bi-annual for those with diagnosed abnormalities, and on maximum dose of statin therapy.
5. Basic Metabolic Panel (Basic Electrolyte Panel)
Given to people who are on certain types of medication, such as for blood pressure, diuretics, blood acidity, and to determine kidney function. Tests:
blood urea nitrogen (BUN); and
Frequency: determined by doctor based on the existing or anticipated clinical situation.
6. Liver Function Test (LFT)
Tests the functional status of the liver including:
albumin and globulin;
AST (aspartate aminotransferase);
ALT (alanine aminotransferase).
Often used as a baseline in screening, diagnostics, and special tests depending on the clinical status of the individual.
Frequency: determined by the clinician.
7. Thyroid Function
These tests are used as a baseline for screening, diagnostic or special testing for thyroid disorders or to help calibrate the dosage of thyroid replacement medications. The most commonly used are:
TSH (Thyroid Stimulating Hormone);
T4 (free thyroxine);
Frequency: Annually, or once in eight weeks for patients on thyroxine therapy, particularly if the dosage has been changed.
8. Vitamin D
Vitamin D, the sunshine vitamin, is now recognized as important for health of the elderly, particularly women.
The routine measurement of Vitamin D levels are part of a baseline or screening investigative routine.
9. Vitamin B12
Includes the measurement of Vit B12 and Methylmalonic acid Vitamin B12 deficiencies, common in older adults, and linked to common problems such as fatigue, memory, and walking difficulties. It is part of a baseline or investigative screening routine.
10. Urine Full Report
This is an important and routine baseline test that is often overlooked.
How to maximise the benefits of your elderly investigations:
1. Be sure you understand why you have been asked to take a given test.
2. Ask your doctor to review the results and explain what they mean to 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.
Condensed from an article written by Dr. R. Haniffa (Consultant Family Physician) for Sunrise Magazine.
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