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Physical Examinations IV

The 4 M’s Framework: Case History and Physical Examination of Older Adults

Published: April 30th, 2023

1Yale School of Medicine

To meet the needs of older adults, all health professionals should be well acquainted with the history and physical examination considerations unique to this population. Physical examination plays an important role in the older patient to detect physiologic changes of aging, risk factors, and signs of pathology. While most of the general principles of the standard examination for adults apply to older patients, there are additional specific considerations. For example, focused examinations of cognitive and functional status are critical, as are assessments of hearing, vision, nutritional status, and the nervous system. This video will provide an overview of key aspects of the physical examination in older adults, including the use of standardized tools such as the 4 M's, the Timed Get Up and Go, and the Mini-Cog.

1. General considerations in the older adult

  1. Prior to beginning the physical examination, ensure that the patient is comfortable (that is, not in pain, does not need to use the restroom) and ask about any specific sensory considerations that you should be aware of during the encounter (that is, vision and hearing impairment).
  2. Observe for nutritional deficiencies, including malnutrition. Monitor for weight loss on recent visits or changes in the fit of clothing. Assess for temporal wasting, atrophy o.......

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Normative Range Abnormal Test
Pulse Pressure (systolic blood pressure-diastolic blood pressure) 40 mmHg >40 mmHg may indicate stiff vasculature 2/2 atherosclerosis
Orthostatic Vitals Systolic Blood Pressure Standing < 10 mmHg than S.......

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