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

Source: Jennifer A. Ouellet and Jaideep Talwalkar; Yale 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

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).
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

	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 Log in or to access full content. Learn more about your institution’s access to JoVE content here 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. Healthcare professionals should be acquainted with an evidence-based m Log in or to access full content. Learn more about your institution’s access to JoVE content here Tags Keywords 4 M s Framework Physical Examination Older Adults Age Friendly Health System What Matters Mobility Medications Mentation Polypharmacy Beers List Deprescribing Cognitive Impairment -- Views Privacy Terms of Use Policies Contact Us Recommend to library JoVE NEWSLETTERS Research JoVE Journal Methods Collections JoVE Encyclopedia of Experiments Archive Education JoVE Core JoVE Business JoVE Science Education JoVE Lab Manual Faculty Resource Center Faculty Site Authors Overview Publishing Process Editorial Board Scope and Policies Peer Review FAQ Submit Librarians Overview Testimonials Subscriptions Access Resources Library Advisory Board FAQ ABOUT JoVE Overview Leadership Blog Copyright © 2024 MyJoVE Corporation. All rights reserved