Approach To Examination of An Elderly Patient With Muculoskeletal Disorders

Elderly or geriatric patients need special evaluation. Musculoskeletal disorders in elderly patients are often not diagnosed because the signs and symptoms may be insidious or chronic in these patients.The evaluation follows the same pattern of history, examination and investigation but needs to take few things into account and perform additional inquiries to exclude common geriatric musculoskeletal disorders

The nature of the problem is often obscured by the presence of multiple interacting factors, including other medical conditions and therapies. An elderly patient is likely to have many many medical problemss like hypertension, diabetes, cardiac problems, renal problems and so on. He might carry a number of prescriptions and drugs that he is taking.

These difficulties are compounded by the diminished reliability of laboratory testing in the elderly, which is secondary to the wider range of nonpathologic variability. For example, erythrocyte sedimentation rates may be misleadingly high and titers of rheumatoid factor or antinuclear antibodies misleadingly low. Although nearly all rheumatic disorders can afflict the elderly, certain disease and drug induced disorders are more common in this age group.

An emphasis on identifying the rheumatic consequences of intercurrent medical conditions and therapy is extremely important. Drug induced lupus erythematosus polymyalgia rheuamtica, gout, and chronic salicylate toxicity are all more common in the elderly than in other individuals.

The physical examination should put an emphasis on coexisting disease that may influence the diagnosis and choice of treatment.

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