Findings during the social assessment of an older patient include all of the following, except:

On average, older patients have 6 diagnosable disorders. A disorder in one organ system can weaken another system, exacerbating the deterioration of both and leading to disability, dependence, and, without intervention, death. Multiple disorders complicate diagnosis and treatment, and effects of the disorders are magnified by social disadvantage (eg, isolation) and poverty (as patients outlive their resources and supportive peers) and by functional and financial problems.

Clinicians should also pay particular attention to certain common geriatric symptoms (eg, delirium Delirium Delirium is an acute, transient, usually reversible, fluctuating disturbance in attention, cognition, and consciousness level. Causes include almost any disorder or drug. Diagnosis is clinical... read more , dizziness Dizziness and Vertigo Dizziness is an imprecise term patients often use to describe various related sensations, including Faintness (a feeling of impending syncope) Light-headedness Feeling of imbalance or unsteadiness... read more , syncope Syncope Syncope is a sudden, brief loss of consciousness with loss of postural tone followed by spontaneous revival. The patient is motionless and limp and usually has cool extremities, a weak pulse... read more , falling Falls in Older People A fall is defined as a person coming to rest on the ground or another lower level; sometimes a body part strikes against an object that breaks the fall. Typically, events caused by acute disorders... read more , mobility problems Gait Disorders in Older Adults Gait disorders encompass a number of issues, including slowing of gait speed and loss of smoothness, symmetry, or synchrony of body movement. For older adults, walking, standing up from a chair... read more , weight or appetite loss Involuntary Weight Loss Involuntary weight loss generally develops over weeks or months. It can be a sign of a significant physical or mental disorder and is associated with an increased risk for mortality. The causative... read more , urinary incontinence Urinary Incontinence in Adults Urinary incontinence is involuntary loss of urine; some experts consider it present only when a patient thinks it is a problem. The disorder is greatly underrecognized and underreported. Many... read more ) because they may result from disorders of multiple organ systems.

If patients have multiple disorders, treatments (eg, bed rest, surgery, drugs) must be well-integrated; treating one disorder without treating associated disorders may accelerate decline. Also, careful monitoring is needed to avoid iatrogenic consequences. For example, with complete bed rest, older patients can lose 1 to 3% of muscle mass and strength each day (causing sarcopenia and sharply reduced mobility), and effects of bed rest alone can ultimately result in death.

Patients' prescription, over-the-counter, and recreational drugs (including marijuana) should be reviewed frequently, particularly to look for drug interactions and use of drugs considered inappropriate for older patients Drug Categories of Concern in Older Adults Some drug categories (eg, analgesics, anticoagulants, antihypertensives, antiparkinsonian drugs, diuretics, hypoglycemic drugs, psychoactive drugs) pose special risks for older adults. Some... read more . This review is especially important during care transitions when reconciliation of drugs is required to eliminate duplication, missed drugs, and errors in dosage and to identify drugs that may be no longer be needed.

• Frequent bruising, especially in difficult-to-reach areas (eg, middle of the back)

• Grip bruises of the upper arms

• Bruises of the genitals

• Peculiar burns

• Unexplained fearfulness of a caregiver in the patient