Health Assessment of the Older Individual by Mathey D. Mezey, Louise Hartnett Rauckhorst, and Shirlee Ann Stokes, New York, Springer Publishing Company, 1980. 145 pages. $10.95 softcover; $16.95 hardcover.
This book was written to provide practitioners with a concise reference text on health assessment of elderly clients. It assumes a basic knowledge of health history taking and physical examination techniques and is intended as a resource for practitioners in various fields, including nursing, medicine and social work. The text was designed to enable the practitioner to: (a) assist older persons in achieving and maintaining optimal health; (2) identify older individuals and groups who have high-risk profiles for health problems; and (3) identify specific deviations from normal and their impact on the older client's life style and activities of daily living. The authors achieve these objectives with varying degrees of success.
Except for a short overview of The Nurses' Role in Assessment in Chapter one, and brief chapters on Growth and Development, Interviewing, and Community and Home Assessment, the majority of this book focuses on physical examination and deviations from normal aging. The five chapters on physical examination are predominantly the traditional medical approach to assessment of organ systems. There is minimal information on functional assessment of these systems: this would have enhanced the value of this text to nurse practitioners. Each chapter contains a brief section on client profiles and history data that is helpful in the evaluation of organ system abnormalities. Information is presented in a concise, readable fashion. Several tablesconsolidate and highlight relevant data.
Unfortunately, this same succinct style often results in the exclusion of pertinent information that should be part of the repertoire of practitioners skilled in assessment of older clients. For example, myxedema is mentioned as the most common thyroid disorder in the aged, often misdiagnosed and attributed to "old age." No information is provided on the atypical symptoms that frequently accompany this disease in the elderly, or the specific assessment skills that would assist the practitioner in assessing this condition.
Another weakness of the chapters on physical examination is the inclusion of a section in each chapter on nursing implications. This approach could have been a valuable addition to the traditional medical examination of organ systems; however, the authors present information in these sections that is superficial and simplistic. Even though this text generally documents resources well, the sections on nursing implications are notable for their lack of documentation and integration of knowledge from nursing research and gerontological nursing.
With only three chapters related to aspects of health - the chapters on Growth and Development, Interviewing, and Community and Home Assessment - it is unlikely that this text will enable the practitioner to assist older persons to achieve maintenance of optimal health. It will provide the practitioner with a brief, introductory overview of some aspects of aging that influence health. A "Community Assessment Guide" in the chapter on Community and Home Assessment should be helpful to beginning practitioners in their evaluations of an older persons' home and surrounding environment. More information on topics like exercises, sleep, nutrition, health beliefs and practices, and social support systems would have enhanced a healthier orientation in this text, and enabled the practitioner to assist elders with the achievement and maintenance of health.
In summary, I would recommend this text as a supplementary resource for medical or nurse practitioners working with older clients. It is a concise reference text and an improvement over several other available resources on physical examination of aged clients. Bibliography and reference materials are current and pertinent, and they could serve as a beginning reference list for further reading on specific deviations from normal aging. It is not a text oriented toward health, but it should help some practitioners identify selective deviations from healthy aging and perhaps assist with the identification of individuals who are at high risk for additional problems.