University of Minnesota
 A Geriatric Home Visit Experience
Physical Examination
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seated seniorThe purpose of this experience is not to practice a complete history or physical examination. There are two features of the physical examination that are relatively easy and are very important parts of a geriatrics assessment—noting general appearance and examining the feet.

The general appearance of the patient gives a picture of the patient's condition and the circumstances of the visit. In the office, the patient will almost always be seen on the exam table, and in the hospital, the patient is in a bed. During a home visit, the patient may be in a chair, in bed, or restlessly walking around. The patient may be dressed in clothes appropriate for the season, night clothes, or semi-undressed. Record the level of patient cooperation to enable other providers to assess the reliability of the information obtained. For similar reasons, also record the general comfort of the patient.

Examination of the feet can provide many kinds of clues to disease and disability. Poor nail care suggests a physical, cognitive, or psychological inability to do (or arrange for) care of the feet. Lack of any callus formation may suggest the patient is rarely walking. Clubbing, cyanosis, or edema suggest a number of specific diseases. Skin breakdown may be due to pressure from immobility or poor fitting shoes. In addition to these foot-specific issues, organ system-based examination of the feet include cardiovascular (pulses), musculoskelatal (range of motion), and neurological (strength). Do not do all of these today.

Dr. Ratner demonstrates how to get started:

video link [:19] audio link

removes shoes

General Appearance:

  • Where is the patient (sitting in a chair, in a wheelchair, lying down in bed, on a couch)?

  • How is he/she dressed?

  • Is the patient cooperative?

  • Does he/she appear comfortable?

The Feet:

  • Nails

  • Color

  • Edema (on a scale of 0-4)

  • Skin breakdown

  • Corns and calluses
 foot examination

This concludes the orientation. Good luck on your home visit.
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University of Minnesota Academic Health Center Seniors as Teachers Program

Date of last revision: December 17, 2001

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