Підказки щодо захворювань у пацієнтів похилого віку

Skin

Itching

Allergic reaction, cancer, dry skin, hyperthyroidism, jaundice, lice, scabies, uremia

Head

Headaches

Anxiety, cervical osteoarthritis, depression, giant cell arteritis, subdural hematoma, tumors

Eyes

Glare from lights at night

Cataracts, glaucoma

Loss of central vision

Macular degeneration

Loss of near vision (presbyopia)

Decreased accommodation of the lens

Loss of peripheral vision

Glaucoma, retinal detachment, stroke

Pain

Giant cell arteritis, glaucoma

Ears

Hearing loss

Vestibular schwannoma (acoustic neuroma), cerumen, foreign body in the external canal, ototoxicity due to use of medications (eg, aminoglycosides, aspirin, furosemide), Paget disease, presbycusis, trauma due to noise, tumor of the cerebellopontine angle, viral infection

Loss of high-frequency range,often difficulty understanding speech

Presbycusis (usually caused by age-related changes in the cochlea)

Mouth

Burning mouth

Pernicious anemia, stomatitis

Denture pain

Dentures that fit poorly, oral cancer

Dry mouth (xerostomia)

Systemic rheumatic diseases (eg, rheumatoid arthritis, Sjögren syndrome, systemic lupus erythematosus), dehydration, medications (eg, antidepressants including tricyclic antidepressants, antihistamines, anti hypertensives, diuretics), psychoactive medications or illicit drugs, salivary gland damage due to infection or to radiation therapy for head and neck tumors

Limited tongue motion

Oral cancer, stroke

Loss of taste

Adrenal insufficiency, medications (eg, antihistamines, antidepressants), infection of the mouth or nose, nasopharyngeal tumor, radiation therapy, smoking, xerostomia

Throat

Dysphagia

Anxiety, cancer, esophageal stricture, foreign body, Schatzki ring, stroke, Zenker diverticulum

Voice changes

Hypothyroidism, recurrent laryngeal nerve dysfunction, vocal cord tumor

Neck

Pain

Cervical arthritis, carotid or vertebral artery dissection, polymyalgia rheumatica

Chest

Dyspnea during exertion

Cancer, COPD, functional decline, heart failure, infection

Paroxysmal nocturnal dyspnea

Gastroesophageal reflux, heart failure

Pain

Angina pectoris, anxiety, aortic dissection, costochondritis, esophageal motility disorders, gastroesophageal reflux, herpes zoster, myocardial infarction, myocarditis, pericarditis, pleural effusion, pleuritis, pneumonia, pneumothorax

Gastrointestinal

Constipation with no other symptoms

Colorectal cancer, dehydration, medications or illicit drugs (eg, aluminum-containing antacids, medications with anticholinergic effects, iron supplements, opioids, tricyclic antidepressants), hypercalcemia (eg, due to hyperparathyroidism), hypokalemia, hypothyroidism, inadequate exercise, laxative abuse, low-fiber diet

Constipation with pain, vomiting, and intermittent diarrhea

Fecal impaction, bowel obstruction

Fecal incontinence

Cerebral dysfunction, fecal impaction, malabsorption, ischemic colitis, intestinal tumors, rectal cancer, spinal cord lesions

Lower abdominal pain (crampy, sudden onset)

Diverticulitis, gastroenteritis, ischemic colitis, obstruction

Postprandial abdominal pain (2–3 hours after eating, lasting 1–3 hours)

Chronic intestinal ischemia

Rectal bleeding

Colon angiodysplasia, colorectal cancer, diverticulosis, hemorrhoids, ischemic colitis

Genitourinary

Frequency, dribbling, hesitancy, weak stream

Benign prostatic hyperplasia, constipation, medications or illicit drugs (eg, antihistamines, opioids), prostate cancer, urinary retention, urinary tract infection

Dysuria with or without fever

Prostatitis, urinary tract infection

Polyuria

Diabetes insipidus (decrease in antidiuretic hormone action), diabetes mellitus, diuretics

Incontinence

Cystitis, functional decline, normal-pressure hydrocephalus, spinal cord dysfunction, stroke, urinary retention or overflow, urinary tract infection

Musculoskeletal

Back pain

Abdominal aortic aneurysm, compression fractures, infection, metastatic cancer, multiple myeloma, osteoarthritis, Paget disease, pyelonephritis, spinal stenosis

Proximal muscle pain

Myopathies, polymyalgia rheumatica, use of statins

Extremities

Leg pain

Intermittent claudication, night cramps, osteoarthritis, radiculopathy (eg, disk herniation, lumbar stenosis), restless legs syndrome

Swollen ankles

If swelling is bilateral, heart failure, hypoalbuminemia, or renal insufficiency; if unilateral or bilateral, venous insufficiency

Neurologic

Change in mental status with fever

Delirium, encephalitis, meningitis, sepsis

Change in mental status without fever

Acute illness, cognitive dysfunction, fecal impaction, delirium, depression, medications or illicit drugs, psychiatric disorders, urinary retention

Clumsiness in tasks requiring fine motor coordination (eg, buttoning shirt)

Arthritis, parkinsonism, spondylotic cervical myelopathy, intention tremor

Excessive sweating during meals

Autonomic neuropathy

Fall without loss of consciousness

Bradycardia, drop attack, neuropathy, orthostatic hypotension, postural instability, tachycardia, transient ischemic attack, vision impairment

Hesitant gait with intention tremor

Parkinson disease

Numbness with tingling in fingers

Carpal tunnel syndrome, peripheral neuropathy, spondylotic cervical myelopathy

Sleep disturbances

Anxiety, circadian rhythm disturbances, depression, medications or illicit drugs, pain, parkinsonism, periodic limb movement disorder, sleep apnea, urinary frequency

Syncope

Aortic stenosis, cardiac arrhythmia, hypoglycemia, orthostatic hypotension (especially medication-related), seizure

Transient interference with speech, muscle strength, sensation, or vision

Transient ischemic attack

Tremor

Alcohol use disorder, central nervous system disorder (eg, cerebellar disorders, poststroke), essential tremor, hyperthyroidism, parkinsonism