Clinical Assessment Domains: Physical Examination and Screening Test

Respiratory Diseases

COPD and respiratory infections such as influenza and pneumonia rank 4th and 6th as the leading cause of death respectively among elderly Filipino Americans. Increased incidence of smoking among Filipino men compared to other Asian ethnic groups put them at higher risk for developing COPD. Increasing age, presence of other chronic co-morbidities like diabetes mellitus, cardiovascular disease such as CHF, and COPD put them at higher risk for developing pneumonia and influenza. Identify personal risk factors, medical history, social habits, and immunization history.

Cognitive and Affective Status

Stigma and shame may delay access to diagnostic and treatment resources for Alzheimer’s disease and mental health problems. It is common for less-educated elderly Filipino immigrants with minimal acculturation experience to perceive such cognitive problems as part of the normal aging process. Highly acculturated families may be hesitant to seek resources. The public image of the family is the prime concern, and there is a tendency to be crisis-oriented.

Psychiatry is perceived to be a resource for the affluent. Somatic symptoms such as headache, loss of appetite, sleeplessness, fatigue and low energy level are common presentations of depression. Medication for treating mental illness is much preferred to psychotherapy. Trusted members in the community such as clergy, lay ministers or healers may be preferred. Family therapy or group therapy may be too threatening to less acculturated older adults.

In evaluating elderly Filipino patients for cognitive dysfunction and mental illness, one should be cognizant of common indigenous traits, perceptions, and coping mechanisms. Simple validated screening tests such as the Geriatric Depression Scale (GDS) for depression, the Mini Cog and the Clock Drawing Test to determine cognitive dysfunction are easy to administer, especially among less educated and less acculturated elderly individuals. For highly educated individuals, more sensitive (98%) and specific (97%) tests such as the Mini Mental State Exam, the Clock Drawing Test and the Mattis Dementia Rating Scale are preferable.

Osteoporosis Screening

Despite limited research concerning the risk and incidence of osteoporosis among elderly Filipino Americans, this group is not immune and is at increased risk with advancing age. Initial screening using the Dexa Scan should begin at age 65 for women with a low risk of developing osteoporosis or fracture. Initial screening using the Dexa Scan should begin between the ages of 60 – 64 for women with a high risk of developing osteoporosis or fracture. Repeat screening every 2 years using the Dexa Scan. In addition to physicians, nurses in the ambulatory care setting play an important role in educating patients and families about this issue.

Cardiac and Vascular Diseases

Cardiovascular disease, stroke, diabetes mellitus, aortic aneurysm and dissection and hypertension rank respectively as numbers 1, 3, 5, 9 and 10 among the leading causes of death for elderly Filipino Americans. These risks are amplified by increasing age, unhealthy social habits (smoking) and dietary practices and physical inactivity.

Cancer

Malignancy ranks second as the leading cause of death for elderly Filipino Americans. Decisions to screen patients should be individualized and be based on the following factors such as expected life expectancy, preferences, plan for what the patient may or may not want to do further if screening had positive findings, as well as degree of burden to the patient (Hall KT, 2010).

Functional Status

Assess patient activities in the community, the presence or absence of activities of daily living (ADL) impairments, and environmental home safety measures. Because of the cultural value of interdependent/ dependent relationships, determining the presence or absence of instrumental activities of daily living (IADL) impairments (driving skills, using and balancing check books, use of modern household appliances) may not be critical for less acculturated and low income elderly individuals who depend heavily on other family members.

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