Medical and physical domain

Older adults often present with overlapping acute illness, chronic disease and geriatric syndromes. A physical domain that merely lists diagnoses misses this complexity.

The physical domain begins with ordinary clinical medicine but extends beyond diagnosis. Acute illness must be recognised and treated while chronic conditions, geriatric syndromes and iatrogenic contributors are reviewed together.

A useful CGA problem list distinguishes active acute problems, chronic conditions requiring adjustment, symptoms, geriatric syndromes and risks. Investigations should answer clinically meaningful questions; more testing is not automatically more comprehensive.

Physical assessment should include pain, hydration, infection, cardiovascular status, respiratory disease, renal function, bowel/bladder issues, skin, oral health and any condition affecting function or treatment tolerance. The plan should state what is reversible, what needs monitoring and what can be simplified.

Mrs Morgan’s fever and confusion require an acute medical assessment. Orthostatic blood-pressure change, renal function, pain after the fall and heart-failure status influence both immediate treatment and rehabilitation.

Problem-list builder: convert raw findings into acute problems, chronic conditions, geriatric syndromes, reversible contributors and monitoring needs.

• Document baseline as well as current state.
• Use collateral information when history is incomplete.
• Convert every important finding into an action or explicit decision not to act.
• State uncertainty rather than disguising it as a score.
• Name ownership and review whenever the plan crosses teams or settings.

How could you make your medical problem list more useful to the wider multidisciplinary team?