Blog series: Comprehensive Health Evaluation for Older Patients - More Than a Set of Vital Signs

An older patient arrives at a clinic after a recent fall. She reports feeling tired, has eaten poorly for several days and feels dizzy when standing up. Her vital signs are not dramatically abnormal and there is no obvious acute illness. So where do we start?

• Authors: Anna Lundberg, RN, Med.Lic., Lecturer, Åland University of Applied Sciences; Jenny Österbacka, RN, MPH, Lecturer, Åland University of Applied Sciences.
• Lecture reference: Lecture 3 – Comprehensive Health Evaluation for Older Patients.

One of the key messages from our lecture on comprehensive health evaluation is that assessing older adults requires more than measuring blood pressure, pulse and temperature. Small changes in function, behavior or daily routines may provide important clues about a person’s health status.

A comprehensive assessment begins with a thorough medical history. Chronic conditions, current symptoms, medications and recent changes in health all contribute to understanding the patient’s situation. For older adults, medication reviews are particularly important, as symptoms may sometimes be related to side effects, interactions or changes in treatment.

The next step is the physical examination. Mobility, balance and functional capacity are essential parts of the assessment. Can the patient stand up safely? Walk without support? Has there been a recent decline in physical function? These observations often provide valuable information that may not be visible in laboratory results.

Diagnostic testing also plays an important role. Nurses contribute by recognizing changes, identifying potential concerns and communicating findings that may require further investigation. Laboratory values and screening results become most meaningful when viewed over time rather than as isolated measurements.

Finally, vital signs remain a cornerstone of assessment. However, in older adults, interpretation is often more important than the measurement itself. A slightly elevated respiratory rate, a modest increase in temperature or a drop in blood pressure when standing may be early signs of deterioration. Understanding what is normal for the individual patient is often more valuable than comparing findings with a standard reference value.

Throughout the lecture, particular attention was given to respiratory rate, pulse, blood pressure and temperature. These observations can reveal important changes in health, especially when trends are monitored over time rather than assessed as single values.

The overall goal of comprehensive health evaluation is not simply to identify disease. The goal is to understand how health conditions affect the person’s daily life, independence and wellbeing. By combining medical history, physical examination, diagnostic testing and careful monitoring of vital signs, healthcare professionals can detect problems earlier and support safer, more person-centered care. In the care of older adults, the most important findings are not always the most obvious ones. Sometimes, it is the small changes that tell the biggest story.

Summary

A comprehensive health evaluation helps healthcare professionals identify subtle changes in older adults and provides the foundation for safe, person-centred care.

A thorough, nurse-led comprehensive health evaluation is the foundation of safe geriatric care. By mastering the clinical nuances of age-related physiological shifts—from atypical fever responses to wider respiratory ranges—nurses can detect clinical deterioration early. Integrating the CGA framework into daily nursing practice changes the paradigm from reactive crisis-management to proactive, preventive, and highly professional care that honors the older patient’s autonomy and specific life situation.

References

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Hartford Institute for Geriatric Nursing. (2020). Age-related changes. ConsultGeri. https://consultgeri.org/geriatric-topics

Kabell Nissen, S., Rueegg, M., Carpenter, C. R., Kaeppeli, T., Busch, J. M., Fournaise, A., Dreher-Hummel, T., Bingisser, R., Brabrand, M., & Nickel, C. H. (2023). Prognosis for older people at presentation to emergency department based on frailty and aggregated vital signs. Journal of the American Geriatrics Society, 71(4), 1250–1258. https://doi.org/10.1111/jgs.18170

Liu, X., Song, L., Xiao, S., & Wang, Y. (2023). Comprehensive Geriatric Assessment, multidisciplinary treatment, and nurse-guided transitional care in hospitalized older adults: A randomized controlled trial. Journal of Gerontological Nursing, 16(5), 224–230. https://doi.org/10.3928/19404921-20230606-03

Lyndon, H., Latour, J. M., Marsden, J., & Kent, B. (2023). A nurse-led Comprehensive Geriatric Assessment intervention in primary care: A feasibility cluster randomized controlled trial. Journal of Advanced Nursing, 79(9), 3473–3486. https://doi.org/10.1111/jan.15652

MedlinePlus. (n.d.). Aging changes in vital signs. U.S. National Library of Medicine. Hämtad 6 mars, 2025, från https://medlineplus.gov/ency/article/004019.htm

Pirushi, R., Imeraj, Z., Veseli, D., & Bilali, V. (2022). The most common cardiovascular, orthopedic, and neurological problems in the elderly and nursing care. Open Access Macedonian Journal of Medical Sciences, 10(B), 691–696. https://doi.org/10.3889/oamjms.2022.7936

Sapra, A., Malik, A., & Bhandari, P. (2023). Vital sign assessment. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553213/

Stratton, L., Thayer, N., & Channa, K. (2023). Determining the accuracy of a medication history at the point of a Comprehensive Geriatric Assessments (CGA) within an inpatient setting on a frailty assessment unit. Journal of Pharmaceutical Health Services Research, 14(3), 244–247. https://doi.org/10.1093/jphsr/rmad012

Touhy, T., & Jett, K. (2021). Ebersole and Hess’ gerontological nursing & healthy aging (6:e uppl.). Elsevier Mosby.

Co-funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Education and Culture Executive Agency (EACEA). Neither the European Union nor EACEA can be held responsible for them.

Keywords: BigPicture, Comprehensive Health Evaluation, Older Adults, Geriatric Nursing, Vital Signs, Person-Centred Care