Assessing Hydration Status

The assessment of volume status in the elderly requires good clinical skills and a history of prior events. The most helpful sign of volume depletion is acute weight loss. Physical examination-based assessment of fluid status in the elderly is somewhat less specific. Skin turgor is best tested on the inner aspect of the thigh or the sternum. Examination of the mouth for dryness of the tongue and mucous membranes could be helpful but can be ordered by certain medications. Reduced turgor of the eyes and muscle weakness also point to dehydration. Postural hypotension and tachycardia can be indicative of hypovolemia.

Head, Eyes, Ear, Nose, and Throat (HEENT) Examination

Examination of the Oral Cavity

This examination is carried out with adequate lighting, and other necessary equipment might include tongue depressor and gauze sponge.

Sialadenitis is a painful infection that is usually caused by bacteria. It is more common among elderly adults with salivary gland stones. The opening of the parotid salivary gland duct, also called the Stensen’s duct, is seen in the punctate soft tissue next to the maxillary second molar tooth.

The buccal mucosa is examined for hyperplastic reaction from chronic irritation from dentures or broken teeth. The tongue might have white spots consistent with oral candidiasis. A smooth and glossy tongue might indicate vitamin B12 deficiency. Dental hygiene can result in dental plaques and gingival inflammation.

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