Geriatric Differential Diagnosis

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Video Runtime: 79 Minutes, Learning Assessments: 36 Minutes

The dynamic and complex nature of aging comes with typical age-related anatomical and physiological changes, in addition to possible multimorbidity and disability. This course explores the challenges of differential diagnosis in the midst of age-related changes and multimorbidities and presents a framework for clinical decision-making for physical therapy for the older adult. The strategies presented in this course are essential for examining and developing a plan of care for older adults with complex diagnoses, pain, orthopedic dysfunctions, neurologic deficits, multimorbidities, and general debility. The course will provide a comprehensive overview of differential diagnosis, examination principles, and clinical decision-making for the physical therapist caring for older adults across multiple system impairments in varied clinical settings, such as rehabilitation, hospital, primary care, home health, outpatient, and inpatient settings. It includes discussion of the International Classification of Functioning, Disability and Health (ICF) model as a framework for physical therapist practice. Discussion combined with ample demonstration sessions will take the clinician through strategies for medical screening, upper and lower quarter screening, movement screening, and comprehensive and specific system screening.

Meet your instructor

Myles Quiben

Myles Quiben, PT, PhD, DPT, MS, is a professor and chair of the department of physical therapy at the University of North Texas Health Science Center, teaching clinical medicine and cardiopulmonary, geriatric, and neurologic physical therapy. She is a board-certified clinical specialist in both neurologic and geriatric…

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Chapters & learning objectives

1. Introduction to Medical Screening

This chapter introduces the physical therapist to medical screening and highlights the role of the therapist in screening, particularly for the aging adult. The complexity of differential screening for aging adults and the considerations for differential diagnosis are discussed, with a focus on the ability to distinguish between signs and symptoms associated with aging and those that are most likely associated with a medical pathology.

2. Differential Diagnosis Principles

This chapter presents the principles of differential diagnosis, including challenges with medical screening. The patient/client management model is discussed in the context of differential diagnosis, with an emphasis on communicating with appropriate healthcare professionals for referral or consultation. The framework of screening for medical disease is presented, with a focus on the patient history/interview and the physical examination for gathering data.

3. Factors to Consider in the Differential Diagnosis Process for Aging Adults

The differential diagnosis process involves two steps: screening for medical conditions and screening for movement dysfunction. The contributions of age-related changes to the movement system, multisystem involvement, social determinants of health, cognitive changes, and pharmacological considerations are presented. The ability to accurately interpret information from the examination is critical, as is the ability to identify noncontributory information.

4. A Framework for Examination for Differential Diagnosis in Aging Adults

This chapter considers signs and symptoms in the aging adult that are within the scope of physical therapist practice and those that warrant further communication with other healthcare professionals. Examination components in the patient history/interviewing that feed into the clinical decision-making process are discussed: diagnostic interviewing, systems review, pain patterns, and associated signs and symptoms. Screening strategies during the physical examination, including upper quarter screening, lower quarter screening, and movement screening will be presented.

5. Let’s Practice

In this chapter, we conclude a case study that allows the therapist to apply the principles of differential diagnosis and screening. The participant will evaluate history and physical examination findings in the clinical decision-making process and is asked to consider signs and symptoms in the aging adult that are within the scope of physical therapist practice and those that warrant communication with a physician.

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