Just like delirium and dizziness, "weakness" can also be multifactorial due to a combination of factors such as dehydration, medication side effects, depression, infections etc. Getting collateral history (Social Circumstances, Baseline Mental status, Mobility) from family, carers, paramedics, old records forms a crucial component of assessment to get a holistic picture. Onset of time (Acute v/s Chronic) and focality (Focal v/s true generalised weakness) are two important clues guiding further work up.
Neuro examination forms the cornerstone of physical exam. Literature suggests that the most common etiology for weakness in elderly are infections, metabolic issues and malignancies. Therefore, initial testing should be geared towards these issues.
- FBC, ESR
- Blood/Urine Cultures
- Renal Function
- Liver Function
- CT/MRI Head (based of history)
- Blood Gas - Includes Blood Glucose and Lactate (based on history)
- Urine Analysis
- POCUS (Assess Cardiac Contractility, IVC, Consolidation)
Common Causes of Weakness in Elderly (not a complete list)
- Infections (Respiratory, Genitourinary, Skin, Abdomen)
- Metabolic (AKI, Dehydration, Na/K/Mg/Phosphorus)
- Endocrine (Thyroid, Adrenal, DM)
- Neuro (Stroke, TIA, Myasthenia Gravis, Neuropathy, MS)
- CVS (ACS, Heart Failure, Anemia)
- Medications (Steroids, Diuretics, Hypnotics)
- Autoimmune (Myopathies, PMR, Vasculitis)
- Anderson RS, Hallen SA. Generalized weakness in the geriatric emergency department patient: an approach to initial management. Clinics in geriatric medicine. 2013 Feb 28;29(1):91-100.
- Chew WM, Birnbaumer DM. Evaluation of the elderly patient with weakness: an evidence based approach. Emergency medicine clinics of North America. 1999 Feb 1;17(1):265-78.
- Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, Saint S, Schaeffer AJ, Tambayh PA, Tenke P, Nicolle LE. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clinical infectious diseases. 2010 Mar 1;50(5):625-63.
- Nickel CH, Nemec M, Bingisser R. Weakness as presenting symptom in the emergency department. Swiss medical weekly. 2009 May;139(17-18):271-2.
- Nemec M, Koller MT, Nickel CH, Maile S, Winterhalder C, Karrer C, Laifer G, Bingisser R. Patients Presenting to the Emergency Department With Non‐specific Complaints: The Basel Non‐specific Complaints (BANC) Study. Academic emergency medicine. 2010 Mar 1;17(3):284-92.