Introduction

A well taken history and careful physical examination provide substantial information to establish a working diagnosis. History taking from an elderly patient is more difficult as compared with younger adult patients. A thorough medical evaluation is complicated and time consuming in the elderly patient who has a longer history of illness and many associated medical problems.

At the initial stage of the clinical interview there is much to be gained by establishing:

• the patient's normal bowel habit

• what is meant by diarrhoea

• whether the problem is spurious (overflow) diarrhoea due to constipation

• whether there is faecal incontinence.

Clinicians are aware that history taking is an art and not a science, and obtaining a comprehensive history is what distinguishes the competent clinician. A poor historian is more often the physician and not the patient. In the elderly history taking is more tedious and may tax the physician's patience. The dulling of memory and the propensity in old age to remember distant past events with greater clarity than recent events may pose problems. More important events, in the view of the elderly patient, have occupied the forefront of the memory stores and crowded out the less important. The recall of names and dosages of medication important to the physician may be burdensome to the patient.

In taking a history from an elderly patient, changes in style and tempo are necessary. The medical interview may be tiring to the elderly patient.