LAUSR

The essence of the science of clinical examination is the art of history taking [1], more so in geriatric patients. In geriatric patients, the geriatric assessment is a multi-dimensional screening tool [2]. It serves to detect overlooked areas of importance in elderly patient management. It is also used to detect the presence of geriatric syndromes and non-medical issues of relevance [3]. The process of assessment is based on assumption that there is no delirium, dementia or cognitive dysfunction [4]. The art of history taking in this situation in view of memory problems and cognition is fraught with danger which might lead to treatment hazards and even medicolegal issues. This key component is rarely a feature of medical literature, academic curricula and do not have clear cut guidelines [5]. The presentation of older people to the emergency room is complicated by the presence of dementia and delirium. Low tech often overlooked or down looked upon the informant/collateral history is the key to the diagnosis and further management. This history is usually collected from friends, relatives, health workers and is about problems experienced with memory, cognition as well as functional ability [6]. Available data say that collateral history taking is usually taken by 3% of physicians, and usually, there is no formal training or curricula for study [7]. The co-element of diagnosis of dementia and delirium is collateral/informant history; in spite of which almost no critical thoughts have been directed towards it [8]. In the context of technology of imaging and bio-marker-driven diagnosis of dementia, is wholly based on clinical diagnosis which is entirely dependent on collateral history. There exists no guidelines, pathway or consensus opinion in performing this important aspect of assessment. Key textbooks, both generalist or specialist, do not exist on this aspect. Audit done on dementia patients in UK showed that only in odd 30% informant history was recorded and available [9]. Assessment of a confused patient is common in both offices based and also in hospital practice. It often goes unrecognized and is poorly managed. Early diagnosis and proper assessment including collateral history taking will improve outcomes. An ideal collateral history should be taken if possible, with the consent of the patient. Patients with memory problems should first be interviewed alone “not only in terms of their own dignity and establishing the doctor patient relationship but also in terms of recognizing the asymmetry of communication and the power of triadic doctor–patient–care–giver relationship”. The rule should be.