Health History and Risk Stratification

Before beginning any exercise program with an older adult client, a thorough health history assessment is essential. This process helps identify potential risks, inform program design, and determine when medical clearance or referral is necessary. As a senior fitness specialist, your ability to gather and interpret this information is fundamental to safe, effective programming.

The Importance of Comprehensive Screening

Older adults are more likely to have multiple health conditions, take multiple medications, and have a more complex medical history than younger clients. A comprehensive screening process:

Identifies contraindications to exercise
Reveals conditions requiring program modification
Highlights needs for medical clearance
Informs appropriate exercise selection and intensity
Establishes baseline for progress tracking
Builds rapport and trust with the client

Components of Health History Assessment

Personal Information

Basic demographic information provides context for the assessment:

Age and date of birth
Emergency contact information
Healthcare provider contact information
Insurance information (if relevant to your setting)

Medical History

Current diagnosed conditions: Systematically inquire about conditions in each body system:

Cardiovascular:

Heart disease (coronary artery disease, heart failure, arrhythmias)
Hypertension
Peripheral vascular disease
History of heart attack or cardiac procedures
Pacemaker or implantable defibrillator

Respiratory:

COPD or emphysema
Asthma
Sleep apnea
Use of supplemental oxygen

Metabolic:

Diabetes (Type 1 or Type 2)
Thyroid disorders
Kidney disease
Liver disease

Musculoskeletal:

Osteoporosis or osteopenia
Arthritis (osteoarthritis, rheumatoid arthritis)
Previous fractures
Joint replacements
Chronic pain conditions

Neurological:

History of stroke or TIA
Parkinson's disease
Multiple sclerosis
Neuropathy
Cognitive impairment or dementia

Other:

Cancer (current or history)
Visual or hearing impairments
Incontinence
Depression or anxiety

Surgical History

Document all surgeries, especially:

Joint replacements (hip, knee, shoulder)
Cardiac procedures (bypass, stents, valve replacement)
Spinal surgeries
Abdominal surgeries
Cancer surgeries
Recent surgeries (within past year)

Medication Review

Medications significantly impact exercise response and safety:

Categories of concern:

Blood pressure medications:

May cause orthostatic hypotension
Beta-blockers blunt heart rate response
Diuretics can affect hydration and electrolytes

Blood thinners:

Increased bleeding/bruising risk
Caution with activities with fall risk

Diabetes medications:

Insulin and sulfonylureas increase hypoglycemia risk
Exercise timing relative to medication important

Pain medications:

May mask warning signs of overexertion
Opioids can cause dizziness and constipation

Psychotropic medications:

Antidepressants, anti-anxiety medications
Can cause dizziness, drowsiness, or balance issues

Other medications affecting exercise:

Osteoporosis medications (some have exercise restrictions)
Corticosteroids (bone and muscle effects)
Statins (potential muscle effects)

Lifestyle Factors

Current physical activity:

Type, frequency, duration, intensity
History of physical activity throughout life
Current barriers to activity

Nutritional status:

General eating patterns
Unintentional weight loss (red flag)
Appetite changes
Hydration habits

Sleep patterns:

Quality and duration of sleep
Sleep disorders
Daytime fatigue

Tobacco and alcohol use:

Current or past smoking
Alcohol consumption frequency and amount

Fall History

Falls are a critical concern in older adults:

Number of falls in past 12 months
Circumstances of falls (when, where, why)
Injuries from falls
Fear of falling
Near-falls or balance concerns

Red flags requiring medical referral:

Two or more falls in past year
Falls with injury
Falls without clear mechanical cause

Functional Status

Assess ability to perform:

Basic Activities of Daily Living (ADLs):

Bathing
Dressing
Toileting
Transferring
Eating

Instrumental Activities of Daily Living (IADLs):

Shopping
Meal preparation
Housekeeping
Managing medications
Managing finances
Transportation

Any limitations in ADLs may indicate need for modified programming or additional support.

Risk Stratification

ACSM Risk Categories

The American College of Sports Medicine provides guidelines for pre-participation health screening:

Low Risk:

No known cardiovascular, metabolic, or renal disease
No signs or symptoms
Generally do not require medical clearance for moderate exercise

Moderate Risk:

One or more risk factors for cardiovascular disease
May need medical clearance for vigorous exercise

High Risk:

Known cardiovascular, metabolic, or renal disease
Signs or symptoms of disease
Medical clearance recommended before beginning exercise

Signs and Symptoms Warranting Medical Clearance

Cardiovascular:

Chest discomfort with exertion
Shortness of breath at rest or with mild exertion
Dizziness or syncope
Ankle edema
Palpitations or tachycardia
Known heart murmur

Other:

Unexplained fatigue
Unusual shortness of breath
Pain or discomfort in arms, jaw, or neck
Recent illness or hospitalization

Physical Activity Readiness Questionnaire for Everyone (PAR-Q+)

The PAR-Q+ is a widely used screening tool that helps determine if medical clearance is needed before exercise. Key questions include:

Has a doctor ever said you have a heart condition?
Do you feel pain in your chest during physical activity?
Have you had chest pain when not doing physical activity?
Do you lose balance because of dizziness or lose consciousness?
Do you have bone or joint problems that could worsen with exercise?
Are you currently taking prescription medications?
Do you know of any other reason you should not be physically active?

A "yes" to any question warrants further investigation and potentially medical clearance.

Documentation Best Practices

Essential Elements

All assessments should be documented including:

Date of assessment
Client signature confirming accuracy
Your signature as the assessor
Periodic updates (annually at minimum)

Confidentiality

Store health information securely
Follow HIPAA guidelines if applicable
Obtain consent for sharing information
Limit access to those who need to know

Communication with Healthcare Providers

When medical clearance is needed:

Send specific questions about exercise capabilities
Include proposed exercise program details
Request information about restrictions or precautions
Document the response received

Practical Application: Case Study Approach

Case Study: Mary, 72 years old

Medical history: Type 2 diabetes, hypertension, osteoarthritis in knees, history of breast cancer (5 years ago, in remission)

Medications: Metformin, lisinopril, occasional ibuprofen

Fall history: One fall last year while gardening, no injury

Current activity: Walks 15-20 minutes 2-3 times per week

Risk stratification: High risk (diabetes)

Programming considerations:

Medical clearance recommended
Blood glucose monitoring around exercise
Knee modifications for osteoarthritis
Avoid exercises that stress surgical sites if any
Build from current walking base
Include balance training (fall history)

Key Takeaways

Comprehensive screening is essential before beginning exercise with older adults
Multiple conditions are common—expect complexity in health histories
Medications significantly impact exercise response—review them carefully
Fall history is critical—multiple falls require medical evaluation
Risk stratification guides decision-making about medical clearance
Document everything—protect yourself and your clients
Communicate with healthcare providers when needed
Update assessments regularly—health status can change