Geriatric Emergencies

 Demographics of the Elderly  The Aging Process  Assessment & Management of the Elderly Patient. Topics

The Elderly...  Are one of the fastest growing segments of our population.  Are persons age 65 or older.  And their growing number presents a challenge to all health care providers.

The Facts  The mean survival rate of older persons is increasing.  The birth rate is declining.  There has been an absence of major wars or other catastrophes.  Health care and living standards have improved significantly since WWII.  By 2030, 70 million people will be 65 or older.

 Gerontology is the scientific study of the effects of aging and age-related diseases on humans.  Geriatrics is the study and treatment of diseases of the aged.

Societal Issues  Elderly persons living alone represent one of the most impoverished and vulnerable parts of society.  Factors include living environments, poverty, loneliness, social support.  A deterioration of independence is not inevitable and not necessarily a function of aging. It may well be a sign of a heretofore untreated illness.

Older active adult

Senior volunteer programs

Ethics  In the course of caring for elderly patients, ethical concerns frequently arise. You may be confronted with:  Multiple decision-makers  Questions about a patient’s competency  Advanced directives, or DNRs

Financing & Resources for Health Care  Medicare  Medicaid  Veterans Administration

VA hospitals provide a variety of services.

In treating the elderly, remember that the best intervention is prevention.

Prevention strategies for the elderly

Meals on wheels provide 1–3 meals a day

Free screening programs for the elderly

General Pathophysiology, Assessment, and Management

Pathophysiology  The body becomes less efficient with age.  The elderly often suffer from more than one illness or disease at a time.  The existence of multiple chronic diseases in the elderly often leads to the use of multiple medications.

Factors that may decrease compliance in the elderly:  Limited income  Memory loss  Limited mobility  Sensory impairment  Fear of toxicity  Child-proof containers  Duration of drug therapy

Factors that may increase compliance in the elderly:  Good patient-physician communication  Belief that a disease or illness is serious  Drug calendars  Compliance counseling  Blister packaging  Pill boxes  Transportation services to the pharmacy  Ability to read  Clear simple directions

Blister-packs are easier for the elderly.

Falls  Present an especially serious problem.  Represent the leading cause of accidental death among the elderly.  May be intrinsic or extrinsic.  The elderly should be encouraged to make their homes safe.

Home safety for the elderly

Communications  Normal physiological changes may include impaired vision, impaired or loss of hearing, an altered sense of taste or smell, and/or a lower sensitivity to touch.  Any of these conditions can affect your ability to communicate with the patient.

Sensory changes in the elderly

Problems with incontinence & elimination are common in the elderly.

Factors in Forming a General Assessment  Living situation  Level of activity  Network of social support  Level of independence  Medication history  Sleep patterns

Try to distinguish the patient’s chief complaint from the primary problem.

Communication Challenges

Cataracts diminish eyesight

Talk directly to the elderly, if possible.

Speak into a stethoscope with the hearing-impaired.

Change in altered mental status can denote serious underlying problems.

 Only experience and practice will allow you to distinguish acute from chronic physical findings in the elderly patient.  When caring for the elderly:  Encourage patients to express their feelings.  DO NOT trivialize their fears.  Avoid questions.  Confirm what the patient says.  Recall all that you have learned about communicating with the elderly.  Assure patients that you understand that they are adults.

Changes in the body systems of the elderly

Common age-related systemic changes

Common Medical Problems in the Elderly

Respiratory Disorders  Pneumonia  COPD  Pulmonary embolism  Pulmonary edema  Lung cancer

Respiratory and cardiac problems can cause dyspnea.

Cardiovascular Disorders  Angina pectoris  Myocardial infarction  Heart failure  Dysrhythmias  Aortic dissection/aneurysm  Hypertension  Syncope

Neurological Disorders  Cerebrovascular disease (stroke)  Seizures  Dizziness/vertigo  Parkinson’s disease  Delirium, dementia, Alzheimer’s

Metabolic & Endocrine Disorders  Diabetes mellitus  Thyroid disorders

GI Disorders  GI hemorrhage  Upper GI bleed  Lower GI bleed  Bowel obstruction  Mesenteric infarct

Skin Disorders  Skin diseases  Pruritus  Herpes zoster  Pressure ulcers (decubitus ulcers)

Musculoskeletal Disorders  Osteoarthritis  Osteoporosis

Stretching and weight-bearing exercises help prevent osteoporosis.

Renal Disorders  Glomerulonephritis

Urinary Disorders  Urinary tract infections  Urosepsis

Environmental Emergencies  Hypothermia  Hyperthermia

Toxicological Emergencies  Lidocaine  Beta-blockers  Antihypertensives/diuretics  ACE inhibitors  Digitalis (digoxin, Lanoxin)  Antipsychotropics  Parkinson’s disease medications  Analgesics  Corticosteroids

Substance Abuse Factors that contribute to substance abuse in the elderly include:  Age-related changes  Employment loss  Loss of spouse  Multiple prescriptions  Malnutrition  Loneliness  Moving to an apartment/care home

Behavioral/Psychological Disorders Some of the common classifications of psychological disorders related to age include:  Organic brain syndrome  Depression  Dependent personality  Paranoid disorders

Trauma in the Elderly

 Trauma is the leading cause of death in the elderly.  Factors include:  Osteoporosis  Reduced cardiac reserve  Decreased respiratory function  Impaired renal function  Decreased elasticity in the peripheral blood vessels

Assessment  Remember that blood pressure and pulse readings can be deceptive indicators of hypoperfusion.  Leading causes of trauma in the elderly include falls, motor vehicle crashes, burns, assault, and syncope.  Observe the scene for signs of abuse and neglect.

Serious head injuries sometimes denote geriatric abuse.

Many states have laws that require EMS personnel to report suspected cases of Geriatric abuse and/or neglect.

General Management When caring for elderly patients, consider the various changes and underlying conditions which may affect your care, such as:  Cardiovascular considerations  Respiratory considerations  Renal considerations

Transport Considerations

Modifications in positioning, immobilization, and packaging may be necessary in the elderly patient.

Specific Injuries  Orthopedic injuries  Burns  Head and spine injuries

Orthopedic Injuries—Common Fractures in the Elderly  Hip or pelvis fractures  Proximal humerus  Distal radius  Proximal tibia  Thoracic and lumbar bodies

Subcapital femoral neck fracture

Burns People age 60 and older are more likely to suffer death from burns than any other group except neonates and infants. Factors include:  Slower reaction time  Pre-existing diseases  Age-related skin changes  Immunological/metabolic changes  Reductions in physiological function

Summary  Demographics of the Elderly  The Aging Process  Assessment & Management of the Elderly Patient