Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 45 Older Adults

45-2 Objectives

Older Adults Many older adults –Have at least one chronic medical condition –May have multiple medical conditions High blood pressure Heart disease Arthritis –Are on multiple medications –May be technology dependent 45-3

Assessment of the Older Adult 45-4

Scene Size-up Scene safety Note the position and location in which the patient is found Determine the need for additional resources 45-5

General Impression Appearance (Work of) Breathing Circulation 45-6

Patient Assessment Level of responsiveness Spinal precautions Airway –Neck arthritis –Dentures 45-7

Patient Assessment Breathing Circulation 45-8

Communication Face the patient Speak slowly, clearly, and respectfully Make sure lighting is adequate Locate hearing aid or eyeglasses if needed Speak to the patient first Give the patient time to respond to questions Show concern and empathy 45-9

Common Health Problems in Older Adults 45-10

Cardiovascular System Changes Thickening of the blood vessels Decreased blood vessel elasticity Increased peripheral vascular resistance Reduced blood flow to organs Hardening and thickening of heart’s valves Degeneration of conduction system Increased blood pressure Decreased stroke volume Decreased cardiac output Abnormal heart rhythms 45-11

Acute Coronary Syndromes Atypical Signs and Symptoms Unexplained new onset or worsened difficulty breathing with exertion Unexplained nausea, vomiting Sweating Unexplained tiredness Change in mental status Weakness Fainting Abdominal discomfort 45-12

Cardiovascular System Heart failure –Common in older adults Left ventricle –Blood backs up into the lungs Pulmonary edema Right ventricle –Blood backs up and causes congestion in the organs and tissues of the body 45-13

Respiratory System Changes Diminished elasticity of the diaphragm Decreased strength in chest wall and accessory muscles Ineffective coughing Decreased number of alveoli that participate in gas exchange Decreased activity of cilia in the lungs increases susceptibility to infection 45-14

Respiratory System Asthma –Typically presents with tightness in the chest, dyspnea, wheezing, retractions, and coughing. –If severe, possible cyanosis and an absence of wheezing COPD –Generally presents with coughing and shortness of breath on exertion that is often accompanied by wheezing

Respiratory System Pneumonia –Gradual onset –Cough productive of sputum –Shortness of breath with or without fever –Fatigue –Loss of appetite –Tightness in the chest 45-16

Respiratory System Pulmonary embolism –Anxious –Sudden onset of dyspnea –May complain of shoulder, back, or chest pain 45-17

Nervous System Changes Difficulty with recent memory Difficulty retrieving information Decreased balance and coordination Forgetfulness Decreased reaction time 45-18

Nervous System Stroke complications –Depression –Pressure sores –Urine incontinence –Difficulty swallowing –Venous clots in the legs that can lead to pulmonary emboli 45-19

Nervous System Right brain stroke –Irritability –Confusion –Sluggishness –Difficulty retaining information –Distortions of time –Unawareness of the left side of the body 45-20

Nervous System Left brain stroke –Difficulty starting tasks –Compulsive behavior –Slow processing of information –Repetition of words –Difficulty expressing self verbally or in writing 45-21

Delirium Sudden change in mental status that is generally caused by a reversible condition Very common in older adults Decreased attention span Disordered stream of thought Disturbances in perception Speech may be incoherent, rambling, hesitant, slow, or rapid 45-22

Dementia A more gradual change in baseline mental status Causes a progressive and sometimes irreversible loss of intellectual functions, psychomotor skills, and social skills Change typically occurs over months to years 45-23

Alzheimer’s Disease Stages –Early (mild) –Middle (moderate) –Late (severe) 45-24

Nervous System Patient is generally a poor historian Obtain patient’s history from such family, friends, neighbors, and environment –Symptom onset –What is different today? –History of similar episodes –History of psychiatric illnesses –Medical conditions 45-25

Restraints If restraints are used, document the following information: –The reason for the restraints –The number of personnel used to restrain the patient –The type of restraint used –The time the restraints were placed on the patient –The status of the patient’s ABCs, and distal pulses before and after the restraints were applied –Reassessment of the patient’s ABCs and distal pulses 45-26

Gastrointestinal System Tooth decay Missing teeth Periodontal disease Decreased saliva production Delayed emptying of the stomach Decreased hydrochloric acid in the stomach Changes in absorption of nutrients Slowing peristalsis causing constipation Rectal sphincter may become weak resulting in fecal incontinence Liver shrinks Decreased blood flow to the liver Decreased metabolism in the liver Decreased pancreatic secretions 45-27

Gastrointestinal System Dry mouth –Common complaint in older adults Dysphagia (difficulty swallowing) 45-28

Gastrointestinal System Upper GI bleeding Lower GI bleeding 45-29

Gastrointestinal System Ulcer disease Constipation Diarrhea Fecal incontinence 45-30

Genitourinary System Reduced kidney function Reduced blood flow to the kidneys Reduced sphincter muscle control Decreased bladder capacity Decline in sensation to urinate Increase in urinating at night Prostate enlarges in males 45-31

Genitourinary System Prostate enlargement Prostate cancer Urinary incontinence Urinary tract infections 45-32

Metabolic and Endocrine Problems Endocrine system changes –Impaired glucose regulation –Fluid and electrolyte imbalances –Reduced thyroid hormone production 45-33

Metabolic and Endocrine Problems Increased risk of heat and cold-related emergencies Reduced thyroid hormone production can result in signs and symptoms that are often attributed to other conditions 45-34

Metabolic and Endocrine Problems Type 2 diabetes mellitus –Most common form of diabetes in older adults Hyperosmolar hyperglycemic state (HHS) –Complication of Type 2 diabetes –Very high glucose concentration in the blood (usually greater than 600 mg/dL) 45-35

Musculoskeletal System Muscle wasting Loss of bone mass Loss of muscle strength Degenerative changes in joints Loss of elasticity in ligaments and tendons Thinning of cartilage and thickening of synovial fluid 45-36

Musculoskeletal System Osteoarthritis –Major cause of knee, hip, and back pain in older adults Osteoporosis –Compression fractures of the vertebrae –Kyphosis 45-37

Toxicological Emergencies Older adults are at risk of toxicity –Decreased kidney function –Altered gastrointestinal absorption –Decreased blood flow in the liver Polypharmacy 45-38

Toxicological Emergencies Noncompliance with medications –May not take his pills at all –May take them every now and then –May accidentally overdose from taking too much medication –May not be able to afford medications –Lack of motor ability to open the bottle cap –Altered mental status –Impaired vision 45-39

Toxicological Emergencies Some medicines can “hide” the signs and symptoms of other illness 45-40

Sensory Changes in Older Adults Visual impairment increases with age. Cataracts –Clouding of the lens of the eye Ability to focus on near objects decreases Lens yellows, affecting color vision Glaucoma Macular degeneration 45-41

Sensory Changes in Older Adults Presbycusis –Hearing loss because of aging –Progressive, occurring gradually over a period of years –Cannot hear high-pitched sounds well 45-42

Sensory Changes in Older Adults Touch sensitivity decreases Pain threshold increases Pain assessment –Acute pain is pain of sudden onset –Chronic pain is pain that is of long duration –Scale from 0 to 10 may not give a true picture of pain –OPQRST 45-43

Questions? 45-44