Geriatric Emergencies

Some Statistics Patients 65 years and older account for over 50 % of all ambulance transports, this is anticipated to grow to 70% by Patients over the age of 65 have a higher severity of illness and greater morbidity and mortality rates than younger people, this accounts for longer hospitalizations and long term care.

Aging vs. Disease 1% Rule of Aging Disease is an interruption in the physiological function that causes harm to the individual. So, functional performance of any organ system depends upon: The rate of deterioration The level of performance needed

Physiological Changes of Aging Overall appearance: skin, eyes Cardiovascular Pulmonary CNS GI tract Renal function Vision Hearing Genitourinary Endocrine Musculoskeletal Pyschological/Social Immune system

Communication Good history alone will give you the right impression in more than 80% of the patients you treat. Ask one question at a time, give the patient time to answer. The right question will give you the right impression quickly. Clarify what the patient is telling you.

Environmental Awareness Private residence: General cleanliness Availability of food and water Hazards Observe for signs of abuse or neglect Polypharmacy Medic Alert emblem or medical information

Environmental Awareness Extended Care or Nursing Home: Immediate complaints Ambulatory? Level of activity? Medical history, medications, allergies Normal intake and output? DNR, advanced directives, POLST orders? Patient’s chart best source for information. Observe for signs of abuse or neglect.

Confusional States in the Elderly Delirium: Abrupt onset Reduced attention span Disorganized thinking At least 2 of: DLOC Perceptual disturbance Increased or decreased psychomotor activity Dementia Gradual onset Impaired recent memory Regression At least 2 of: Disjointed thinking Poor judgment Loss of mental function

Assessment Same approach as with any patient, remember they are not large “kids.” Treat with respect, introduce self & partner. Tell the patient exactly what you are going to do…before you do it. Respect their privacy, protect their modesty. Remember that someday you just might be in the same situation.