1. EMS Training on Falls Prevention 1.0 Hour CME Credit for “Geriatrics” Part of Tompkins County’s “Step Up to Stop Falls” Program Beth Harrington, CIC #3385 August 2011 Don’t Call Me Honey

2.  Overall population increase from 1975 to 2025 is about 60% (216 million to 350 million)  % of age 65 and older increases from10.6 to 18.2  The Baby Boom includes people born from mid-1946 to 1964 … the elderly segment is increasing almost twice as fast as the rest of the population

4.  Elderly patients are responsible for approximately 22- 39 % of EMS calls nationally Emergency Medical Service utilization by the elder. Annals of Emergency Medicine. 1982;11:610-612 Geriatric use of Emergency Medical Services. Annals of Emergency Medicine 1996;27:199-203  Geriatric use of EMS is twice that of patients less than age 65 and three times greater over the age of 85 Medical transport of the elder: A population-based study. American Journal of Emergency Medicine 1995;13:297-300

5.  Geriatric patients are at increased risks of morbidity and mortality when experiencing trauma of all varieties, and although they account for just 12.5% of the population, they account for one-third of all traumatic deaths. Elderly trauma inpatients in New York State: 1994- 1998. Journal of Trauma. 2004 Jun;56(6):1297-304 “Geriatric Trauma” in The Trauma Manual. Lippincott Williams and Wilkins: Philadelphia, 2002, pp. 469-476

7.  Cognitive decline  Alzheimers  Physical realities Loss of hearing and deterioration of vision Weakening of musculoskeletal system Loss of quality of skin integrity Overall decrease in organ functioning  Existence of multiple chronic diseases Better living conditions Better primary health care Better acute health care Better pharmaceuticals

8.  Falls are a major threat to the health and independence of older adults  1/3 of people 65 years or older will fall each year Leading reason for EMS calls in Tompkins County  10% of all falls result in a serious injury (head or hip injury) Average of over 1 year recovery time May never return home  Leading cause of death in the elderly

9.  Biological Risk Factors Mobility problems (muscle weakness, balance issues) Chronic health problems Peripheral neuropathy  Behavioral Risk Factors Inactivity (often associated with “a fear of falling”) Medication side effects Alcohol use  Environmental Risk Factors Home and environmental factor Incorrect size and/or use of assistive devices Poorly designed public spaces

10.  Female in her 80’s  Lives with someone  Does need transport to hospital … after evaluation by EMS  Has some pain, bleeding, lacerations and/or abrasions associated with fall  Most common area of fall is in the home in the living room  Most common time of fall is around 1700  Most common cause is trip/slip  Takes 4 or more medications

11. “Bag of meds” or “Meds in the shoebox” syndrome -Multiple MDs -OTC medications  Medication side effects … blurred vision, hypotension, sedation, decreased alertness  Medication interactions Aging affects: -Absorption -Distribution -Metabolism -Elimination (toxic accumulation) -Increased sensitivity to potential side effects Psychoactive medications Seizure medications Cardiovascular medications Analgesia

12.  Most common: Falls Fractures Open wounds Superficial injuries Strains and sprains  MVC – fewer, but more serious injuries and/or deaths related to older drivers  Burns

13.  Be aware of underlying medical problems  Different splinting /immobilization techniques need to be utilized  Think outside of the box

15.  Normal physiological changes may include: An impaired or loss of vision An impaired or loss of hearing An altered sense of taste and/or smell A lower sensitivity to touch  Any of these conditions can affect your ability to fully communicate with the patient

16.  Talk directly to the patient Formal, respectful approach Face your patient when speaking  Try to stay in the middle of the field of vision  Protect the dignity of your patient – DO NOT use terms like “Sweetie”, “Hon”, “Dear”, “Pops” Use Mr., Mrs. or Ms., or simply ask: “My name is Ray. May I call you (insert first name here)?”

17.  Don’t let well-meaning family members and/or care givers prevent you from hearing what the patient has to say if he or she can speak.  Watch out for “I don’t want to bother anyone” syndrome More minor injuries/illness can become more serious over time Probe for significant complaints/ symptoms Chief complaint may be trivial/non-specific Patient may not volunteer information

18.  Speak slowly utilizing easy to understand terms (watch the acronyms and big medical words!)  Allow for autonomy – is it really that bad to let a patient lock their own door or take a few minutes to find a favorite hat ?

19.  Factors needed to form a complete patient impression Living situation Level of activity Network of social support Level of independence Medication history

20.  Geriatric patients who are especially “at risk” : Live alone Have recently been hospitalized Have recently been bereaved Have an altered mental status Are incontinent Are immobile

21.  Loss of memory  Robbery/assault  Stroke/loss of mobility  Loss of vision  Cancer  Finances/loss of health insurance  Health of children  Health of a spouse  Loss of ability to drive LOSS OF INDEPENDENCE and INABILITY TO REMAIN IN THEIR OWN HOME

22.  DO NOT assume: Confusion is normal for any elderly patient Aging means impaired thinking ability  DO assume: An altered mental status is the result of trauma or a medical condition until proven otherwise That there is a need to confirm what “normal mental status” is for this patient

23.  Abuse is the: “Willful infliction of injury, unreasonable confinement, intimidation or cruel punishment, resulting in physical harm, pain, or mental anguish; Willful deprivation of goods or services that are necessary to avoid physical harm, mental anguish, or mental illness”

24.  Physical  Emotional  Sexual  Financial exploitation  Neglect (includes self-neglect)  Occurrence ranges from 2 to 10% … but it is thought that for every 1 reported case, there are 5 victims not reported  Abuse may exacerbate pre-existing conditions

25.  Note explanations that just sound “wrong”:  Conflicting histories from patient and caregiver  History inappropriate to the type or degree of injury  Bizarre or unrealistic explanation  Long delay in treatment from time of injury.  History of being “accident prone”  Denial in view of obvious injury  Injuries inconsistent with story - bruises, black eyes, welts, lacerations, rope marks, fractures.  Open wounds, untreated injures in different stages of healing.

26.  Office of Children & Family Services Protective Services for Adults Tompkins County Social Services Adult Protective Services at 274-5285  NYS Hotline 1-800-342-3009 (Press Option 6)  Document what you see, hear and do

27.  For any patient who has fallen but does not need and/or refuses transport to the hospital  Provide informational brochure  Complete brief data form