1. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Division 5 Special Considerations/ Operations

2. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 43 Geriatric Emergencies

3. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Topics Demographics of the Elderly The Aging Process Assessment and Management of the Elderly Patient

4. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The Elderly... Are one of the fastest growing segments of our population. Are persons age 65 or older. Their growing number presents a challenge to all health care providers.

5. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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.

6. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Gerontology vs. Geriatrics 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.

7. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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.

8. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Older active adult © The Stock Market Photo Agency

9. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Senior volunteer programs

10. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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 –Advance directives or DNRs

11. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Example of a DNR order

12. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Financing and Resources for Health Care Medicare Medicaid Veterans Administration

13. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ VA hospitals provide a variety of services.

14. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ In treating the elderly, remember that the best intervention is prevention.

15. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

16. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Meals on Wheels provides 1–3 meals a day.

17. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Free screening programs for the elderly

18. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ General Pathophysiology, Assessment, and Management

19. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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.

20. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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

21. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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

22. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Blister-packs are easier for the elderly.

23. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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.

24. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

25. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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.

26. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Sensory Changes in the Elderly

27. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Problems with incontinence and elimination are common in the elderly.

28. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Factors in Forming a General Assessment Living situation Level of activity Network of social support Level of independence Medication history Sleep patterns

29. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Try to distinguish the patient’s chief complaint from the primary problem.

30. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Communication Challenges

31. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Cataracts diminish eyesight.

32. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Talk directly to the elderly, if possible.

33. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Speak into a stethoscope with the hearing-impaired. © Craig Jackson/In the Dark Photography

34. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Change in altered mental status can denote serious underlying problems.

35. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Only experience and practice will allow you to distinguish acute from chronic physical findings in the elderly patient.

36. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Caring for the Elderly Encourage patients to express their feelings. DO NOT trivialize their fears. Avoid judgmental 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.

37. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

38. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

39. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Common Medical Problems in the Elderly

40. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Disorders Pneumonia COPD Pulmonary embolism Pulmonary edema Lung cancer

41. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory and cardiac problems can cause dyspnea.

42. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Cardiovascular Disorders Angina pectoris Myocardial infarction Heart failure Dysrhythmias Aortic dissection/aneurysm Hypertension Syncope

43. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Neurological Disorders Cerebrovascular disease (stroke) Seizures Dizziness/vertigo Parkinson’s disease Delirium, dementia, Alzheimer’s

44. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Dementia vs. Delirium

45. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Metabolic and Endocrine Disorders Diabetes mellitus Thyroid disorders Hormone Replacement Therapy (HRT) –Possible increased risk of breast cancer and stroke in menopausal woman

46. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ GI Disorders GI hemorrhage –Upper GI bleed –Lower GI bleed Bowel obstruction Mesenteric infarct

47. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Skin Disorders Skin diseases –Pruritus –Herpes zoster Pressure ulcers (decubitus ulcers)

48. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Musculoskeletal Disorders Osteoarthritis Osteoporosis

49. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Stretching and weight-bearing exercises help prevent osteoporosis. © Corbis/The Stock Market

50. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Renal Disorders Glomerulonephritis

51. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Urinary Disorders Urinary tract infections Urosepsis

52. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Environmental Emergencies Hypothermia Hyperthermia

53. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Toxicological Emergencies Lidocaine Beta-blockers Antihypertensives/diuretics ACE inhibitors Digitalis (digoxin, Lanoxin) Antipsychotropics Parkinson’s disease medications Analgesics Corticosteroids

54. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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

55. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Behavioral/Psychological Disorders Some of the common classifications of psychological disorders related to age include: –Organic brain syndrome –Depression –Dependent personality –Paranoid disorders

56. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Trauma in the Elderly

57. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Trauma Factors 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

58. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Assessment 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.

59. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Serious head injuries sometimes denote geriatric abuse.

60. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Many states have laws that require EMS personnel to report suspected cases of geriatric abuse and/or neglect.

61. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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

62. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Transport Considerations

63. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Modifications in positioning, immobilization, and packaging may be necessary in the elderly patient.

64. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Specific Injuries Orthopedic injuries Burns Head and spine injuries

65. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Orthopedic Injuries—Common Fractures in the Elderly Hip or pelvis fractures Proximal humerus Distal radius Proximal tibia Thoracic and lumbar bodies

66. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Subcapital femoral neck fracture

67. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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

68. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Summary Demographics of the Elderly The Aging Process Assessment and Management of the Elderly Patient