1. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 3 Geriatric Emergencies

2. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Topics Demographics of the Elderly The Aging Process Assessment and Management of the Elderly Patient

3. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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.

4. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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.

5. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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.

6. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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.

7. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Older active adult

8. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Senior volunteer programs

9. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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

10. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Example of a DNR order

11. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Financing and Resources for Health Care Medicare Medicaid Veterans Administration

12. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ VA hospitals provide a variety of services.

13. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ In treating the elderly, remember that the best intervention is prevention.

14. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

15. Meals on Wheels provides 1–3 meals a day.

16. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Free screening programs for the elderly

17. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ General Pathophysiology, Assessment, and Management

18. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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.

19. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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

20. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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

21. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Blister-packs are easier for the elderly.

22. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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.

23. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

24. 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.

25. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Sensory Changes in the Elderly

26. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Problems with incontinence and elimination are common in the elderly.

27. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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

28. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Try to distinguish the patient’s chief complaint from the primary problem.

29. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Communication Challenges

30. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Cataracts diminish eyesight.

31. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Talk directly to the elderly, if possible.

32. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Speak into a stethoscope with the hearing-impaired.

33. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Change in altered mental status can denote serious underlying problems.

34. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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.

35. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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.

36. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

38. Common Medical Problems in the Elderly

39. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Disorders Pneumonia COPD Pulmonary embolism Pulmonary edema Lung cancer

40. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory and cardiac problems can cause dyspnea.

41. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Cardiovascular Disorders Angina pectoris Myocardial infarction Heart failure Dysrhythmias Aortic dissection/aneurysm Hypertension Syncope

42. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Neurological Disorders Cerebrovascular disease (stroke) Seizures Dizziness/vertigo Parkinson’s disease Delirium, dementia, Alzheimer’s

43. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Dementia vs. Delirium

44. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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

45. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ GI Disorders GI hemorrhage –Upper GI bleed –Lower GI bleed Bowel obstruction Mesenteric infarct

46. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Skin Disorders Skin diseases –Pruritus –Herpes zoster Pressure ulcers (decubitus ulcers)

47. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Musculoskeletal Disorders Osteoarthritis Osteoporosis

48. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Stretching and weight-bearing exercises help prevent osteoporosis.

49. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Renal Disorders Glomerulonephritis

50. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Urinary Disorders Urinary tract infections Urosepsis

51. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Environmental Emergencies Hypothermia Hyperthermia

52. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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

53. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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

54. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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

55. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Trauma in the Elderly

56. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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

57. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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.

58. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Serious head injuries sometimes denote geriatric abuse.

59. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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.

60. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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

61. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Transport Considerations

62. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Modifications in positioning, immobilization, and packaging may be necessary in the elderly patient.

63. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Specific Injuries Orthopedic injuries Burns Head and spine injuries

64. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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

65. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Subcapital femoral neck fracture

66. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 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

67. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Summary Demographics of the Elderly The Aging Process Assessment and Management of the Elderly Patient