1 Geriatric Review 2 Geriatrics Geriatric patients are individuals older than years of age. In 2000, the geriatric population was almost 35 million. By 2020, the geriatric population is projected to be greater than 54 million. Older people are major users of and health care in general. Effective treatment will require an increased understanding of geriatric care issues. 3 Communications Show the patient. Position yourself at eye level in front of the patient facing the patient Allows for reading of lips slowly and distinctly. Give the patient time to answer. Be. Older patients may need a little more to process your question 4 The GEMS Diamond patients: Normal aging, atypical presentation assessment: Safety, neglect assessment: Past history, medications assessment: Basic needs, social network 5 Physiologic Changes (1 of 3) Skin Susceptible to injury; longer time Senses of the senses Respiratory system Decreased ability to exchange 6 Physiologic Changes (2 of 3) Cardiovascular system Increased of cardiovascular disease Renal system in kidney function Nervous system Memory impairment, decreased psychomotor skills, of brain 7 Physiologic Changes (3 of 3) Musculoskeletal system 1
in muscle mass and strength Gastrointestinal system Decrease in ability of body to food properly 8 Polypharmacy Polypharmacy refers to the use of prescriptions by a single patient. Older people account for a large portion of overall medication usage. Many medications can have or counter actions when taken together. 9 Geriatrics and Trauma (1 of 2) An older patient may have decreased ability to even simple injuries. Assessment must include all medical conditions. are the leading cause of trauma death and disability in the elderly. 10 Geriatrics and Trauma (2 of 2) Motor vehicle trauma is the leading cause of death. The body s ability to isolate simple injury. conditions can result in falls or MVCs. 11 Cardiovascular Emergencies Syncope Interruption of blood flow to the brain Many underlying Heart attack symptoms often not present 12 Acute Abdomen (1 of 3) Acute abdominal aneurysm Walls of the weaken. Treat for shock and provide prompt transport. Gastrointestinal bleeding Blood in May cause 13 Acute Abdomen (2 of 3) Bowel obstructions nerve is stimulated and produces vasovagal syndrome. Vasovagal syndrome can cause dizziness and 2
. Patient requires transport to out other conditions. 14 Acute Abdomen (3 of 3) Older patients with pain have higher chances of hospitalization, surgery, and death than younger patients. 15 Altered Mental Status Delirium onset Usually associated with underlying cause Dementia Develops over a period of years 16 Psychiatric Emergencies is common among older adults. Physical pain, psychological distress, and loss of loved ones can lead to depression. are more likely to suffer depression. Older men have the highest suicide rate. Older patients use much more means. EMS should consider all suicidal thoughts or actions to be serious. 17 Signs of Physical Abuse Signs of abuse may be obvious or. Obvious signs include bruises, bites, and burns. Look for injuries to the. Consider injuries to the or rectum with no reported trauma as evidence of abuse. 18 Geriatric Assessment Address the patient by a, such as Mr. or Ms., and his or her last name. Preexisting conditions may affect findings. Maintain contact. Geriatric assessment may take longer. Observe the patient s behavior and actions. Ask -ended questions. 19 Primary Assessment Never assume altered mental status is. May have to rely on or caregiver to establish patient s baseline LOC Assess the patient s chief complaint and. 20 Focused History and Physical Exam (1 of 3) is usually the key in helping to assess a patient s problem. 3
Patience and good skills are essential. Treat the patient with respect. the patient and speak in a normal tone. 21 Focused History and Physical Exam (2 of 3) Obtain a list of and doses Often have multiple medication Ask about medications recently started or. Determine if the patient has taken other medications. Meds may alter S/S Sensation of may be diminished 22 Focused History and Physical Exam (3 of 3) Be aware that elderly are more prone to during assessment. Remove only necessary during the examination. 23 Detailed Physical Exam Very beneficial in assessment of geriatric patients Many times, geriatric patients do not realize that they have or other symptoms Can help to clarify complaints 24 Reassessment Normal aging may affect physical findings. Increased, respiratory changes Chronic changes can mask problems. Ongoing reassessments will help determine changes. Geriatric patients have ability to compensate. 25 Head Injuries Assume a injury in older patients who have signs and symptoms of head injury. Suspect brain injury in patients who take blood and who suffer head injury. Maintain delivery to brain. 26 Injuries to Pelvis and Hip Fractures Often present as hip or pain Pelvic ring disruption can lead to or internal organ injury. Hip fractures: Common debilitating injury Maintain leg in position to prevent further injury. 4
27 Medical Emergencies Determining chief complaint is challenging. Multiple conditions and complaints Ask what bothers them today. Sensation of may be diminished. Fear of hospitalization Conditions may present. 28 Cardiovascular Emergencies 29 Dyspnea 30 Syncope symptoms are often not present. Many have heart attacks. Common signs and symptoms Difficulty breathing Arm pain pain Related to many causes COPD Congestive heart failure Provide oxygen for all patients experiencing dyspnea. Can occur for many reasons in geriatric patients up too fast Straining to have movement Myocardial infarction Diabetic shock 31 Altered Mental Status onset is not normal in any patient. Most sudden changes are caused by a condition. Evaluate and treat for or hypoglycemia if present. 32 Acute Abdomen Complaints of abdominal pain in older patients usually indicate a event. Nervous system response to pain is. Consider gastrointestinal problems or abdominal aortic aneurysm. 33 Septicemia 5
Results from presence of microorganisms or their products in bloodstream Patients may present with: Hot, appearance Tachycardia and tachypnea Chills, cough 34 Response to Nursing and Skilled Care Facilities Important information to know from staff: What is the patient s chief complaint? What initial problem caused the patient to be admitted to the facility? Ask the staff about the patient s overall condition and normal. Obtain any type of transfer. 35 Key Points (1 of 2) Don t, most geriatrics are healthy. Aggressive taking. May or may not have classic C/C. history is very important. Take medications to ER. Treat patient with respect. 36 Key Points (2 of 2) Be aware of needs Eye glasses Hearing Walker See that patient s husband or wife is cared for See that patient s are secured 6