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Geriatrics

Geriatrics. Aaron J. Katz, AEMT-P, CIC www.es26medic.net. The elderly are not just old adults!. Problems. Multiple medical problems Often caused by changes in physiology as a normal part of the aging process Polypharmacy. Skin. Wrinkled, thinner, more prone to injury

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Geriatrics

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  1. Geriatrics Aaron J. Katz, AEMT-P, CIC www.es26medic.net

  2. The elderly are not just old adults!

  3. Problems • Multiple medical problems • Often caused by changes in physiology as a normal part of the aging process • Polypharmacy

  4. Skin • Wrinkled, thinner, more prone to injury • Less sweat glands – hyperthermia risk • Less elastic – more prone to bruises and lacerations

  5. Senses • Cataracts • Hearing loss/balance problems • Loss of teeth/poorly fitting dentures • Airway problems • Digestion problems • Decreased sensitivity to pain • May not feel the pain of a serious illness

  6. Respiratory system • Decreased elasticity/lung surface area • Decreased O2 and CO2 exchange • Impaired ability to cough • Decreased ability to remove mucus… • More prone to infection

  7. Cardiovascular system • Syncope • Decreased cardiac output • Increased workload on the heart • Decreased exercise tolerance • Cholesterol buildup (atherosclerosis)

  8. Cardiovascular system • Hardening of the arteries (arteriosclerosis) • Hypertension • MI • CVA • Bowel infarction • Aneurysm • Atrial fibrillation • Valvular disease

  9. Nervous system • Number of brain cells can be decreased by up to 45% • Loss of brain mass • More prone to serious head trauma • CVA/TIA • Parkinsons disease • Dementia • Syncope

  10. Genito-urinary/renal system • Loss of 30-40% of kidney function • Electrolyte/fluid imbalance • BPH / urinary retention • Urinary incontinence

  11. Musculoskeletal system • Decreased muscle mass • Bones more easily fractured • Arthritis • Osteoporosis

  12. GI system • Decreased GI motility, taste buds, saliva production • Malnourishment • Constipation • Diverticulitis • Decreased liver function • Increased “clearing times” for drugs • Accidental overdoses • AAA

  13. Endocrine system • Diabetes • Thyroid disorders • Hypothyroidism • Heat regulation problems

  14. Psychiatric • Depression • Does it surprise you?

  15. Geriatric assessment • Same as for adults, modify PRN • Only one person to ask the questions! • Speak as loudly as needed, slowly and clearly • Get down to their level; establish eye contact • RESPECT! • Don’t call them by nicknames

  16. Geriatric assessment -- 2 • Observation • A key element in the assessment • Avoid complicated questions • Use “Yes/No” questions if appropriate • Use “open ended” questions as much as possible • Always assume a medical component of any trauma case • Don’t assume that AMS is normal for them… • Try to find out what their baseline mental status is

  17. Common emergencies • Syncopy – many causes • Cardiac arrhythmias • Rate too fast; slow; irregular • Blood flow to the brain is insufficient • MI • Vasodilation • Often due to medication interactions • Septic shock

  18. Common emergencies -- 2 • Volume depletion • GI bleed • Aneurysm • Sweating • Neurological • CVA/TIA

  19. MI in the elderly • Elderly often do not experience classic MI S/S • Look for: • Syncope • Extreme weakness • Dyspnea • Nausea/vomiting • Sweating • Altered mental status

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