Special Considerations for the Geriatric Patient

1. 24 Special Considerations for the Geriatric Patient

2. Objectives • Review the major stages of lifespan development of the adult patient. • Define the following terms: • Alzheimer's disease • Dementia • Elder abuse • Elder neglect • Elderly • Geriatric • Self-neglect (continued)

3. Objectives • Describe the general characteristics commonly associated with geriatric patients. • Describe some of the most common age-related physical changes found in geriatric patients. • Describe the common medical problems of geriatric patients. • Explain the unique challenges that can arise when assessing and caring for the geriatric patient. (continued)

4. Objectives • Describe changes in the approach to care when caring for geriatric patients. • Describe common signs and symptoms of abuse and neglect. • Explain the role of the Emergency Medical Responder in cases of suspected abuse and/or neglect. • Demonstrate the ability to properly assess and care for the geriatric patient. (continued)

5. Objectives • Demonstrate various techniques that can be employed to maximize successful assessment of the geriatric patient. • Value the role of the Emergency Medical Responder with respect to patient advocacy.

6. Media Slide 41 Alzheimers Disease Video

7. Topics • Understanding Geriatric Patients • Characteristics of Geriatric Patients • Age-Related Physical Changes • Assessment of Geriatric Patients • Common Medical Problems of Geriatric Patients

8. UNDERSTANDING GERIATRIC PATIENTS

9. Understanding Geriatric Patients • Geriatric • Of or relating to elderly person • Elderly • Term to describe person age 65 or older • Appropriate care of elderly patients involves understanding the physical, emotional, and financial difficulties commonly experienced by this group.

10. The vast majority of the elderly lead healthy, active lives.

11. Think About It • What types of unique life experiences may impact the way an elderly person interacts with you? • What are some physical, emotional, and financial challenges facing the elderly? • Treat an elderly patient the way you would want your own parent or elderly loved one treated. s

12. CHARACTERISTICS OFGERIATRIC PATIENTS

13. Characteristics of Geriatric Patients • Elderly people commonly have multiple medical conditions, illnesses, or diseases at one time. • Creates a unique challenge for emergency responder who is assessing geriatric patient. • Your job is to perform thorough assessment and care for primary complaint.

14. Characteristics of Geriatric Patients • Elderly patients take numerous prescriptions and OTC medications daily. • Average 4.5 medications per day. • Incorrect medication: overdosing or underdosing.

15. Many elderly people use a pill organizer to help them remember when to take their medications.

16. Characteristics of Geriatric Patients • Elderly persons live increasingly sedentary lifestyles. • Isolation • Poor nutrition • Depression • Difficulty using bathroom • Loss of independence • Higher likelihood for falls or other injuries

17. Characteristics of Geriatric Patients • Many geriatric patients have some age-related sensory changes. • Lower sensitivity to pain or touch • Altered sense of smell or taste • Hearing loss • Impaired vision or blindness

18. Age-Related Difficulties with Communication

19. Characteristics of Geriatric Patients • Factors that predispose elderly persons to inability to retain urine or feces: • Diseases such as diabetes • Illnesses that cause diarrhea • Certain medications • 15 percent to 60 percent of all elderly people suffer from some form of incontinence.

20. Characteristics of Geriatric Patients • Confused or altered geriatric patients can become belligerent, argumentative, or physically abusive. • Keep your own safety and safety of others at scene in mind. • Do not take offensive language or attitude personally. • Do not allow yourself to be in position where patient can easily assault you.

21. Think About It • You respond to a nursing home where you are met by an LPN that reports a patient has fallen from a chair. You find a 92-year-old male seated on the floor complaining of back pain. You begin to question him and he yells “Don't touch me or I'll sock you in the nose!” • How do you proceed?

22. AGE-RELATEDPHYSICAL CHANGES

23. Age-Related Physical Changes • Respiratory System • Reduced strength and endurance of respiratory muscles • Decreased chest wall flexibility • Loss of lung elasticity • Collapse of smaller airway structures

24. Age-Related Physical Changes • Cardiovascular System • Enlargement of left ventricle • Stiffening and elongation of aorta • Degeneration of heart's electrical system • Loss of elasticity in blood vessels

25. Age-Related Physical Changes • Nervous System • Decreased reaction times • Difficulty with recent memory • Psychomotor slowing • Assess for sluggishness, confusion, or mental status below level of full coherence. • Depression is common condition found among elderly patients.

26. Age-Related Physical Changes • Musculoskeletal System • Changes in posture, range of motion, and balance. • Some elderly people lose up to three inches of height due to deterioration of discs between vertebrae and osteoporosis. • Osteoporosis: loss of minerals from bones.

27. During the aging process, osteoporosis causes a reduction in the quality of bone, making the skeletal tissue more brittle and less elastic.

28. Age-Related Physical Changes • Integumentary System (Skin) • Skin loses its elasticity and thickness. • Dark areas of pigment on skin, usually called “age spots” or “liver spots.” • Dry and flaky due to decrease in production of oils. • Ability to perspire tends to decrease.

29. Common changes in the body systems of the elderly.

30. Think About It • You respond to the home of an elderly female. A neighbor greets you and tells you when she went to check on the patient, she found her on the floor. You see a significant skin tear on her left elbow and a bruised bump above her left eye. She is confused (new finding) and has osteoporosis. • How do you proceed?

31. ASSESSMENT OF GERIATRIC PATIENTS

32. Assessment of Geriatric Patients • Scene Size-up • Inadequate food, shelter, or hygiene • Lack of working heating or cooling system • Potential fall hazards • Conditions that suggest abuse or neglect

33. When you encounter evidence of trauma, consider the possibility of abuse until proven otherwise.

34. Assessment of Geriatric Patients • Primary Assessment • Perform complete primary assessment. • Make note of position. • Confirm clear airway and breathing with adequate rate and tidal volume. • Confirm adequate pulse; no immediate threats to life before moving to secondary assessment.

35. Assessment of Geriatric Patients • Obtaining a History • Gathering medical history on elderly person may take quite a bit of time. • Obtain patient's medications. • Be aware of patient's surroundings. • Verify information with reliable source such as caregiver.

36. Assessment of Geriatric Patients • The Physical Exam • Handle elderly patients gently. • Histories and exams can easily tire elderly patients. • Always explain what you are going to do before you do it. • Anticipate numerous layers of clothing. • Respect modesty and privacy.

37. Think About It • You respond to a single-vehicle MVC and find a 72-year-old female, seated and restrained in the front passenger seat. Her son, the driver, who is uninjured, reports that his mother had a stroke one year ago and is unable to speak. • How might you conduct a thorough assessment?

38. COMMON MEDICAL PROBLEMS OF GERIATRIC PATIENTS

39. Common Medical Problems of Geriatric Patients • Illnesses • Pneumonia • Chronic obstructive pulmonary diseases • Cancer • Heart failure • Aneurysm • High blood pressure • Brain attack (stroke) (continued)

40. Common Medical Problems of Geriatric Patients • Illnesses • Dementia • Parkinson's disease • Diabetes • Bleeding in stomach, esophagus or intestines • Urinary tract infections • Reactions to medications • Alzheimer's disease

41. Click here to view a video on the topic of Alzheimer’s Disease. BACK TO DIRECTORY

42. Common Medical Problems of Geriatric Patients • Injuries • Trauma caused by falls is leading cause of injury death among elderly. • Look for potential dangers (unsecured rugs, loose handrails, unsafely stacked items); make caregiver or family member aware of safety concerns.

43. Common Medical Problems of Geriatric Patients • Elder Abuse and Neglect • Elder neglect: abandonment or deprivation of basic needs (water, food, housing, clothing, and medical care). • Self-neglect: inability or unwillingness to provide or care for oneself.

44. Common Medical Problems of Geriatric Patients • Elder abuse comes in many forms: • Physical • Sexual • Emotional or verbal • Financial

45. Common Medical Problems of Geriatric Patients • Indicators of abuse and neglect include: • Sores, bruises, other wounds • Unkempt appearance • Poor hygiene • Malnutrition • Dehydration

46. Common Medical Problems of Geriatric Patients • Advocate for the Elderly • As an EMR you have a duty to serve as an advocate for your patients. • Common signs of suspected abuse: • Unrealistic/vague explanation for injuries • Obvious delay in seeking care • Unexplained injuries (past or present) • Poor interaction between patient and caregiver

47. Think About It • You respond to the home of an elderly couple for an “unknown” complaint. You find an 80-year-old female with a history of Alzheimer's in her bedroom. She has a red area under her eye that is rapidly swelling. When asked what happened, she states “He hit me.” • How do you proceed?

48. SUMMARY

49. Summary • Assessment and emergency care of geriatric patients can sometimes be challenging due to normal age-related changes in human body.

50. Summary • Many Geriatric Patients: • Have multiple illnesses • Take numerous prescription and over-the-counter medications • Have problems with mobility • Have issues of incontinence