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Don’t Call Me Honey. AGING IN PLACE. EMS Training on Falls Prevention 1.0 Hour CME Credit for “Geriatrics” Part of Tompkins County’s “ Step Up to Stop Falls ” Program Beth Harrington, CIC #3385 August 2011. US Population Growth.
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Don’t Call Me Honey AGING IN PLACE EMS Training on Falls Prevention 1.0 Hour CME Credit for “Geriatrics” Part of Tompkins County’s “Step Up to Stop Falls” Program Beth Harrington, CIC #3385 August 2011
US Population Growth • Overall population increase from 1975 to 2025 is about 60% (216 million to 350 million) • % of age 65 and older increases from10.6 to 18.2 • The Baby Boom includes people born from mid-1946 to 1964 … the elderly segment is increasing almost twice as fast as the rest of the population
In 2010 there were 53,364 people age 100 years or older (80% of them being female)
Geriatric Use of EMS • Elderly patients are responsible for approximately 22- 39 % of EMS calls nationally • Emergency Medical Service utilization by the elder. Annals of Emergency Medicine. 1982;11:610-612 • Geriatric use of Emergency Medical Services. Annals of Emergency Medicine 1996;27:199-203 • Geriatric use of EMS is twice that of patients less than age 65 and three times greater over the age of 85 • Medical transport of the elder: A population-based study. American Journal of Emergency Medicine 1995;13:297-300
Geriatric Use of EMS • Geriatric patients are at increased risks of morbidity and mortality when experiencing trauma of all varieties, and although they account for just 12.5% of the population, they account for one-third of all traumatic deaths. • Elderly trauma inpatients in New York State: 1994-1998. Journal of Trauma. 2004 Jun;56(6):1297-304 • “Geriatric Trauma” in The Trauma Manual. Lippincott Williams and Wilkins: Philadelphia, 2002, pp. 469-476
What do you picture when you get the call for the“unknown medical 75 year old male?”
Aging … • Cognitive decline Alzheimers • Physical realities • Loss of hearing and deterioration of vision • Weakening of musculoskeletal system • Loss of quality of skin integrity • Overall decrease in organ functioning • Existence of multiple chronic diseases • Better living conditions • Better primary health care • Better acute health care • Better pharmaceuticals
Falls in the Elderly • Falls are a major threat to the health and independence of older adults • 1/3 of people 65 years or older will fall each year • Leading reason for EMS calls in Tompkins County • 10% of all falls result in a serious injury (head or hip injury) • Average of over 1 year recovery time • May never return home • Leading cause of death in the elderly
Falls are Preventable … they are not an inevitable consequence of aging • Biological Risk Factors • Mobility problems (muscle weakness, balance issues) • Chronic health problems • Peripheral neuropathy • Behavioral Risk Factors • Inactivity (often associated with “a fear of falling”) • Medication side effects • Alcohol use • Environmental Risk Factors • Home and environmental factor • Incorrect size and/or use of assistive devices • Poorly designed public spaces
The “typical” fall victim in Tompkins County • Female in her 80’s • Lives with someone • Does need transport to hospital … after evaluation by EMS • Has some pain, bleeding, lacerations and/or abrasions associated with fall • Most common area of fall is in the home in the living room • Most common time of fall is around 1700 • Most common cause is trip/slip • Takes 4 or more medications
Polypharmia • Aging affects: • Absorption • Distribution • Metabolism • Elimination (toxic accumulation) • Increased sensitivity to potential side effects • “Bag of meds” or “Meds in the shoebox” syndrome • Multiple MDs • OTC medications • Medication side effects … blurred vision, hypotension, sedation, decreased alertness • Medication interactions Psychoactive medications Seizure medications Cardiovascular medications Analgesia
Geriatric Trauma • Most common: • Falls • Fractures • Open wounds • Superficial injuries • Strains and sprains • MVC – fewer, but more serious injuries and/or deaths related to older drivers • Burns
Geriatric Trauma • Be aware of underlying medical problems • Different splinting /immobilization techniques need to be utilized • Think outside of the box
Failure to Communicate • Normal physiological changes may include: • An impaired or loss of vision • An impaired or loss of hearing • An altered sense of taste and/or smell • A lower sensitivity to touch • Any of these conditions can affect your ability to fully communicate with the patient
Communication “Do’s” • Talk directly to the patient • Formal, respectful approach • Face your patient when speaking • Try to stay in the middle of the field of vision • Protect the dignity of your patient – DO NOT use terms like “Sweetie”, “Hon”, “Dear”, “Pops” • Use Mr., Mrs. or Ms., or simply ask: • “My name is Ray. May I call you (insert first name here)?”
Communication “Do’s” • Don’t let well-meaning family members and/or care givers prevent you from hearing what the patient has to say if he or she can speak. • Watch out for “I don’t want to bother anyone” syndrome • More minor injuries/illness can become more serious over time • Probe for significant complaints/ symptoms • Chief complaint may be trivial/non-specific • Patient may not volunteer information
Communication “Do’s” • Speak slowly utilizing easy to understand terms (watch the acronyms and big medical words!) • Allow for autonomy – is it really that bad to let a patient lock their own door or take a few minutes to find a favorite hat ?
Assessment • Factors needed to form a complete patient impression • Living situation • Level of activity • Network of social support • Level of independence • Medication history
Assessment • Geriatric patients who are especially “at risk” : • Live alone • Have recently been hospitalized • Have recently been bereaved • Have an altered mental status • Are incontinent • Are immobile
What do seniors fear most? • Loss of memory • Robbery/assault • Stroke/loss of mobility • Loss of vision • Cancer • Finances/loss of health insurance • Health of children • Health of a spouse • Loss of ability to drive LOSS OF INDEPENDENCE and INABILITY TO REMAIN IN THEIR OWN HOME
Mental Status … • DO NOT assume: • Confusion is normal for any elderly patient • Aging means impaired thinking ability • DO assume: • An altered mental status is the result of trauma or a medical condition until proven otherwise • That there is a need to confirm what “normal mental status” is for this patient
Not Always the “Golden Years” • Abuse is the: • “Willful infliction of injury, unreasonable confinement, intimidation or cruel punishment, resulting in physical harm, pain, or mental anguish; • Willful deprivation of goods or services that are necessary to avoid physical harm, mental anguish, or mental illness”
Elder Abuse • Physical • Emotional • Sexual • Financial exploitation • Neglect (includes self-neglect) • Occurrence ranges from 2 to 10% … but it is thought that for every 1 reported case, there are 5 victims not reported • Abuse may exacerbate pre-existing conditions
Assessment and History • Note explanations that just sound “wrong”: • Conflicting histories from patient and caregiver • History inappropriate to the type or degree of injury • Bizarre or unrealistic explanation • Long delay in treatment from time of injury. • History of being “accident prone” • Denial in view of obvious injury • Injuries inconsistent with story - bruises, black eyes, welts, lacerations, rope marks, fractures. • Open wounds, untreated injures in different stages of healing.
Reporting • Office of Children & Family Services • Protective Services for Adults • Tompkins County Social Services Adult Protective Services at 274-5285 • NYS Hotline 1-800-342-3009 (Press Option 6) • Document what you see, hear and do
Falls Prevention Program • For any patient who has fallen but does not need and/or refuses transport to the hospital • Provide informational brochure • Complete brief data form