1. Special Considerations for the Geriatric Patient24
Special Considerations for the Geriatric Patient

2. Review the major stages of lifespan development of the adult patient.
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. Describe the common medical problems of geriatric patients.
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. Describe common signs and symptoms of abuse and neglect.
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
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.
Critical Thinking: How might the EMR address fear of mortality when caring for an elderly patient?

10. The vast majority of the elderly lead healthy, active lives.
Teaching Tip: Contact your local council on aging to invite a speaker to discuss changes and challenges associated with aging.
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 OF GERIATRIC 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.
Critical Thinking: Why would multiple medical conditions create a unique challenge?

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.
Critical thinking: What might be a cause for overdosing? What about underdosing?

15. Talking Point: Sometimes patients will refer to their pill organizer when you ask about medications. Encourage them to show you the actual prescription bottles or ask them for a list, ensuring that the list contains the dosage details.
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
Critical Thinking: Why might the elderly have a higher likelihood for falls? Why is a fall from a standing position more serious for an elderly person than for a young adult?

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
Class Activity: Provide a selection of “age progression” items such as smudged glasses, restrictive clothing, earplugs or cotton balls, wheelchairs, canes. Direct students to use the items to simulate how it feels to have age-related issues. Discuss the experience.

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.
Discussion Question: Why is it important to allow the patient to maintain dignity when suffering from 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.
Talking Point: Try your best to remain calm and talk gently and in a reassuring way to help minimize agitation.

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-RELATED PHYSICAL 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
Critical Thinking: What major lifestyle choice can help keep the respiratory system healthy?
Answer: Don't smoke; or quit smoking.

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
Talking Point: Degeneration of the heart's electrical system will often lead to a heart condition that causes an irregular heart beat in the elderly. It is important to ask the patient if they have a cardiac history.

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.
Critical Thinking: What are some risks associated with decreased reaction times? Why is depression such a common condition among the elderly?

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.
Critical Thinking: How might osteoporosis and curvature of the spine affect your ability to manage a patient's airway or effectively immobilize him following an injury?

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.
Talking Point: As skin becomes thinner with age, it is much more prone to tears even with minimal trauma. Use extra care when handling these patients.

29. Common changes in the body systems of the elderly.
Discussion Topic: Discuss age-related changes of the major systems of the body.
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
Discussion Question: What clues to the patient's condition might you find in the patient's surroundings?

33. Teaching Tip: Provide local guidelines and regulations for reporting elder abuse.
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.
Discussion Question: Why is it important to first attempt to talk directly to the elderly patient rather than asking family members your assessment questions?

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.
Discussion Topic: Discuss strategies to improve history-taking with a geriatric patient.

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.
Class Activity: Provide a realistic scenario and assign the role of patient, EMR, and concerned family member. Using manikins or volunteers, direct students to work in these groups to demonstrate various techniques that can be employed to maximize successful assessment of the geriatric patient.

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)
Discussion Topic: Discuss the psychological effects of suffering from multiple illnesses.
(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
Critical Thinking: How might substance abuse or prescribed painkiller dependence impact the medical condition of a geriatric patient?

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.
Class Activity: Consult the Council on Aging or conduct web research to find common safety concerns that may be found in an elderly person's home. Have students work in pairs (one as EMR; the other as a family member) to practice talking about safety concerns that have been identified as well as suggestions to remedy them.

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.
Discussion Question: How might economic concerns impact the healthcare of a geriatric patient?

44. Common Medical Problems of Geriatric Patients
Elder abuse comes in many forms:
Physical
Sexual
Emotional or verbal
Financial
Discussion Topic: Discuss strategies for addressing concerns of abuse.

45. Common Medical Problems of Geriatric Patients
Indicators of abuse and neglect include:
Sores, bruises, other wounds
Unkempt appearance
Poor hygiene
Malnutrition
Dehydration
Discussion Topic: Discuss assessment findings that might lead to suspicions of abuse.

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
Teaching Tip: Review local guidelines and regulations for reporting elder abuse.

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

51. Summary Respiratory System
Reduction in strength and endurance of muscles that assist breathing
Loss of lung elasticity
Collapsing of smaller airway structures

52. Summary Circulatory System Affected by thickening of walls of heart.
Reduction in effectiveness of heart's conduction system.
Loss of elasticity of blood vessels.
Reduced cardiac output; dysrhythmia; aneurysms that burst.

53. Summary Nervous System Slowing of psychomotor functioning.
Decreased reaction times.
Forgetfulness.
Loss of sensation and coordination, which is cause of falls among elderly.

54. Summary
Osteoporosis and degeneration of musculoskeletal system can cause bone weakness and general instability.
Makes immobilization and airway maintenance a challenge.

55. Summary Skin Becomes thinner and weaker.
More susceptible to tears, injuries.
Due to sluggish cellular regeneration, can be very slow to heal.

56. Summary Look for things in patient's environment Unsafe conditions.
Nonworking heating and cooling systems.
Signs that indicate abuse or neglect.

57. Summary
Ensure modesty and privacy when physically examining a geriatric patient.
Elder abuse can be physical, emotional, sexual, and financial.
As an EMR you have legal duty to report suspected cases of abuse and neglect to appropriate authorities.

58. REVIEW QUESTIONS

59. What are the common medical problems of geriatric patients?
Review Questions
What are the general characteristics commonly associated with geriatric patients?
What are some of the most common age-related physical changes found in geriatric patients?
What are the common medical problems of geriatric patients?
What are some of the unique challenges that can arise when assessing and caring for the geriatric patient?
(continued)

60. What are common signs and symptoms of abuse and neglect?
Review Questions
How would you change your approach to care when caring for a geriatric patients?
What are common signs and symptoms of abuse and neglect?
What is the role of the Emergency Medical Responder in cases of suspected abuse and/or neglect?

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