Presentation on theme: "Special Considerations for the Geriatric Patient"— Presentation transcript:
1Special Considerations for the Geriatric Patient 24Special Considerations for the Geriatric Patient
2Review the major stages of lifespan development of the adult patient. ObjectivesReview the major stages of lifespan development of the adult patient.Define the following terms:Alzheimer's diseaseDementiaElder abuseElder neglectElderlyGeriatricSelf-neglect(continued)
3Describe the common medical problems of geriatric patients. ObjectivesDescribe 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)
4Describe common signs and symptoms of abuse and neglect. ObjectivesDescribe 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)
5ObjectivesDemonstrate 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.
9Understanding Geriatric Patients Of or relating to elderly personElderlyTerm to describe person age 65 or olderAppropriate 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?
10The 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.
11Think About ItWhat 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
13Characteristics 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?
14Characteristics 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?
15Talking 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.
16Characteristics of Geriatric Patients Elderly persons live increasingly sedentary lifestyles.IsolationPoor nutritionDepressionDifficulty using bathroomLoss of independenceHigher likelihood for falls or other injuriesCritical 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?
17Characteristics of Geriatric Patients Many geriatric patients have some age-related sensory changes.Lower sensitivity to pain or touchAltered sense of smell or tasteHearing lossImpaired vision or blindnessClass 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.
19Characteristics of Geriatric Patients Factors that predispose elderly persons to inability to retain urine or feces:Diseases such as diabetesIllnesses that cause diarrheaCertain medications15 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?
20Characteristics 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.
21Think About ItYou 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?
23Age-Related Physical Changes Respiratory SystemReduced strength and endurance of respiratory musclesDecreased chest wall flexibilityLoss of lung elasticityCollapse of smaller airway structuresCritical Thinking: What major lifestyle choice can help keep the respiratory system healthy?Answer: Don't smoke; or quit smoking.
24Age-Related Physical Changes Cardiovascular SystemEnlargement of left ventricleStiffening and elongation of aortaDegeneration of heart's electrical systemLoss of elasticity in blood vesselsTalking 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.
25Age-Related Physical Changes Nervous SystemDecreased reaction timesDifficulty with recent memoryPsychomotor slowingAssess 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?
26Age-Related Physical Changes Musculoskeletal SystemChanges 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?
27During the aging process, osteoporosis causes a reduction in the quality of bone, making the skeletal tissue more brittle and less elastic.
28Age-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.
29Common 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.
30Think About ItYou 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?
32Assessment of Geriatric Patients Scene Size-upInadequate food, shelter, or hygieneLack of working heating or cooling systemPotential fall hazardsConditions that suggest abuse or neglectDiscussion Question: What clues to the patient's condition might you find in the patient's surroundings?
33Teaching Tip: Provide local guidelines and regulations for reporting elder abuse. When you encounter evidence of trauma, consider the possibility of abuse until proven otherwise.
34Assessment of Geriatric Patients Primary AssessmentPerform 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?
35Assessment of Geriatric Patients Obtaining a HistoryGathering 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.
36Assessment of Geriatric Patients The Physical ExamHandle 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.
37Think About ItYou 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?
39Common Medical Problems of Geriatric Patients IllnessesPneumoniaChronic obstructive pulmonary diseasesCancerHeart failureAneurysmHigh blood pressureBrain attack (stroke)Discussion Topic: Discuss the psychological effects of suffering from multiple illnesses.(continued)
40Common Medical Problems of Geriatric Patients IllnessesDementiaParkinson's diseaseDiabetesBleeding in stomach, esophagus or intestinesUrinary tract infectionsReactions to medicationsAlzheimer's diseaseCritical Thinking: How might substance abuse or prescribed painkiller dependence impact the medical condition of a geriatric patient?
41Click here to view a video on the topic of Alzheimer’s Disease. BACK TO DIRECTORY
42Common Medical Problems of Geriatric Patients InjuriesTrauma 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.
43Common Medical Problems of Geriatric Patients Elder Abuse and NeglectElder 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?
44Common Medical Problems of Geriatric Patients Elder abuse comes in many forms:PhysicalSexualEmotional or verbalFinancialDiscussion Topic: Discuss strategies for addressing concerns of abuse.
45Common Medical Problems of Geriatric Patients Indicators of abuse and neglect include:Sores, bruises, other woundsUnkempt appearancePoor hygieneMalnutritionDehydrationDiscussion Topic: Discuss assessment findings that might lead to suspicions of abuse.
46Common Medical Problems of Geriatric Patients Advocate for the ElderlyAs an EMR you have a duty to serve as an advocate for your patients.Common signs of suspected abuse:Unrealistic/vague explanation for injuriesObvious delay in seeking careUnexplained injuries (past or present)Poor interaction between patient and caregiverTeaching Tip: Review local guidelines and regulations for reporting elder abuse.
47Think About ItYou 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?
49SummaryAssessment and emergency care of geriatric patients can sometimes be challenging due to normal age-related changes in human body.
50Summary Many Geriatric Patients: Have multiple illnesses Take numerous prescription and over-the-counter medicationsHave problems with mobilityHave issues of incontinence
51Summary Respiratory System Reduction in strength and endurance of muscles that assist breathingLoss of lung elasticityCollapsing of smaller airway structures
52Summary 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.
53Summary Nervous System Slowing of psychomotor functioning. Decreased reaction times.Forgetfulness.Loss of sensation and coordination, which is cause of falls among elderly.
54SummaryOsteoporosis and degeneration of musculoskeletal system can cause bone weakness and general instability.Makes immobilization and airway maintenance a challenge.
55Summary Skin Becomes thinner and weaker. More susceptible to tears, injuries.Due to sluggish cellular regeneration, can be very slow to heal.
56Summary Look for things in patient's environment Unsafe conditions. Nonworking heating and cooling systems.Signs that indicate abuse or neglect.
57SummaryEnsure 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.
59What are the common medical problems of geriatric patients? Review QuestionsWhat 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)
60What are common signs and symptoms of abuse and neglect? Review QuestionsHow 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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