1. Geriatrics

2. Geriatrics
Assessment and treatment of disease in a person 65 years or older

3. Generational Considerations
Many on fixed incomes
Coping with loss of loved ones
Struggling to maintain independence
Be patient / respectful
Avoid ageism
Assuming all elderly people are
Hard of hearing
Have dimentia
Lead sedentary lives

4. Communications Introduce self and address pt with formal greeting
Mr or Mrs Smith
Body language speaks as loud as words
Make eye contact when speaking and listening
Speak clear and concise
One question at a time
Give time for them to respond
Listen to their answer
Explain what you are doing, don’t use technical jargon
Don’t speak with crew or other family members about pt as if they are not there.

5. Common Complaints
Simple injuries in a year old may be life threatening in elderly

6. Common Conditions Hypertension Arthritis Heart disease Cancer Diabetes
Sinusitis / respiratory issues

7. Leading Causes of Death
Heart disease
Cancer
Stroke
COPD
Pneumonia / Influenza
Diabetes
Trauma

8. Assessment Challenges
Communications ?
Altered mental status
Complicated medical history
Previous injuries or illnesses unrelated to current problem
Medications
Use OPQRST for chest pain
Use PASTE for shortness of breath
Progression/AssociatedChest Pain/ Sputum/Talking Tiredness/Exercise Tolerance
SAMPLE Hx can be challenging and may have to be obtained from family or caregiver

9. GEMS Diamond
Geriatrics are different from younger pt’s and may present atypically
Environmental issues
Home condition/ safety issues
Medical assessment
Medical problems
Medications
Social Assessment
ADL’s independent or require assistance

10. Changes in Body Respiratory system Pneumonia Influenza
Muscles are weaker
Decreased breathing capacity
Less recoil of chest
Pneumonia
Influenza

11. Cardiovascular System
Atherosclerosis
Arteriosclerosis
Decreased Coronary artery profusion
Decrease in cardiac output
Aneurysms
HTN MI
Blood clots
Heart failure
Stroke

12. Nervous System Brain decreases in size and weight
Longer retrieval times for long and short term memory
Loss of neurons effects sensory organs
Vision
Hearing
Taste
Touch
Increased chance of head injuries
Dementia
Delirium
Syncope
Neuropathy

13. Gastrointestinal System
Slower motility leads to slower gastric emptying
Sphincter muscles weaken
Heart burn
Incontinence
GI bleeding
Upper
Lower
Gall Bladder
Diverticulitits
Bowel obstructions
Ulcers

14. Renal System Bladder capacity decreases Sphincters weaken
Incontinence stress / urge
Voiding sense declines
Prostate enlargement in males causes incomplete emptying and retention
Nocturnal voiding
Reduced filtering / renal failure
UTI’s

15. Endocrine System
Hormone producing system that controls all aspects of body
Body temperature
Growth
Heart rate
Fluid balance
Glucose levels

16. Immune System Less effective making elderly more prone for infections
Pneumonia
UTI’s

17. Musculoskeletal System
Bone mass decreases
Osteoporosis
Decrease muscle mass
Decrease in flexibility of ligaments and tendons.
Lack of confidence leads to inactivity
Higher risk of fractures

18. Skin Skin elasticity declines
Pressure ulcers become a risk for those who are immobile
Decubitus ulcers can lead to more serious infections

19. Toxicology
Due to reduced liver and kidney function meds are not filtered from body and levels can increase to toxic levels
Often take multiple meds or polypharmacy
Sometimes don’t take meds properly

20. Psychiatric Emergencies
Depression
Loss of independence
Loneliness
Suicide
Substance abuse

21. Trauma in Elderly More prone to injuries Higher mortality rate
Fractures
Soft tissue injuries
Head injuries
Higher mortality rate
Complications from immobility
Risk factors
Falls
Burns
Less compensatory mechanisms for shock
Abuse
Medical emergencies resulting in falls

22. Facilities Nursing facilities Long term care Assisted living
Age specific apartments

23. Advanced Directives Living wills Do not resuscitate
Medical power of attorney
People wishing to die at home
Terminally ill
Hospice pt’s
When in doubt resuscitate.

24. Elder Abuse and Neglect
Physical
Assault
Neglect
Dietary
Home maintenance poor
Poor hygiene
Psychological
Verbal
Deprivation of sensory stimulation
Financial
Theft of valuables
embezzlement