1. 25
Special Considerations for the Geriatric Patient

2. Objectives Learn about Lifespan development Geriatric characteristics
Age related changes
Assessment challenges with geriatrics
Caring for the geriatric
Patient advocacy
Abuse and neglect

3. UNDERSTANDING GERIATRIC PATIENTS

4. 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.
Age dependent and variable
Critical Thinking: How might the EMR address fear of mortality when caring for an elderly patient?

5. The vast majority of the elderly lead healthy, active lives.
Treat an elderly patient the way you would want your own parent or elderly loved one treated.

6. CHARACTERISTICS OF GERIATRIC PATIENTS

7. 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 a thorough assessment and care for the primary complaint.
Critical Thinking: Why would multiple medical conditions create a unique challenge?

8. Characteristics of Geriatric Patients
Elderly patients take
numerous prescriptions
and OTC
medications daily.
Incorrect medication.
Multiple doctors.
Overdosing or underdosing.
Taking medication incorrectly.
Critical thinking: What might be a cause for overdosing? What about underdosing?

9. It can be challenging to keep track of multiple medications

10. Characteristics of Geriatric Patients
Elderly persons can live increasingly sedentary lifestyles.
Isolation
Poor nutrition
Depression
Difficulty using bathroom
Loss of independence
Higher likelihood for falls or injuries
Poor personal hygiene
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?

11. Characteristics of Geriatric Patients
Many geriatric patients have some age-related sensory changes.
Vision
Decreased vision
Inability to differentiate colors
Decreased night vision
Far sightedness
Decrease in depth perception
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.

12. Characteristics of Geriatric Patients
Many geriatric patients have some age-related sensory changes.
Hearing
Inability to hear higher frequency sounds
May require hearing aids
Sense of touch and pain
Decreased balance
Diminished pain perception
Difficulty differentiating hot and cold
Decreased tolerance of hot and cold
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.

13. Position yourself at the patient’s level, make good eye contact, and speak slowly and clearly.

14. Characteristics of Geriatric Patients
15 percent to 60 percent of all elderly people suffer from some form of incontinence.
Diseases such as diabetes
Illnesses that cause diarrhea
Certain medications
Discussion Question: Why is it important to allow the patient to maintain dignity when suffering from incontinence?

15. 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.

16. AGE-RELATED PHYSICAL CHANGES

17. Age-Related Physical Changes
Respiratory System
Diminished Breathing Capacity
Decreased chest wall flexibility
Loss of lung elasticity
Collapse of smaller airway structures
Reduced strength and endurance of respiratory muscles
Decreased ability to cough
Increased lung infections
Critical Thinking: What major lifestyle choice can help keep the respiratory system healthy?
Answer: Don't smoke; or quit smoking.

18. Age-Related Physical Changes
Cardiovascular System
Increased risk of Heart Attack and Stroke
Enlargement of left ventricle
Increase in blood pressure
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.

19. Age-Related Physical Changes
Nervous System
Decreased reaction times (reflexes)
Difficulty with recent memory
Psychomotor slowing
Assess for sluggishness, confusion or diminished mental status.
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?

20. Age-Related Physical Changes
Gastro-Intestinal System
Difficulty with digestion
Difficulty chewing
Muscles
Tongue
Dentures, bridges
Increased risk of FBAO
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.

21. Age-Related Physical Changes
Musculoskeletal System
Loss of strength and size of muscles
Loss of minerals from bones
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.
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?

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

23. 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.

25. ASSESSMENT OF GERIATRIC PATIENTS

26. Assessment of Geriatric Patients
Scene Size-up
Living conditions
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?

27. 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.
Dentures
Confirm adequate pulse.
Irregular pulse may be normal
Confirm no immediate life threats 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?

28. Assessment of Geriatric Patients
Obtaining a History
Gathering medical history on elderly person may take quite a bit of time.
Obtain patient's medications.
Review patient's surroundings.
Verify information with reliable source such as caregiver.
Discussion Topic: Discuss strategies to improve history-taking with a geriatric patient.

29. Assessment of Geriatric Patients
The Physical Exam (Secondary Assessment)
Handle elderly patients gently.
Always explain what you are going to do before you do it. Reassure the patient.
Anticipate numerous layers of clothing.
Respect modesty and privacy.
Keep the patient warm.
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.

30. COMMON MEDICAL PROBLEMS OF GERIATRIC PATIENTS

31. Common Medical Problems of Geriatric Patients
Injuries
Trauma caused by falls is leading cause of injury death among elderly.
Look for potential dangers.
Use of blood thinners
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.

32. Common Medical Problems of Geriatric Patients
Elder Abuse and Neglect
Elder abuse
Physical
Sexual
Emotional or verbal
Financial
Discussion Topic: Discuss strategies for addressing concerns of abuse.

33. Common Medical Problems of Geriatric Patients
Elder Abuse and Neglect
Elder neglect
Abandonment or deprivation of basic needs
Water
Food
Housing
Clothing
Medical care
Discussion Question: How might economic concerns impact the health care of a geriatric patient?

34. Common Medical Problems of Geriatric Patients
Elder Abuse and Neglect
Self-neglect
Inability or unwillingness to provide or care for oneself
Causes for Self-neglect
Depression
Funds
Discussion Question: How might economic concerns impact the health care of a geriatric patient?

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

36. Common Medical Problems of Geriatric Patients
Abuse and neglect
Assess and manage the patient and scene
Be aware of the legal aspects and follow local laws
Document thoroughly and notify appropriate authorities
Discussion Topic: Discuss assessment findings that might lead to suspicions of abuse.

37. 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
- End Geriatrics-
Teaching Tip: Review local guidelines and regulations for reporting elder abuse.