1. . Geriatric Emergencies Copyright © Texas Education Agency, 2014. All rights reserved.

2. . Copyright © Texas Education Agency, 2014. These Materials are copyrighted © and trademarked ™ as the property of the Texas Education Agency (TEA) and may not be reproduced without the express written permission of TEA, except under the following conditions: 1) Texas public school districts, charter schools, and Education Service Centers may reproduce and use copies of the Materials and Related Materials for the districts’ and schools’ educational use without obtaining permission from TEA. 2) Residents of the state of Texas may reproduce and use copies of the Materials and Related Materials for individual personal use only, without obtaining written permission of TEA. 3) Any portion reproduced must be reproduced in its entirety and remain unedited, unaltered and unchanged in any way. 4) No monetary charge can be made for the reproduced materials or any document containing them; however, a reasonable charge to cover only the cost of reproduction and distribution may be charged. Private entities or persons located in Texas that are not Texas public school districts, Texas Education Service Centers, or Texas charter schools or any entity, whether public or private, educational or non-educational, located outside the state of Texas MUST obtain written approval from TEA and will be required to enter into a license agreement that may involve the payment of a licensing fee or a royalty. For information contact: Office of Copyrights, Trademarks, License Agreements, and Royalties, Texas Education Agency, 1701 N. Congress Ave., Austin, TX 78701-1494; phone 512-463-7004; email: copyrights@tea.state.tx.us.copyrights@tea.state.tx.us Copyright © Texas Education Agency, 2014. All rights reserved.

3. . Physical Changes in the Geriatric Patient Aging produces a variety of physical changes. These changes often limit the body’s ability to compensate for illness and injury. A decrease in sensory function due to aging could result in a painless but deadly heart attack. You can reduce your chances of misattributing signs and symptoms by determining the patient’s normal or baseline condition. Copyright © Texas Education Agency, 2014. All rights reserved.

4. . Communication with the Geriatric Patient Always attempt to communicate with the older patient first rather than assuming the patient will give an unreliable history and asking others about the patient. Do not assume that confusion is caused by dementia unless someone else who knows the patient can confirm this is a chronic condition. Make sure the patient can see and hear you. Speaking loudly, slowly, or very clearly to a patient does not mean speaking down to a patient. Copyright © Texas Education Agency, 2014. All rights reserved.

5. . Communication with the Geriatric Patient Treat the patient with respect and dignity. Begin by calling the patient by a title and last name (for example, “Mrs. Sanchez”). Ask the patient how she would like to be addressed before assuming that you may use her first name. Whenever possible, speak to the patient at eye level. This may involve crouching or even kneeling. Copyright © Texas Education Agency, 2014. All rights reserved.

6. . Assessment of the Geriatric Patient Assessment of an older patient is very similar to the typical patient assessment; however, EMTs must account for particular issues associated with aging. General impression. What is the level of distress? Mental status. This can be challenging because some older people have abnormal mental status as part of their baseline condition. Airway. You may find it difficult to extend or flex the neck due to arthritic bone changes. Also consider dentures. Breathing. Elderly are at risk for FBAO: two major risks are poorly chewed food and dentures. Circulation. Finding a radial pulse is usually no different than for other patients; however, the pulse is often irregular. Copyright © Texas Education Agency, 2014. All rights reserved.

7. . Assessment of the Geriatric Patient Identifying priority in older patients may be difficult, because they are less likely to complain about severe symptoms. For example, older patients having a heart attack experience less pain. Even if symptoms seem mild or vague keep a high index of suspicion for serious conditions. Regardless of circumstances you must gather as much information about the patient as possible. As people age, systolic blood pressure tends to increase. Due to surgery or eye conditions, their pupils may not be round. When conducting a physical exam, keep the patient’s dignity in mind. Copyright © Texas Education Agency, 2014. All rights reserved.

8. . Assessment of the Geriatric Patient Many older patients have a high threshold for pain and may not react to pain from a fracture. Be sensitive to this when performing an exam. Injuries to the head and face are very common in older patients who have sustained a fall or been involved in a motor-vehicle collision. Immobilizing an elderly patient may be challenging due to stiffness in the neck and the head being moved forward from its normal position. Use folded towels or other materials to keep the head in its normal position, prevent hyperextension, and make the patient more comfortable. In assessing the chest you may see Shingles which produce a rash around the torso. The chest area is not commonly injured in elderly patient. Serious abdominal pain that would cause younger people agony may produce only slight discomfort in elderly patients. Copyright © Texas Education Agency, 2014. All rights reserved.

9. . Assessment of the Geriatric Patient They may have decreased breath sounds because of decreased lung capacity and movement of the chest wall. Listen to the lungs for wheezes or crackles, which can be signs of respiratory or cardiac problems. The hip and/or proximal femur are commonly fractured in a fall, especially in women, mostly because women are more prone to lose calcium from their bones. This causes so much weakening of the bone that a fracture is sometimes the cause of a fall rather than a result. Rather than showing a sudden change in condition, it is more common for older patients to show a slow, steady decline. Copyright © Texas Education Agency, 2014. All rights reserved.

10. . Assessment of the Geriatric Patient The patient does not suddenly tell you or show sudden signs. Instead, you may be lulled into a false sense of security because there is little or no appreciable change from one minute to the next. Check mental status, maintain an open airway, monitor breathing, reassess pulse, and monitor skin color, temperature, and moisture. Reassess vital signs every 5 minutes if patient is unstable; every 15 minutes if stable. Elderly patients commonly have an elevated systolic reading. The femoral head is most commonly fractured in female patients who have fallen. Stiffness of the neck and the head being moved forward must be dealt with when immobilizing elderly patients. Copyright © Texas Education Agency, 2014. All rights reserved.

11. . Medication Older patients often encounter difficulty with medications. Accidental overdose, drug interactions, and noncompliance are common issues. Medications may stay in an older person’s body longer, so a larger dose may be incapacitating. Some elderly patients take 6–10 or more different medications, so there is a high likelihood that one drug will interact negatively with another drug. Some medications are prescribed to counteract the effects of other medications. NSAIDs can irritate the GI tract and cause bleeding. More than 16,000 arthritis sufferers who take NSAIDs die every year in the United States because of GI bleeding. Copyright © Texas Education Agency, 2014. All rights reserved.

12. . Medical Conditions The elderly can experience shortness of breath as a result of the same diseases that cause this symptom in younger patients, such as asthma or pulmonary embolism. The older population, however, is more likely to have conditions such as emphysema and heart failure (pulmonary edema) or a combination of these diseases that causes shortness of breath. Older patients experiencing cardiac problems are more likely to complain about shortness of breath than about chest pain. Keep a high index of suspicion for cardiac problems in these patients. Chest pain in this population can be related to a lot of causes. The most common are angina, myocardial infarction, pneumonia, and aortic aneurysm. Copyright © Texas Education Agency, 2014. All rights reserved.

13. . Medical Conditions Some of the more common causes of altered mental status in the older patient are adverse effects from medications (many drugs have sedating effects that are more pronounced in the elderly), hypoglycemia (perhaps from taking too much diabetic medication), stroke (from chronic or untreated hypertension), generalized infection in the bloodstream (the immune system may not fend off microbes as well as it used to), and hypothermia (the elderly patient may lose heat at a temperature that is comfortable for others). Pneumonia may also be at play. An altered mental status resulting from hypoxia may be the only outward sign of pneumonia. Abdominal pain must be taken very seriously, as they could be due to life-threatening conditions such as abdominal aortic aneurysm, diverticulitis, or bowel obstruction. Ask patient if they have had black, tarry stools. Copyright © Texas Education Agency, 2014. All rights reserved.

14. . Medical Conditions Weakness can be the result of cardiac dysrhythmias. If an elderly patient’s heart is beating 180 times a minute there isn’t time for the heart to fill completely between contractions. Bradycardia can be just as much of a life threat. Both can be treated with medications, a pacemaker, or both. Depression is very common in the elderly. Observe the patient’s mood, speech, and activity. A number of elderly people fall because of abnormal heart rhythms. EMTs can help prevent falls by looking for and advising the patient of potential hazards when entering the home. Copyright © Texas Education Agency, 2014. All rights reserved.

15. . Abuse Elder abuse is a far too common problem. EMTs must learn to recognize the signs of abuse and neglect. Neglect can be physical, psychological, or financial. Physical abuse includes pushing, shoving, hitting, or shaking, and occasionally sexual abuse. Physical neglect includes improper feeding, poor hygiene, or inadequate medical care. Copyright © Texas Education Agency, 2014. All rights reserved.

16. . Abuse Psychological abuse and neglect include threats, insults, or ignoring an older person (“the silent treatment”). Financial abuse and neglect include exploitation or misuse of an older person’s belongings or money. Copyright © Texas Education Agency, 2014. All rights reserved.