geriatric
DESCRIPTION
TRANSCRIPT
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Geriatric Emergencies
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Demographics of the Elderly The Aging Process Assessment & Management of the
Elderly Patient.
Topics
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The Elderly...
Are one of the fastest growing segments of our population.
Are persons age 65 or older.
And their growing number presents a challenge to all health care providers.
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The Facts
The mean survival rate of older persons is increasing.
The birth rate is declining. There has been an absence of major
wars or other catastrophes. Health care and living standards have
improved significantly since WWII. By 2030, 70 million people will be 65 or
older.
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Gerontology is the scientific study of the effects of aging and age-related diseases on humans.
Geriatrics is the study and treatment of diseases of the aged.
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Societal Issues Elderly persons living alone represent
one of the most impoverished and vulnerable parts of society.
Factors include living environments, poverty, loneliness, social support.
A deterioration of independence is not inevitable and not necessarily a function of aging. It may well be a sign of a heretofore untreated illness.
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Older active adult
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Senior volunteer programs
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Ethics
In the course of caring for elderly patients, ethical concerns frequently arise. You may be confronted with: Multiple decision-makers Questions about a patient’s
competency Advanced directives, or DNRs
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Financing & Resourcesfor Health Care
Medicare Medicaid Veterans Administration
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VA hospitals provide a variety of services.
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In treating the elderly, remember that the best
intervention is prevention.
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Prevention strategies for the elderly
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Meals on wheels provide 1–3 meals a day
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Free screening programs for the elderly
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General Pathophysiology, Assessment, and
Management
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Pathophysiology The body becomes less efficient with
age. The elderly often suffer from more
than one illness or disease at a time. The existence of multiple chronic
diseases in the elderly often leads to the use of multiple medications.
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Factors that may decrease compliance in the elderly:
Limited income Memory loss Limited mobility Sensory impairment Fear of toxicity Child-proof containers Duration of drug therapy
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Factors that may increase compliance in the elderly:
Good patient-physician communication Belief that a disease or illness is serious Drug calendars Compliance counseling Blister packaging Pill boxes Transportation services to the pharmacy Ability to read Clear simple directions
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Blister-packs are easier for the elderly.
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Falls
Present an especially serious problem.
Represent the leading cause of accidental death among the elderly.
May be intrinsic or extrinsic. The elderly should be encouraged
to make their homes safe.
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Home safety for the elderly
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Communications
Normal physiological changes may include impaired vision, impaired or loss of hearing, an altered sense of taste or smell, and/or a lower sensitivity to touch.
Any of these conditions can affect your ability to communicate with the patient.
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Sensory changes in the elderly
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Problems with incontinence & elimination are
common in the elderly.
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Factors in Forming a General Assessment
Living situation Level of activity Network of social support Level of independence Medication history Sleep patterns
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Try to distinguish the patient’s chief complaint
from the primary problem.
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Communication Challenges
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Cataracts diminish eyesight
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Talk directly to the elderly,
if possible.
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Speak into a stethoscope with the
hearing-impaired.
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Change in altered mental status can denote serious
underlying problems.
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Only experience and practice will allow you to distinguish acute from chronic physical findings in the elderly patient.
When caring for the elderly: Encourage patients to express their feelings. DO NOT trivialize their fears. Avoid questions. Confirm what the patient says. Recall all that you have learned about
communicating with the elderly. Assure patients that you understand that they are
adults.
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Changes in the body systems of the elderly
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Common age-related systemic changes
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Common Medical Problems
in the Elderly
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Respiratory Disorders
Pneumonia COPD Pulmonary
embolism Pulmonary
edema Lung cancer
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Respiratory and cardiac problems can cause
dyspnea.
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Cardiovascular Disorders
Angina pectoris Myocardial infarction Heart failure Dysrhythmias Aortic dissection/aneurysm Hypertension Syncope
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Neurological Disorders
Cerebrovascular disease (stroke) Seizures Dizziness/vertigo Parkinson’s disease Delirium, dementia, Alzheimer’s
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Metabolic & Endocrine Disorders
Diabetes mellitus Thyroid disorders
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GI Disorders
GI hemorrhage Upper GI bleed Lower GI bleed
Bowel obstruction Mesenteric infarct
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Skin Disorders
Skin diseases Pruritus Herpes zoster
Pressure ulcers (decubitus ulcers)
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Musculoskeletal Disorders
Osteoarthritis Osteoporosis
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Stretching and weight-bearing exercises help prevent
osteoporosis.
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Renal Disorders
Glomerulonephritis
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Urinary Disorders
Urinary tract infections Urosepsis
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Environmental Emergencies
Hypothermia Hyperthermia
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Toxicological Emergencies
Lidocaine Beta-blockers Antihypertensives/diuretics ACE inhibitors Digitalis (digoxin, Lanoxin) Antipsychotropics Parkinson’s disease medications Analgesics Corticosteroids
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Substance Abuse
Factors that contribute to substance abuse in the elderly include:
Age-related changes Employment loss Loss of spouse Multiple prescriptions Malnutrition Loneliness Moving to an apartment/care home
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Behavioral/Psychological Disorders
Some of the common classifications of psychological disorders related to age include:
Organic brain syndrome Depression Dependent personality Paranoid disorders
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Trauma in the Elderly
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Trauma is the leading cause of death in the elderly.
Factors include: Osteoporosis Reduced cardiac reserve Decreased respiratory function Impaired renal function Decreased elasticity in the peripheral blood
vessels
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Assessment
Remember that blood pressure and pulse readings can be deceptive indicators of hypoperfusion.
Leading causes of trauma in the elderly include falls, motor vehicle crashes, burns, assault, and syncope.
Observe the scene for signs of abuse and neglect.
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Serious head injuries sometimes denote geriatric
abuse.
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Many states have laws that require EMS personnel to report suspected cases
of Geriatric abuse and/or neglect.
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General ManagementWhen caring for elderly patients,
consider the various changes and underlying conditions which may affect your care, such as: Cardiovascular considerations Respiratory considerations Renal considerations
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Transport Considerations
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Modifications in positioning, immobilization, and packaging may be
necessary in the elderly patient.
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Specific Injuries
Orthopedic injuries Burns Head and spine injuries
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Orthopedic Injuries—Common Fractures in the
Elderly Hip or pelvis fractures Proximal humerus Distal radius Proximal tibia Thoracic and lumbar bodies
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Subcapital femoral neck fracture
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Burns
People age 60 and older are more likely to suffer death from burns than any other group except neonates and infants. Factors include:
Slower reaction time Pre-existing diseases Age-related skin changes Immunological/metabolic changes Reductions in physiological function
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Summary
Demographics of the Elderly The Aging Process Assessment & Management of the
Elderly Patient