Download Geriatrics

Geriatrics
Geriatrics
• Assessment and treatment of disease in
a person 65 years or older
Generational Considerations
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Many on fixed incomes
Coping with loss of loved ones
Struggling to maintain independence
Be patient / respectful
Avoid stereotyping the elderly
– Assuming all elderly people are
• Hard of hearing
• Have dementia
• Lead sedentary lives
Communications
• Introduce self and address the patient with formal
greeting such as 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
Communications Cont.
• 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
the patient as if they are not there.
Common Complaints
• Simple injuries in a 20-30 year old may
be life threatening in elderly
Common Conditions
• Hypertension
• Arthritis
• Heart disease
• Cancer
• Diabetes
• Sinusitis / respiratory issues
Leading Causes of Death
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Heart disease
Cancer
Stroke
COPD
Pneumonia / Influenza
Diabetes
Trauma
Assessment Challenges
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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 / Associated Chest Pain / Sputum / Talking
Tiredness / Exercise Tolerance
 SAMPLE History can be challenging and may have to be
obtained from family or caregiver
GEMS Diamond
• Geriatrics are different from younger patients
and may present atypically
• Environmental issues
– Home condition/ safety issues
• Medical assessment
– Medical problems
– Medications
• Social Assessment
– Activities of Daily Living are independent or require
assistance
Changes in Body
• Respiratory system
– Muscles are weaker
– Decreased breathing capacity
– Less recoil of chest
• Pneumonia
• Influenza
Cardiovascular System
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Atherosclerosis
Arteriosclerosis
Decreased Coronary artery profusion
Decrease in cardiac output
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Aneurysms
HTN
MI
Blood clots
Heart failure
Stroke
Nervous System
 Brain decreases in size and weight
 Longer retrieval times for long and short term
memory
 Loss of neurons effects sensory organs
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Vision
Hearing
Taste
Touch
Increased chance of head injuries
Dementia
Delirium
Syncope
Neuropathy
Gastrointestinal System
 Slower motility leads to slower gastric emptying
 Sphincter muscles weaken
 Heart burn
 Incontinence
 GI bleeding
 Upper
 Lower
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Gall Bladder
Diverticulitis
Bowel obstructions
Ulcers
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
• UTIs
Endocrine System
• Hormone producing system that controls all
aspects of body
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Body temperature
Growth
Heart rate
Fluid balance
Glucose levels
Immune System
• Less effective making elderly more prone for
infections
– Pneumonia
– UTIs
Musculoskeletal System
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Bone mass decreases
Osteoporosis
Decrease muscle mass
Decrease in flexibility of ligaments and tendons.
Lack of confidence leads to inactivity
Higher risk of fractures
Skin
• Skin elasticity declines
• Pressure ulcers become a risk for those who are
immobile
• Decubitus ulcers can lead to more serious
infections
Toxicology
• Due to reduced liver and kidney function
medications are not filtered from body and levels
can increase to toxic levels
• Often take multiple meds or polypharmacy.
Polypharmacy is common in 40% of elderly
patients and pertains to those taking four or more
prescription medications.
• Sometimes don’t take meds properly
Psychiatric Emergencies
• Depression
• Loss of independence
• Loneliness
• Suicide
• Substance abuse
Trauma in Elderly
 More prone to injuries
 Fractures
 Soft tissue injuries
 Head injuries
 Higher mortality rate
 Complications from immobility
 Risk factors
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Falls
Burns
Less compensatory mechanisms for shock
Abuse
Medical emergencies resulting in falls
Facilities
• Nursing facilities
• Long term care
• Assisted living
• Age specific apartments
Advanced Directives
• Living wills
• Do not resuscitate
• Medical power of attorney
• People wishing to die at home
– Terminally ill
– Hospice patients
• When in doubt resuscitate.
Elder Abuse and Neglect
 Physical
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Assault
Neglect
Dietary
Home maintenance poor
Poor hygiene
 Psychological
 Verbal
 Deprivation of sensory stimulation
 Financial
 Theft of valuables
 Embezzlement