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CHAPTER
24
Special Considerations for the
Geriatric Patient
Emergency
Medical Responder: First on Scene, Ninth Edition
Emergency Care,
Twelfth Edition
Le •Baudour
Bergeron
• Wesley
Daniel J. Limmer
O’Keefe ••Grant
• Murray
• Bergeron • Dickinson
Copyright ©2012 by Pearson Education, Inc.
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Objectives
1. Review the major stages of lifespan
development of the adult patient.
2. Define the following terms:
a.
b.
c.
d.
e.
f.
g.
Alzheimer's disease
Dementia
Elder abuse
Elder neglect
Elderly
Geriatric
Self-neglect
(continued)
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Medical Responder: First on Scene, Ninth Edition
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• Wesley
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Objectives
3. Describe the general characteristics
commonly associated with geriatric
patients.
4. Describe some of the most common
age-related physical changes found in
geriatric patients.
5. Describe the common medical
problems of geriatric patients.
6. Explain the unique challenges that can
arise when assessing and caring for
the geriatric patient.
(continued)
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Medical Responder: First on Scene, Ninth Edition
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Objectives
7.Describe changes in the approach to
care when caring for geriatric patients.
8.Describe common signs and symptoms
of abuse and neglect.
9.Explain the role of the Emergency
Medical Responder in cases of
suspected abuse and/or neglect.
10.Demonstrate the ability to properly
assess and care for the geriatric
patient.
(continued)
Emergency
Medical Responder: First on Scene, Ninth Edition
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Objectives
11.Demonstrate various techniques that
can be employed to maximize
successful assessment of the geriatric
patient.
12.Value the role of the Emergency
Medical Responder with respect to
patient advocacy.
Emergency
Medical Responder: First on Scene, Ninth Edition
Emergency Care,
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• Wesley
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Media
Slide 41
Alzheimers Disease Video
Emergency
Medical Responder: First on Scene, Ninth Edition
Emergency Care,
Twelfth Edition
Le •Baudour
Bergeron
• Wesley
Daniel J. Limmer
O’Keefe ••Grant
• Murray
• Bergeron • Dickinson
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Topics
•
•
•
•
•
Understanding Geriatric Patients
Characteristics of Geriatric Patients
Age-Related Physical Changes
Assessment of Geriatric Patients
Common Medical Problems of Geriatric
Patients
Emergency
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UNDERSTANDING GERIATRIC
PATIENTS
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Understanding Geriatric Patients
• Geriatric
– 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.
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The vast majority of the elderly lead healthy, active lives.
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Think About It
• What types of unique life experiences
may impact the way an elderly person
interacts with you?
• What are some physical, emotional,
and financial challenges facing the
elderly?
• Treat an elderly patient the way you
would want your own parent or elderly
loved one treated.
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CHARACTERISTICS OF
GERIATRIC PATIENTS
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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 thorough
assessment and care for primary
complaint.
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Characteristics of Geriatric
Patients
• Elderly patients take numerous
prescriptions and OTC medications
daily.
– Average 4.5 medications per day.
– Incorrect medication: overdosing or
underdosing.
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Many elderly people use a pill organizer to help them remember
when to take their medications.
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Characteristics of Geriatric
Patients
• Elderly persons live increasingly
sedentary lifestyles.
–
–
–
–
–
–
Isolation
Poor nutrition
Depression
Difficulty using bathroom
Loss of independence
Higher likelihood for falls or other injuries
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Characteristics of Geriatric
Patients
• Many geriatric patients have some agerelated sensory changes.
–
–
–
–
Lower sensitivity to pain or touch
Altered sense of smell or taste
Hearing loss
Impaired vision or blindness
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Age-Related Difficulties with Communication
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Characteristics of Geriatric
Patients
• Factors that predispose elderly persons
to inability to retain urine or feces:
– Diseases such as diabetes
– Illnesses that cause diarrhea
– Certain medications
• 15 percent to 60 percent of all elderly
people suffer from some form of
incontinence.
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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.
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Think About It
• You respond to a nursing home where
you are met by an LPN that reports a
patient has fallen from a chair. You find
a 92-year-old male seated on the floor
complaining of back pain. You begin to
question him and he yells “Don't touch
me or I'll sock you in the nose!”
• How do you proceed?
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AGE-RELATED
PHYSICAL CHANGES
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Age-Related Physical Changes
• Respiratory System
– Reduced strength and endurance of
respiratory muscles
– Decreased chest wall flexibility
– Loss of lung elasticity
– Collapse of smaller airway structures
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Age-Related Physical Changes
• Cardiovascular System
–
–
–
–
Enlargement of left ventricle
Stiffening and elongation of aorta
Degeneration of heart's electrical system
Loss of elasticity in blood vessels
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Age-Related Physical Changes
• Nervous System
– Decreased reaction times
– Difficulty with recent memory
– Psychomotor slowing
• Assess for sluggishness, confusion, or
mental status below level of full
coherence.
• Depression is common condition found
among elderly patients.
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Age-Related Physical Changes
• Musculoskeletal System
– 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.
– Osteoporosis: loss of minerals from bones.
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During the aging process, osteoporosis causes a reduction in the
quality of bone, making the skeletal tissue more brittle and less
elastic.
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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.
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Common changes in the body systems of the elderly.
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Think About It
• You respond to the home of an elderly
female. A neighbor greets you and tells
you when she went to check on the
patient, she found her on the floor. You
see a significant skin tear on her left
elbow and a bruised bump above her
left eye. She is confused (new finding)
and has osteoporosis.
• How do you proceed?
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ASSESSMENT OF GERIATRIC
PATIENTS
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Assessment of Geriatric Patients
• Scene Size-up
–
–
–
–
Inadequate food, shelter, or hygiene
Lack of working heating or cooling system
Potential fall hazards
Conditions that suggest abuse or neglect
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When you encounter evidence of trauma, consider the possibility of
abuse until proven otherwise.
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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.
– Confirm adequate pulse; no immediate
threats to life before moving to secondary
assessment.
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Assessment of Geriatric Patients
• Obtaining a History
– Gathering medical history on elderly person
may take quite a bit of time.
– Obtain patient's medications.
– Be aware of patient's surroundings.
– Verify information with reliable source such
as caregiver.
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Assessment of Geriatric Patients
• The Physical Exam
– Handle elderly patients gently.
– Histories and exams can easily tire elderly
patients.
– Always explain what you are going to do
before you do it.
– Anticipate numerous layers of clothing.
– Respect modesty and privacy.
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Think About It
• You respond to a single-vehicle MVC
and find a 72-year-old female, seated
and restrained in the front passenger
seat. Her son, the driver, who is
uninjured, reports that his mother had
a stroke one year ago and is unable to
speak.
• How might you conduct a thorough
assessment?
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COMMON MEDICAL PROBLEMS OF
GERIATRIC PATIENTS
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Common Medical Problems of
Geriatric Patients
• Illnesses
–
–
–
–
–
–
–
Pneumonia
Chronic obstructive pulmonary diseases
Cancer
Heart failure
Aneurysm
High blood pressure
Brain attack (stroke)
(continued)
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Common Medical Problems of
Geriatric Patients
• Illnesses
Dementia
Parkinson's disease
Diabetes
Bleeding in stomach, esophagus or
intestines
– Urinary tract infections
– Reactions to medications
– Alzheimer's disease
–
–
–
–
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Click here to view a video on the topic of Alzheimer’s Disease.
BACK TO DIRECTORY
Emergency
Medical Responder: First on Scene, Ninth Edition
Emergency Care,
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• Wesley
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Common Medical Problems of
Geriatric Patients
• Injuries
– Trauma caused by falls is leading cause of
injury death among elderly.
– Look for potential dangers (unsecured
rugs, loose handrails, unsafely stacked
items); make caregiver or family member
aware of safety concerns.
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Common Medical Problems of
Geriatric Patients
• Elder Abuse and Neglect
– Elder neglect: abandonment or deprivation
of basic needs (water, food, housing,
clothing, and medical care).
– Self-neglect: inability or unwillingness to
provide or care for oneself.
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Common Medical Problems of
Geriatric Patients
• Elder abuse comes in many forms:
–
–
–
–
Physical
Sexual
Emotional or verbal
Financial
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Common Medical Problems of
Geriatric Patients
• Indicators of abuse and neglect
include:
–
–
–
–
–
Sores, bruises, other wounds
Unkempt appearance
Poor hygiene
Malnutrition
Dehydration
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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
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Think About It
• You respond to the home of an elderly
couple for an “unknown” complaint.
You find an 80-year-old female with a
history of Alzheimer's in her bedroom.
She has a red area under her eye that
is rapidly swelling. When asked what
happened, she states “He hit me.”
• How do you proceed?
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SUMMARY
Emergency
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Summary
• Assessment and emergency care of
geriatric patients can sometimes be
challenging due to normal age-related
changes in human body.
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Summary
• Many Geriatric Patients:
– Have multiple illnesses
– Take numerous prescription and over-thecounter medications
– Have problems with mobility
– Have issues of incontinence
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Summary
• Respiratory System
– Reduction in strength and endurance of
muscles that assist breathing
– Loss of lung elasticity
– Collapsing of smaller airway structures
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Summary
• Circulatory System
– Affected by thickening of walls of heart.
– Reduction in effectiveness of heart's
conduction system.
– Loss of elasticity of blood vessels.
– Reduced cardiac output; dysrhythmia;
aneurysms that burst.
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Summary
• Nervous System
–
–
–
–
Slowing of psychomotor functioning.
Decreased reaction times.
Forgetfulness.
Loss of sensation and coordination, which
is cause of falls among elderly.
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Summary
• Osteoporosis and degeneration of
musculoskeletal system can cause bone
weakness and general instability.
– Makes immobilization and airway
maintenance a challenge.
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Summary
• Skin
– Becomes thinner and weaker.
– More susceptible to tears, injuries.
– Due to sluggish cellular regeneration, can
be very slow to heal.
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Summary
• Look for things in patient's environment
– Unsafe conditions.
– Nonworking heating and cooling systems.
– Signs that indicate abuse or neglect.
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Summary
• Ensure modesty and privacy when
physically examining a geriatric patient.
• Elder abuse can be physical, emotional,
sexual, and financial.
• As an EMR you have legal duty to
report suspected cases of abuse and
neglect to appropriate authorities.
Emergency
Medical Responder: First on Scene, Ninth Edition
Emergency Care,
Twelfth Edition
Le •Baudour
Bergeron
• Wesley
Daniel J. Limmer
O’Keefe ••Grant
• Murray
• Bergeron • Dickinson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
REVIEW QUESTIONS
Emergency
Medical Responder: First on Scene, Ninth Edition
Emergency Care,
Twelfth Edition
Le •Baudour
Bergeron
• Wesley
Daniel J. Limmer
O’Keefe ••Grant
• Murray
• Bergeron • Dickinson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Review Questions
1. What are the general characteristics
commonly associated with geriatric
patients?
2. What are some of the most common
age-related physical changes found in
geriatric patients?
3. What are the common medical
problems of geriatric patients?
4. What are some of the unique
challenges that can arise when
assessing and caring for the geriatric
patient?
(continued)
Emergency
Medical Responder: First on Scene, Ninth Edition
Emergency Care,
Twelfth Edition
Le •Baudour
Bergeron
• Wesley
Daniel J. Limmer
O’Keefe ••Grant
• Murray
• Bergeron • Dickinson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Review Questions
5. How would you change your approach
to care when caring for a geriatric
patients?
6. What are common signs and
symptoms of abuse and neglect?
7. What is the role of the Emergency
Medical Responder in cases of
suspected abuse and/or neglect?
Emergency
Medical Responder: First on Scene, Ninth Edition
Emergency Care,
Twelfth Edition
Le •Baudour
Bergeron
• Wesley
Daniel J. Limmer
O’Keefe ••Grant
• Murray
• Bergeron • Dickinson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Please visit
www.bradybooks.com
and follow the Resource Central links
to access content for this text.
Emergency
Medical Responder: First on Scene, Ninth Edition
Emergency Care,
Twelfth Edition
Le •Baudour
Bergeron
• Wesley
Daniel J. Limmer
O’Keefe ••Grant
• Murray
• Bergeron • Dickinson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.