Download Elder Abuse

Andy Johnson, NYS AEMT-P CIC
Objectives

Describe the concept of the GEMS diamond.

Discuss the social aspects of aging.

Describe negative stereotyping of older
people.

Describe the living arrangements of older
people.
The GEMS Diamond

Remember the following when caring
for older people:
Geriatric patients
Environmental assessment
Medical assessment
Social assessment
Aging Statistics

13% of people in the US are
over age 65.

“Baby Boomers” will increase
this number.

Expect to see an increase in
emergency calls involving
older patients.
Epidemiology

35 million people were over 65 years of age at
the turn of this last century


Projections estimate this will double by 2030 A.D.
Of the 35 million, less than 20% have some
type of significant disability

This estimate includes those with disability severe
enough to warrant institutionalization

Caring for those with disabling fractures alone
costs upwards of $10 billion pear year
How old do you have to be?

General age range for the “elderly”


General age range for the “old old”


Anyone between 75 an 85 years old
General age range for the “oldest of old”


Anyone 65 years of age or older
Anyone greater than 85 years old
Any individual age 62 or older

OR
Any individual with physical problems that mimic the
physiology of aging
“As organisms age, they accrue
functional impairments in virtually
every physiologic system.”
Geriatric Medicine, Copyright 2003 Spring-Verlag New York, Inc.
In other words, it’s not the age that gets you
but the wear and tear !
Case Study


Dispatched to a residence for an
84-year-old woman who has
fallen
Patient, Mrs. Reed, cannot get
up.
Mrs. Reed
Case Study (continued)

En route your partner says,
“Oh no, not another ‘I can’t get
up’ call!”
Is this attitude healthy?
Mrs. Reed
Case Study (continued)
Mrs. Reed is on the kitchen
floor.
 She is alert but weak.
 States she fell last night
 Has pain in left hip
 Vital signs are normal.

Mrs. Reed
Case Study (continued)

You conduct a GEMS exam:
Small amounts of food, home is
warm and clean
 No significant medical history, no
medications
 Son reports that mother lives
alone, no regular contact with
friends

Mrs. Reed
Case Study Conclusion
Mrs. Reed is transported to
ED.
 Report to Social Services for
potential follow up.

Mrs. Reed
Ageism

Stereotyping and discrimination of older
people

Categorizing people as senile, eccentric,
or stubborn

“Geezer,” “Lizard,” and “GOMER”
perpetuate ageism

Use of “honey” or “dear” is a milder form
Living Arrangements
Most live at home.
 Women are more likely
to live alone.
 Less than 5% are
institutionalized.

Access to Essential Services
Transportation
 Meal preparation
 Health care
 Social activities

Objectives

Describe normal and abnormal
assessment findings.

Recognize common emotional and
psychological reactions.

Describe common complaints in the
older patient.
General Patient Assessment

Scene size-up includes environmental
assessment:




General appearance, cleanliness
Temperature, food
Drugs, alcohol, signs of abuse
Initial assessment looks for life threats:



Airway cannot be protected as well.
Breathing can be complicated by previous
disease.
Circulatory system has slowed responses.
Mental Status Assessment
Confusion is not normal.
 Distinguish chronic
changes from new ones.
 Enlist help from family.
 Establish a baseline
mental status.
 Don’t be misled.

Assessment
Prioritize patient status.
 Detailed physical exam
 Ongoing assessment is required.

Case Study 1
Dispatched for an 82-year-old
woman acting strangely; patient
does not know why you are there.
 Daughter states mother has
Alzheimer’s.

Mrs. Randish
Case Study 1 (continued)



Daughter tells you that her mother
is not listening today.
She tells you that her mother has
had a cold.
Mrs. Randish is febrile, pale, and
dry.
How would you approach
assessment of this patient?
Mrs. Randish
Case Study 1 (continued)
Pulse = 96 beats/min
 Respirations = 24 breaths/min
 BP = 110/70 mm Hg
 Pulse Ox = 90%
 Lungs have crackles in the
lower left side.
 Hands are cold.

Mrs. Randish
Case Study 1 (continued)
• Signs include increasing agitation
per daughter.
• Allergic to sulfa
Mrs. Randish
• Medications include: Aricept, Paxil
• Past history of Alzheimer’s disease
• Last meal was breakfast
• Events are increasing agitation
since this morning.
Case Study 1 (continued)
Mrs. Randish is becoming
irritated with your questions.
 Daughter is able to calm
patient down.
 Patient agrees to treatment
and transport.

Mrs. Randish
Case Study 1 Conclusion
• Mrs. Randish is given oxygen to
bring saturation into mid 90’s.
• IV, cardiac monitor, 200 mL fluid
bolus
• Transported to the hospital,
diagnosed with pneumonia
• Treated and released after 1 week
Mrs. Randish
Case Study 2
Dispatched to a park to
evaluate a 79-year-old man,
Mr. Peterson, for difficulty
breathing
 He was taking his daily walk,
became short of breath

Mr. Peterson
Case Study 2 (continued)
Is there a respiratory problem?
Does the problem always match
the complaint?
Mr. Peterson
Assessing the Chief
Complaint
Determining the chief complaint can be
hard.
 Start with what is bothering the patient
most.
 Chief complaints may not be the life
threat.
 Communication is a big component.

Chief Complaint:
Shortness of Breath





Frequently life threatening
Often respiratory or cardiac in
origin
Can occur for other reasons such
as pain, bleeding, medications
Are there associated signs and
symptoms?
Does patient have a history of
respiratory complaints?
Chief Complaint: Chest Pain
Often cardiac in nature
 Many experience pain differently.
 Medication history is important.
 Have the patient locate the pain.
 Expose the chest: scars, pacemaker,
medication patches

Chief Complaint:
Altered Mental Status





Some causes manifest quickly,
others over days
Medication reactions are a frequent
issue.
Determine LOC and orientation to
person, place, and time.
Check motor and sensory response.
Get an ECG and blood sugar
reading.
Chief Complaint:
Abdominal Pain
More likely to be hospitalized
 Potential causes change with age.
 Overall pain response is decreased.
 Patient history is key.
 Look for additional signs.

Chief Complaint:
Dizziness or Weakness




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Factors: balance, injury, oxygen, and energy
History will help clarify the complaint.
Check ECG, orthostatic changes, blood sugar
Check for signs of stroke.
Assess for signs of head trauma.
Chief Complaint: Fever
Normal response to infection
 Suspect serious infection when
accompanied by changed LOC.
 Look for immediate life threats.
 Fever means illness until proven
otherwise.

Chief Complaint: Trauma





Exam follows the ABCs.
Look for potential medical
causes.
Past history may change the
needs of the patient.
Find the patient’s baseline
status.
Fractures are serious injuries.
Chief Complaint: Pain



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Unpleasant sensory or emotional experience
Use open-ended questions to evaluate.
Pain scale can be helpful.
Interpret vital sign changes as medical
issues.
Older patients may hesitate to complain of
pain.
Chief Complaint: Falls
Generally result from contributing
factors
 Look for medical reason for fall.
 Assess for injury and life threats.
 ECG, blood glucose, pulse oximetry

Chief Complaint:
Nausea, Vomiting, and
Diarrhea
Can originate in or out of GI tract
 Check for changes in diet or
medications.
 Look for signs of dehydration or
electrolyte abnormalities.
 Assess for GI bleeding.

Summary
Changes with age affect assessment
findings in older patients.
 Emotional or psychological findings in
the older patient should be evaluated.
 Common complaints fall into ten main
areas.

Leading Causes of Death in
Older People
Disease of the heart
 Cancer
 CVA/Stroke
 COPD
 Pneumonia

Case Study
Dispatched for 79-year-old man
with difficulty breathing
 Says he always gets winded
easily and cannot catch his
breath today
 Environment is clean and warm.

Mr. Brophy
Case Study (continued)

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History of AMI, CHF, COPD,
hypertension, diabetes
Pulse = 112 beats/min
Respirations = 28 breaths/min
Blood pressure = 160/96 mm
Hg
ECG = A-fib
Pulse Ox = 92% on oxygen
Mr. Brophy
Case Study (continued)
What factors influence how
well Mr. Brophy can
compensate for his illness?
How will aging affect these
factors?
Mr. Brophy
The Aging Body:
Integumentary System
Wrinkles
 Thinner skin
 Decreased fat
 Gray hair

Decubitis Ulcers (bedsores)




The result of circulatory failure due to
pressure resulting in dead tissue (necrosis)
May indicate that a bed-ridden patient is not
being properly cared for and/or moved by the
caregiver
Note: can also result from insufficient
circulation due to medical conditions (e.g.
diabetes)
Suspect neglect if:


Deep decubiti, multiple sites
Foul smelling dead tissue
Decubitus Ulcers
Bed sore

Immobility

Skin over bony surfaces

Vasculature compression

Vascular insufficiency

Tissue necrosis

Inflammation

Infection

Sepsis

Shock
Skin Ulcers in Diabetic with Severe Vascular Insufficiency
General Condition
•Edges
•Centers
•Smell
•Surrounding Skin
The Aging Body:
Respiratory System
Changes in airway
 Decreasing muscles of
ventilation
 Increased residual volume
 Decreased sensitivity of
chemoreceptors

The Aging Body:
Cardiovascular System
Development of atherosclerosis
 Decreasing cardiac output
 Development of arrhythmias
 Changes in blood pressure

The Aging Body:
Nervous System
Brain shrinkage
 Slowing of peripheral nerves
 Slowed reflexes
 Decreasing pain
sensation

Case Study (continued)


Mr. Brophy appears to have a
hard time hearing your
questions.
Does not respond to all of your
requests
What are the sensory changes
found in older patients?
Mr. Brophy
The Aging Body:
Sensory Changes
Vision distorts and eye
movement slows.
 Hearing loss is more common.
 Taste decreases.

Case Study (continued)
Mr. Brophy reports feeling
“down” lately.
 Lives alone and has few
friends still around

Is this patient at risk for
depression?
Mr. Brophy
The Aging Body:
Psychological Changes
Depression
 Anxiety
 Adjustment
disorders

Case Study (continued)

When asked about
medications, Mr. Brophy
directs your attention to a
shoebox.
How does the body react to
medications with aging?
Mr. Brophy
General rule of thumb is that
seniors often require lower
starting doses medications due
to the potential for adverse
events and toxicity
“START LOW AND GO SLOW”
The Aging Body:
Renal, Hepatic, and GI
Systems
Kidneys become smaller.
 Hepatic blood flow decreases.
 Production of enzymes
declines.
 Salivation decreases.
 Gastric motility slows.

The Aging Body:
Musculoskeletal System
Decreased muscle mass
 Changes in posture
 Arthritic changes
 Decrease in bone mass

The Aging Body:
Immune System
Less effective immune response
 Pneumonia and UTI are common.
 Increase in abnormal immune
system substances

Case Study Conclusion
Mr. Brophy is treated for
exacerbation of COPD.
 Admitted to hospital, found to
be on interacting medications
 On discharge, Mr. Brophy was
given follow-up visits with a
home care service.

Mr. Brophy
Summary

Diseases common to the older
population are familiar to EMS.

Organ systems decline in the aging
body.
Summary

Aging body has:
Decrease in muscle and bone
 Change in body structure
 Less ability to compensate for stress


Psychological changes:

Often caused by stress encountered in
older population
Summary
•
•
•
•
Number of people over age 65 is rising
Older people have many social and
environmental concerns.
We must understand and accept aging.
Family remains the most common residence
for the older population.
Remember…………………….
All is not
always what
it appears to be
Thank You!
