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Chapter 17
Geriatric
Emergencies
National EMS Education
Standard Competencies (1 of 4)
Trauma
Uses simple knowledge to recognize and
manage life threats based on assessment
findings for an acutely injured patient while
awaiting additional emergency medical
response.
National EMS Education
Standard Competencies (2 of 4)
Special Considerations in Trauma
Recognition and management of trauma in
• Pregnant patient
• Pediatric patient
• Geriatric patient
National EMS Education
Standard Competencies (3 of 4)
Special Patient Populations
Recognizes and manages life threats based
on simple assessment findings for a patient
with special needs while awaiting additional
emergency response.
National EMS Education
Standard Competencies (4 of 4)
Geriatrics
• Impact of age-related changes on
assessment and care
Patients With Special Challenges
• Recognizing and reporting abuse and
neglect
Introduction (1 of 2)
• A geriatric patient is a patient who is older
than 65 years.
– By 2010, more than 40 million people will be
older than 65 years.
• The natural aging process results in a
decline in the functioning of all body
systems.
Introduction (2 of 2)
• Do not prejudge the
physical or mental
condition of older
patients.
• Most EMS systems
respond to many calls
involving geriatric
patients.
© Photodisc
– You must conduct a
complete full-body
examination on all
patients.
Sensory Changes
• Two of the most socializing senses are
hearing and sight.
• Many people experience some loss of
hearing and sight as they age.
– Driving and walking can become hazardous.
– Impaired vision and confusion often contribute
to mistakes in taking medications.
Hearing-Impaired or Deaf
Patients (1 of 3)
• Some older adults require the use of a
hearing aid.
• People with certain inner ear disorders are
more prone to poor balance and falls.
• Communication
– Be certain an elderly patient can hear and
understand what you say.
– Identify yourself and speak slowly and clearly.
Hearing-Impaired or Deaf
Patients (2 of 3)
• Communication (cont’d)
– Do not shout; ask the patient if he or she can
hear you.
– Speak directly into the patient’s ear or maintain
eye contact for lip readers.
– If you are still having difficulties communicating,
offer paper and a pencil.
– Use sign language if you know it.
Hearing-Impaired or Deaf
Patients (3 of 3)
Visually Impaired or Blind
Patients (1 of 2)
• Look for signs
indicating visual
impairment during
the scene size-up:
– Eyeglasses
– Cane
– Service dog
Courtesy of the Guide Dog Foundation for the Blind.
Photographed by Christopher Appoldt.
Visually Impaired or Blind
Patients (2 of 2)
• A visually impaired patient may feel
vulnerable during an emergency scene.
– Tell the patient what is happening, identify
noises, and describe the surroundings.
– Find out the patient’s name and use it.
– Provide psychological support.
– Keep eyeglasses with the patient if possible.
Techniques for Communicating
With Older Patients (1 of 2)
• Identify yourself.
• Look directly at the patient.
• Speak slowly and distinctly.
• Explain what you are going to do in clear,
simple language.
• Listen to the patient.
Techniques for Communicating
With Older Patients (2 of 2)
• Show the patient respect.
• Do not talk about the patient in front of the
patient.
• Be patient.
Musculoskeletal and Mobility
Issues (1 of 2)
• As a person ages, several changes occur to
the musculoskeletal system.
– Muscles lose strength.
– The disks between the vertebrae narrow, which
can cause loss of height, curvature of the spine,
and loss of flexibility.
– Bones in the skeletal system lose strength.
– Older people experience some loss of balance.
Musculoskeletal and Mobility
Issues (2 of 2)
• These changes result in an increased
incidence of falls among elderly patients.
– Falls result in an increased risk for brain injuries
because the blood vessels are more fragile and
the brain gets smaller as a person ages.
Slowed Movements
• As a person ages, movements become
slower.
• Lend a helping hand or supporting arm.
• Allow enough time for patients to move
safely rather than trying to rush them.
Fractures (1 of 3)
• Fractures occur frequently in the geriatric
population because the loss of bone density
often results in osteoporosis.
• Fractures of the wrist, spine, and hip are
particularly common.
• Geriatric patients may have a diminished
awareness of pain.
Fractures (2 of 3)
• Hip fractures are a common result of
osteoporosis.
– Occur most frequently in elderly women
– The injured leg is usually (but not always)
shortened in relation to the other leg.
– The toes of the injured leg are externally
rotated.
• Splint the patient and transport promptly.
Fractures (3 of 3)
Medical Considerations
• As people get older:
– They are generally less able to fight off
diseases.
– Their immune systems become less effective.
– They are not able to cough as effectively.
– They have increased difficulty handling
secretions.
Cardiovascular Diseases (1 of 2)
• Cardiovascular diseases are conditions that
affect the heart and blood vessels.
• As a person ages, the body loses its ability
to speed up heart contractions and the
blood vessels become stiffer and narrowed
by fatty deposits.
– These changes increase the occurrence of
heart attacks, angina, and congestive heart
failure.
Cardiovascular Diseases (2 of 2)
• Strokes and abdominal aortic aneurysms
are two common conditions related to
problems with blood vessels.
• Geriatric patients may not have the classic
signs and symptoms.
– Older patients have a decreased awareness or
sensation to the pain.
– Treat older patients with a high degree of
suspicion.
Respiratory Diseases (1 of 3)
• As a person ages:
– The alveoli lose some of their elasticity.
– The muscles associated with respirations
become weaker.
• Two major types of respiratory diseases:
– Chronic respiratory diseases
– Acute respiratory diseases
Respiratory Diseases (2 of 3)
• Patients with COPD may live with this
condition for many years.
– A cold or other respiratory infection can result in
a medical emergency.
• Acute respiratory diseases strike quickly.
– Pneumonia is common in elderly patients.
– A physician should examine an elderly patient
who has congestion and a possible fever.
Respiratory Diseases (3 of 3)
• Treatment
– Carefully examine the patient.
– Secure an accurate medical history (past and
present).
– Treat the patient’s presenting symptoms.
– Arrange for transport.
Cancer
• Cancer can strike any part of the body.
• Patients call for help when complications
from cancer result in:
– Acute pain
– Shortness of breath
– Shock
– Some other medical condition
• Provide support and transport.
Altered Mental Status
• Common causes of decreased
responsiveness in elderly patients
– Lack of adequate oxygen to the brain
– Low blood glucose level
– Hypothermia
• Assess patients and provide treatment
according to the signs and symptoms you
note.
Medications (1 of 2)
• Many older people take a large number of
medications every day.
– They may see several doctors for different
conditions.
– Some medications may interfere with the action
of other medications or cause adverse side
effects.
– They may not take their medications as
instructed.
Medications (2 of 2)
• Determine which
types of medication
a patient takes.
• If the patient is
being transported,
bring the
medications to the
hospital.
Long-Term Care Patients (1 of 4)
• Many patients with chronic conditions are
now treated at home by nurses or family.
• A variety of complex medical devices are
used with these patients.
– Devices that help patients breathe include:
• Ventilators
• Oxygen-enrichment devices
• Surgically inserted breathing tubes
• Monitors
Long-Term Care Patients (2 of 4)
• Complex medical devices (cont’d)
– Patients with certain heart conditions may have
pacemakers and automatic defibrillators.
– Tubes inserted into a patient’s arm, neck, or
stomach may provide fluids or food.
– Catheters may drain urine from the patient’s
bladder.
• These patients often take a wide variety of
medications.
Long-Term Care Patients (3 of 4)
© Jim Slosiarek, Journal Times/AP Photos
© Dr. P. Marazzi/Photo Researchers, Inc.
Long-Term Care Patients (4 of 4)
• Remember your role as an EMR.
– Assess the immediate problem.
– Take the appropriate steps in providing care.
– Do not get overwhelmed or distracted by the
complex equipment.
– Question the patient and the caregivers.
– In most situations, you need to stabilize the
patient for only a few minutes until more highly
trained EMS personnel arrive.
Depression (1 of 2)
• Most common psychiatric condition
experienced by older adults
– Occurs in 6% of the geriatric population
– More common in women than in men
• Contributing factors
– Living in nursing homes and/or living alone
– Loss of a spouse or a close friend
Depression (2 of 2)
• Contributing factors (cont’d)
– Declining health, chronic health conditions, or
terminal illnesses
• Be alert for signs and symptoms of
persistent feelings of sadness or despair.
• If you observe signs of depression, bring
them to the attention of other EMS
providers or other medical professionals.
Suicide (1 of 2)
• Older men have the highest suicide rate of
any age group in the United States.
– Older people choose more lethal means,
resulting in more deaths from suicide.
• Factors that contribute to this problem:
– Physical illnesses, especially terminal ones
– Loss of a loved one
– Alcohol abuse
Suicide (2 of 2)
• Listen carefully to the
patient and be alert for
indications of
hopelessness,
depression, or
attempts at suicide.
© dundanim/ShutterStock, Inc.
• If you suspect a
patient may be
considering suicide,
arrange for transport.
Dementia (1 of 5)
• A pattern of decline in mental function
• Marked by impairment in memory and may
result in decreases in:
– Reasoning
– Judgment
– Comprehension
– Ability to communicate verbally
Dementia (2 of 5)
• 20% to 40% of people older than 85 years
have some degree of dementia.
• Causes of dementia
– Small strokes
– Hardening of the arteries
– Heredity
Dementia (3 of 5)
• Alzheimer disease
– Most common type of dementia
– Chronic degenerative disorder that attacks the
brain and results in impaired memory, behavior,
and thinking
– Affects an estimated 5 million people in the
United States
Dementia (4 of 5)
• Alzheimer disease (cont’d)
– In the terminal stages, patients may be unable
to walk, lose control of their bowels and bladder,
and become unable to swallow.
• When caring for patients with dementia:
– Speak clearly and use the patient’s name.
– Let the patient know what you are doing at each
step of your assessment and treatment.
Dementia (5 of 5)
• When caring for
patients with
dementia: (cont’d)
© Glen E. Ellman
– You may need to
rely on family
members or
caregivers to
provide a medical
history.
– Use a kind and
caring approach.
Hospice Care (1 of 2)
• A hospice is a health care program that
brings together a variety of caregivers to
provide physical, emotional, spiritual, social,
and economic care for patients who have
terminal illnesses and who are expected to
die within the next 6 months.
• Interdisciplinary programs provide pain
relief and other supportive care.
Hospice Care (2 of 2)
• Pain relief is provided through:
– Oral medications
– Special pain-relieving patches
– Medicine placed in the mouth between the gum
and the cheek
• EMS is usually called when the patient
experiences unexpected problems such as
shortness of breath.
Advance Directives (1 of 2)
• Document that outlines the care patients
want to receive if they are not able to make
their own medical decisions
• May include do not resuscitate (DNR)
orders
– A DNR order is a request to withhold CPR and
other lifesaving measures if a person’s heart
stops or if he or she stops breathing.
Advance Directives (2 of 2)
• It is important for you to know the
regulations concerning these documents in
your state.
• If you cannot determine whether an
advance directive is valid, begin appropriate
medical care and leave the questions to
physicians.
Elder Abuse (1 of 3)
• Elderly people who are physically weak or
mentally compromised are at a high risk for
abuse by a:
– Spouse
– Family member or friend
– Caregiver
• Elder abuse may be physical, sexual, or
emotional.
Elder Abuse (2 of 3)
• Signs and
symptoms of
abuse
– Bruises
– Burns
– Trauma in the
genital area
– Signs of neglect
Courtesy of Rhonda Beck
Elder Abuse (3 of 3)
• If you suspect abuse, report it to the
authorities.
• Many community-based programs assist in
supporting geriatric patients who need:
– Physical assistance
– Nutritional support
– Emotional help
Summary (1 of 3)
• The natural aging process results in a
decline in the functioning of all body
systems, including sensory and
musculoskeletal changes.
• Fractures occur often in older people
because of the loss of bone density that can
lead to osteoporosis.
Summary (2 of 3)
• Common medical concerns for geriatric
patients include cardiovascular and
respiratory diseases.
• Three common causes of altered mental
status are lack of adequate oxygen to the
brain, low blood glucose level, and
hypothermia.
Summary (3 of 3)
• Do not overlook signs of mental health
problems in elderly patients. Three types of
mental problems seen frequently in older
people are depression, suicidal thoughts,
and dementia.
• Elder abuse may take the form of physical
abuse, sexual abuse, emotional abuse,
financial abuse, or neglect.
Review
1. When caring for an older patient who is
hearing-impaired, you should:
A. speak very loudly to be sure the patient can
hear you.
B. speak directly into the patient’s ear or maintain
eye contact for lip readers.
C. assume that the patient can read lips.
D. not attempt to communicate because it will only
frustrate the patient.
Review
Answer:
B. speak directly into the patient’s ear or
maintain eye contact for lip readers.
Review
2. Fractures occur frequently in the geriatric
population due to a condition that weakens
bones known as:
A. syncope.
B. osteoporosis.
C. dementia.
D. dislocation.
Review
Answer:
B. osteoporosis.
Review
3. Which of the following statements
regarding suicide in the elderly is MOST
accurate?
A. Older women have the highest rate of suicide.
B. Most elderly people seek counseling when
they become depressed.
C. Elderly patients tend to use more lethal means
than younger patients.
D. Alcohol abuse is not a contributing factor.
Review
Answer:
C. Elderly patients tend to use more lethal
means than younger patients.
Credits
• Opener: © Glen E. Ellman
• Background slide image (ambulance): ©
Comstock Images/Alamy Images
• Background slide images (non-ambulance):
© Jones & Bartlett Learning. Courtesy of
MIEMSS.