Chapter 45
Older Adults
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45-1
Objectives
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Older Adults
• Many older adults
– Have at least one chronic medical
condition
– May have multiple medical conditions
• High blood pressure
• Heart disease
• Arthritis
– Are on multiple medications
– May be technology dependent
45-3
Assessment of the Older Adult
45-4
Scene Size-up
• Scene safety
• Note the position and location in which the
patient is found
• Determine the need for additional resources
45-5
General Impression
• Appearance
• (Work of) Breathing
• Circulation
45-6
Patient Assessment
• Level of responsiveness
• Spinal precautions
• Airway
– Neck arthritis
– Dentures
45-7
Patient Assessment
• Breathing
• Circulation
45-8
Communication
• Face the patient
• Speak slowly, clearly, and
respectfully
• Make sure lighting is
adequate
• Locate hearing aid or
eyeglasses if needed
• Speak to the patient first
• Give the patient time to
respond to questions
• Show concern and empathy
45-9
Common Health Problems
in Older Adults
45-10
Cardiovascular System Changes
• Thickening of the
blood vessels
• Decreased blood
vessel elasticity
• Increased peripheral
vascular resistance
• Reduced blood flow
to organs
• Hardening and
thickening of heart’s
valves
• Degeneration of
conduction system
• Increased blood
pressure
• Decreased stroke
volume
• Decreased cardiac
output
• Abnormal heart
rhythms
45-11
Acute Coronary Syndromes
Atypical Signs and Symptoms
• Unexplained new
onset or worsened
difficulty breathing
with exertion
• Unexplained
nausea, vomiting
• Sweating
• Unexplained
tiredness
• Change in mental
status
• Weakness
• Fainting
• Abdominal
discomfort
45-12
Cardiovascular System
• Heart failure
– Common in older adults
• Left ventricle
– Blood backs up into the lungs
• Pulmonary edema
• Right ventricle
– Blood backs up and causes congestion in
the organs and tissues of the body
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Respiratory System Changes
• Diminished elasticity of the diaphragm
• Decreased strength in chest wall and
accessory muscles
• Ineffective coughing
• Decreased number of alveoli that participate
in gas exchange
• Decreased activity of cilia in the lungs
increases susceptibility to infection
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Respiratory System
• Asthma
– Typically presents with tightness in the
chest, dyspnea, wheezing, retractions, and
coughing.
– If severe, possible cyanosis and an
absence of wheezing
• COPD
– Generally presents with coughing and
shortness of breath on exertion that is
often accompanied by wheezing.
45-15
Respiratory System
• Pneumonia
– Gradual onset
– Cough productive of sputum
– Shortness of breath with or without fever
– Fatigue
– Loss of appetite
– Tightness in the chest
45-16
Respiratory System
• Pulmonary embolism
– Anxious
– Sudden onset of dyspnea
– May complain of shoulder, back, or
chest pain
45-17
Nervous System Changes
• Difficulty with recent memory
• Difficulty retrieving information
• Decreased balance and coordination
• Forgetfulness
• Decreased reaction time
45-18
Nervous System
• Stroke complications
– Depression
– Pressure sores
– Urine incontinence
– Difficulty swallowing
– Venous clots in the legs that can lead to
pulmonary emboli
45-19
Nervous System
• Right brain stroke
– Irritability
– Confusion
– Sluggishness
– Difficulty retaining information
– Distortions of time
– Unawareness of the left side of the body
45-20
Nervous System
• Left brain stroke
– Difficulty starting tasks
– Compulsive behavior
– Slow processing of information
– Repetition of words
– Difficulty expressing self verbally or
in writing
45-21
Delirium
• Sudden change in mental status that is
generally caused by a reversible condition
• Very common in older adults
• Decreased attention span
• Disordered stream of thought
• Disturbances in perception
• Speech may be incoherent, rambling,
hesitant, slow, or rapid
45-22
Dementia
• A more gradual change in baseline
mental status
• Causes a progressive and sometimes
irreversible loss of intellectual
functions, psychomotor skills, and
social skills
• Change typically occurs over months
to years
45-23
Alzheimer’s Disease
• Stages
– Early (mild)
– Middle (moderate)
– Late (severe)
45-24
Nervous System
• Patient is generally a poor historian
• Obtain patient’s history from such family,
friends, neighbors, and environment
– Symptom onset
– What is different today?
– History of similar episodes
– History of psychiatric illnesses
– Medical conditions
45-25
Restraints
• If restraints are used, document the following
information:
– The reason for the restraints
– The number of personnel used to restrain the
patient
– The type of restraint used
– The time the restraints were placed on the patient
– The status of the patient’s ABCs, and distal
pulses before and after the restraints were applied
– Reassessment of the patient’s ABCs and distal
pulses
45-26
Gastrointestinal System
•
•
•
•
Tooth decay
Missing teeth
Periodontal disease
Decreased saliva
production
• Delayed emptying of
the stomach
• Decreased hydrochloric
acid in the stomach
• Changes in absorption
of nutrients
• Slowing peristalsis
causing constipation
• Rectal sphincter may
become weak resulting
in fecal incontinence
• Liver shrinks
• Decreased blood flow
to the liver
• Decreased metabolism
in the liver
• Decreased pancreatic
secretions
45-27
Gastrointestinal System
• Dry mouth
– Common complaint in older adults
• Dysphagia (difficulty swallowing)
45-28
Gastrointestinal System
• Upper GI bleeding
• Lower GI bleeding
45-29
Gastrointestinal System
• Ulcer disease
• Constipation
• Diarrhea
• Fecal incontinence
45-30
Genitourinary System
• Reduced kidney function
• Reduced blood flow to the kidneys
• Reduced sphincter muscle control
• Decreased bladder capacity
• Decline in sensation to urinate
• Increase in urinating at night
• Prostate enlarges in males
45-31
Genitourinary System
• Prostate enlargement
• Prostate cancer
• Urinary incontinence
• Urinary tract infections
45-32
Metabolic and Endocrine Problems
• Endocrine system changes
– Impaired glucose regulation
– Fluid and electrolyte imbalances
– Reduced thyroid hormone production
45-33
Metabolic and Endocrine Problems
• Increased risk of heat and cold-related
emergencies
• Reduced thyroid hormone production can
result in signs and symptoms that are often
attributed to other conditions
45-34
Metabolic and Endocrine Problems
• Type 2 diabetes mellitus
– Most common form of diabetes in older
adults
• Hyperosmolar hyperglycemic state (HHS)
– Complication of Type 2 diabetes
– Very high glucose concentration in the
blood (usually greater than 600 mg/dL)
45-35
Musculoskeletal System
• Muscle wasting
• Loss of bone mass
• Loss of muscle strength
• Degenerative changes in joints
• Loss of elasticity in ligaments and tendons
• Thinning of cartilage and thickening of
synovial fluid
45-36
Musculoskeletal System
• Osteoarthritis
– Major cause of knee, hip,
and back pain in older
adults
• Osteoporosis
– Compression fractures of
the vertebrae
– Kyphosis
45-37
Toxicological Emergencies
• Older adults are at risk of
toxicity
– Decreased kidney
function
– Altered gastrointestinal
absorption
– Decreased blood flow in
the liver
• Polypharmacy
45-38
Toxicological Emergencies
• Noncompliance with medications
– May not take his pills at all
– May take them every now and then
– May accidentally overdose from taking too
much medication
– May not be able to afford medications
– Lack of motor ability to open the bottle cap
– Altered mental status
– Impaired vision
45-39
Toxicological Emergencies
• Some medicines can
“hide” the signs and
symptoms of other illness
45-40
Sensory Changes in Older Adults
• Visual impairment increases with age.
• Cataracts
– Clouding of the lens of the eye
• Ability to focus on near objects decreases
• Lens yellows, affecting color vision
• Glaucoma
• Macular degeneration
45-41
Sensory Changes in Older Adults
• Presbycusis
– Hearing loss because of aging
– Progressive, occurring gradually over a
period of years
– Cannot hear high-pitched sounds well
45-42
Sensory Changes in Older Adults
• Touch sensitivity decreases
• Pain threshold increases
• Pain assessment
– Acute pain is pain of sudden onset
– Chronic pain is pain that is of long
duration
– Scale from 0 to 10 may not give a true
picture of pain
– OPQRST
45-43
Questions?
45-44