Geriatric Emergencies
Some Statistics
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Patients 65 years and older account for over
50 % of all ambulance transports, this is
anticipated to grow to 70% by 2030.
Patients over the age of 65 have a higher
severity of illness and greater morbidity and
mortality rates than younger people, this
accounts for longer hospitalizations and
long term care.
Aging vs. Disease
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1% Rule of Aging
Disease is an interruption in the
physiological function that causes harm to
the individual.
So, functional performance of any organ
system depends upon:
• The rate of deterioration
• The level of performance needed
Physiological Changes of Aging
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Overall appearance:
skin, eyes
Cardiovascular
Pulmonary
CNS
GI tract
Renal function
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Vision
Hearing
Genitourinary
Endocrine
Musculoskeletal
Pyschological/Social
Immune system
Communication
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Good history alone will give you the right
impression in more than 80% of the patients
you treat.
Ask one question at a time, give the patient
time to answer.
The right question will give you the right
impression quickly.
Clarify what the patient is telling you.
Environmental Awareness
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Private residence:
• General cleanliness
• Availability of food and water
• Hazards
• Observe for signs of abuse or neglect
• Polypharmacy
• Medic Alert emblem or medical information
Environmental Awareness
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Extended Care or Nursing Home:
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Immediate complaints
Ambulatory? Level of activity?
Medical history, medications, allergies
Normal intake and output?
DNR, advanced directives, POLST orders?
Patient’s chart best source for information.
Observe for signs of abuse or neglect.
Confusional States in the Elderly
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Delirium:
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• Gradual onset
• Impaired recent
• Abrupt onset
• Reduced attention span
memory
• Regression
• Disorganized thinking
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At least 2 of:
• DLOC
• Perceptual disturbance
• Increased or decreased
psychomotor activity
Dementia
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At least 2 of:
• Disjointed thinking
• Poor judgment
• Loss of mental
function
Assessment
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Same approach as with any patient,
remember they are not large “kids.”
Treat with respect, introduce self & partner.
Tell the patient exactly what you are going
to do…before you do it.
Respect their privacy, protect their modesty.
Remember that someday you just might be
in the same situation.