Geriatric EmergenciesGeriatric Emergencies

Some StatisticsSome Statistics• 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. DiseaseAging vs. Disease

• 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 AgingPhysiological Changes of Aging

• Overall appearance: skin, eyes

• Cardiovascular• Pulmonary• CNS• GI tract• Renal function

• Vision• Hearing• Genitourinary• Endocrine• Musculoskeletal• Pyschological/Social• Immune system

CommunicationCommunication• 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 AwarenessEnvironmental Awareness

• 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 AwarenessEnvironmental Awareness

• Extended Care or Nursing Home:• 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 ElderlyConfusional States in the Elderly

• Delirium:• Abrupt onset• Reduced attention span• Disorganized thinking

• At least 2 of:• DLOC• Perceptual disturbance• Increased or decreased

psychomotor activity

• Dementia• Gradual onset• Impaired recent

memory• Regression

• At least 2 of:• Disjointed thinking• Poor judgment• Loss of mental

function

AssessmentAssessment• 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.