EMS Training on Falls Prevention1.0 Hour CME Credit for “Geriatrics”

Part of Tompkins County’s “Step Up to Stop Falls” ProgramBeth Harrington, CIC #3385

August 2011

Don’t Call Me Honey

Overall population increase from 1975 to 2025 is about 60% (216 million to 350 million)

% of age 65 and older increases from10.6 to 18.2

The Baby Boom includes people born from mid-1946 to 1964 … the elderly segment is increasing almost twice as fast as the rest of the population

Elderly patients are responsible for approximately 22- 39 % of EMS calls nationally

Emergency Medical Service utilization by the elder. Annals ofEmergency Medicine. 1982;11:610-612

Geriatric use of Emergency Medical Services. Annals of Emergency

Medicine 1996;27:199-203 Geriatric use of EMS is twice that of patients less than

age 65 and three times greater over the age of 85 Medical transport of the elder: A population-based study.

American Journal of Emergency Medicine 1995;13:297-300

Geriatric patients are at increased risks of morbidityand mortality when experiencing trauma of allvarieties, and although they account for just 12.5% of the population, they account for one-third of alltraumatic deaths.

Elderly trauma inpatients in New York State: 1994-1998. Journal of Trauma. 2004 Jun;56(6):1297-304

“Geriatric Trauma” in The Trauma Manual. Lippincott Williams and Wilkins: Philadelphia, 2002, pp. 469-476

Cognitive decline Alzheimers Physical realities

Loss of hearing and deterioration of vision Weakening of musculoskeletal system Loss of quality of skin integrity Overall decrease in organ functioning

Existence of multiple chronic diseases Better living conditions Better primary health care Better acute health care Better pharmaceuticals

Falls are a major threat to the health and independence of older adults

1/3 of people 65 years or older will fall each year Leading reason for EMS calls in Tompkins County

10% of all falls result in a serious injury (head or hip injury) Average of over 1 year recovery time May never return home

Leading cause of death in the elderly

Biological Risk Factors Mobility problems (muscle weakness, balance issues) Chronic health problems Peripheral neuropathy

Behavioral Risk Factors Inactivity (often associated with “a fear of falling”) Medication side effects Alcohol use

Environmental Risk Factors Home and environmental factor Incorrect size and/or use of assistive devices Poorly designed public spaces

Female in her 80’s Lives with someone Does need transport to hospital … after evaluation

by EMS Has some pain, bleeding, lacerations and/or

abrasions associated with fall Most common area of fall is in the home in the living

room Most common time of fall is around 1700 Most common cause is trip/slip Takes 4 or more medications

“Bag of meds” or “Meds in the shoebox” syndrome-Multiple MDs-OTC medications

Medication side effects … blurred vision, hypotension, sedation, decreased alertnessMedication interactions

Aging affects:-Absorption-Distribution-Metabolism-Elimination (toxic accumulation)-Increased sensitivity to potential side effects

Psychoactive medicationsSeizure medicationsCardiovascular medicationsAnalgesia

Most common: Falls Fractures Open wounds Superficial injuries Strains and sprains

MVC – fewer, but more serious injuries and/ordeaths related to older drivers

Burns

Be aware of underlying medical problems Different splinting /immobilization

techniques need to be utilized Think outside of the box

Normal physiological changes may include: An impaired or loss of vision An impaired or loss of hearing An altered sense of taste and/or smell A lower sensitivity to touch

Any of these conditions can affect your

ability to fully communicate with the patient

Talk directly to the patient Formal, respectful approach Face your patient when

speaking Try to stay in the middle of the

field of vision Protect the dignity of your

patient – DO NOT use terms like “Sweetie”, “Hon”, “Dear”, “Pops”

Use Mr., Mrs. or Ms., or simply ask:

“My name is Ray. May I call you (insert first name here)?”

Don’t let well-meaning family members and/orcare givers prevent you from hearing what thepatient has to say if he or she can speak.

Watch out for “I don’t want to bother anyone” syndrome More minor injuries/illness can become more

serious over time Probe for significant complaints/ symptoms Chief complaint may be trivial/non-specific Patient may not volunteer information

Speak slowly utilizing easy to understand terms (watch the acronyms and big medical words!)

Allow for autonomy – is it really that bad to let a patient lock their own door or take a few minutes to find a favorite hat ?

Factors needed to form a complete patient

impression Living situation Level of activity Network of social support Level of independence Medication history

Geriatric patients who are especially “at

risk” : Live alone Have recently been hospitalized Have recently been bereaved Have an altered mental status Are incontinent Are immobile

Loss of memory Robbery/assault Stroke/loss of mobility Loss of vision Cancer

Finances/loss of

health insurance Health of children Health of a spouse Loss of ability to drive

LOSS OF INDEPENDENCE and INABILITY TO REMAIN IN

THEIR OWN HOME

DO NOT assume: Confusion is normal for any elderly patient Aging means impaired thinking ability

DO assume: An altered mental status is the result of trauma

or a medical condition until proven otherwise That there is a need to confirm what “normal

mental status” is for this patient

Abuse is the: “Willful infliction of injury, unreasonable confinement,

intimidation or cruel punishment, resulting in physical harm, pain, or mental anguish;

Willful deprivation of goods or services that are necessary to avoid physical harm, mental anguish, or mental illness”

Physical Emotional Sexual Financial exploitation Neglect (includes self-neglect) Occurrence ranges from 2 to 10% … but it is

thought that for every 1 reported case, there are 5 victims not reported

Abuse may exacerbate pre-existing conditions

Note explanations that just sound “wrong”: Conflicting histories from patient and caregiver History inappropriate to the type or degree of injury Bizarre or unrealistic explanation Long delay in treatment from time of injury. History of being “accident prone” Denial in view of obvious injury Injuries inconsistent with story - bruises, black eyes,

welts, lacerations, rope marks, fractures. Open wounds, untreated injures in different stages

of healing.

Office of Children & Family Services Protective Services for Adults Tompkins County Social Services Adult

Protective Services at 274-5285 NYS Hotline 1-800-342-3009 (Press

Option 6) Document what you see, hear and do

For any patient who has fallen but does not need and/or refuses transport to the hospital

Provide informational brochure Complete brief data form