Chapter 26 Geriatrics PDF

Chapter 26 Geriatrics 8/22/2024 Slide 1 Overview  Anatomy and Physiology  Assessment of the Geriatric Patient  Trauma  Common Medical Emergencies  Special Considerations in the Elderly  Medication Considerations  Abuse and Neglect  Expanding...

Chapter 26 Geriatrics 8/22/2024 Slide 1 Overview  Anatomy and Physiology  Assessment of the Geriatric Patient  Trauma  Common Medical Emergencies  Special Considerations in the Elderly  Medication Considerations  Abuse and Neglect  Expanding the Role of EMS 8/22/2024 Slide 2 Geriatric Overview  Understanding unique problems of the elderly is important  The elderly are the fastest-growing segment of our population  A child born in 1900 could expect to live just 49 years  A child born in 1976 could expect to live almost 73 years and this continues to increase 8/22/2024 Slide 3 Geriatric Overview Percentage of population increase by age group Slide 4 Geriatric Overview  Multiple reasons for this increasing age  Better health care  Decreased rates due to vaccinating against preventable illness 8/22/2024 Slide 5 Geriatric Overview  The leading cause of death in the geriatric population is cardiovascular disease, which encompasses heart attack and stroke. This is followed by cancer. 8/22/2024 Slide 6 Geriatric Overview  The elderly are more difficult to transport, but not to diagnose and treat  Many reasons  Multiple medical problems  Difficulty in communication  Changes in anatomy and physiology with aging  A host of social factors 8/22/2024 Slide 7 Anatomy and Physiology  Changes occur in all of our body systems as we age  General decline in function that begins slowly and is often not noticed until a problem occurs in another system  The decline in body systems starts at an early age, even the 30s 8/22/2024 Slide 8 Anatomy and Physiology  Respiratory system  Decrease in vital capacity by 50%  Air moved in one breath is less than normal  Maximum breathing capacity decreases by 60%  Maximum oxygen uptake decreases 70%  Limits exercise and exertion  Prohibits rapid bursts of activity 8/22/2024 Slide 9 Vital capacity 8/22/2024 10 Anatomy and Physiology  Cardiovascular system  Decrease in stroke volume  Decrease in contractility  Degeneration of the conduction system  Dysrhythmias more common  Variations in rate from minute to minute  Irregularities 8/22/2024 Slide 11 Stroke volume 8/22/2024 12 Anatomy and Physiology  Cardiovascular system  Hypertrophy of the heart muscle  Creates more area for the coronary arteries to supply  Inability to vasoconstrict quickly  Dizziness on standing 8/22/2024 Slide 13 Vascular problems Varicose veins Peripheral arterial disease 8/22/2024 14 Anatomy and Physiology  Renal system  Decrease in functional units of the renal system by 30%-40%  Renal blood flow decreases by 50%  Cannot produce very diluted or very concentrated urine  Limits ability to react to changes in fluids or electrolytes  Alters blood chemistry 8/22/2024 Slide 15 Renal system 8/22/2024 16 Anatomy and Physiology  Nervous system  45% reduction in brain cells in areas responsible for higher function  6%-7% decrease in brain weight  Decreased cerebral blood flow  Decreased nerve conduction velocity 8/22/2024 Slide 17 Anatomy and Physiology  Musculoskeletal system  Changes  Stature  Gait  Ability to ambulate 8/22/2024 Slide 18 Anatomy and Physiology  Musculoskeletal system changes  Predisposes patients to falls  Decrease in height of 2-3 inches  Posture changes  Kyphosis 8/22/2024 Slide 19 Kyphosis and scoliosis kyphosis scoliosis 8/22/2024 20 Anatomy and Physiology  Gastrointestinal system  ⅓ reduction in the volume of saliva  Decreased esophageal motility  Results in bowel disorders and constipation 8/22/2024 Slide 21 Common Medical Emergencies  Management is similar to other adult patients Slide 22 Common Medical Emergencies  Respiratory distress  Frequently have underlying pulmonary diseases  May present in an atypical manner  Pneumonia presents as not eating or generalized weakness 8/22/2024 Slide 23 Common Medical Emergencies  Cardiovascular conditions  Related to progression of atherosclerosis  Syncope  Rhythm disturbances  Atypical presentations 8/22/2024 Slide 24 Common Medical Emergencies  Acute neurological changes  Seizures related to CNS disease  Stroke  TIA  Dizziness  Dementia  Organic brain syndrome 8/22/2024 Slide 25 Transient ischemic attack 8/22/2024 26 Brain scarring 8/22/2024 27 dementia 8/22/2024 28 Common Medical Emergencies  Gastrointestinal bleeding  Upper more common coffee ground emesis.  Blood loss can precipitate other issues. 8/22/2024 Slide 29 Common Medical Emergencies  Environmental emergencies  Poor thermoregulation  More at risk than other adults 8/22/2024 Slide 30 Common medical emergencies  Psychiatric disorders  alcoholism  Risk of suicide  Depression 8/22/2024 31 Trauma  Serious problem in the elderly  Common causes  Falls  Motor vehicle crashes  Violence 8/22/2024 Slide 32 Trauma  Physiologic changes  Loss of elasticity of blood vessels  More subject to tearing  Concern for head bleeds  Cervical spine Injury  Common  Difficult to diagnose  Positioning and immobilization may need to be modified 8/22/2024 Slide 33 Trauma Slide 34 Trauma  In general, trauma care is similar to all patient populations  Keep in mind the changes associated with aging  Be alert for medications that blunt the normal response 8/22/2024 Slide 35 Assessment of the Geriatric Patient  Complicated process  Difficult to separate the effects of aging from the consequences of disease  Often suffer from more than one disease at the same time 8/22/2024 Slide 36 Assessment of the Geriatric Patient  Chief complaint may appear nonspecific, confusing.  May be the underlying reason for the real problem  Often fail to report important symptoms 8/22/2024 Slide 37 Assessment of the Geriatric Patient  Chronic problems make it difficult to sort out the original problem  Aging changes an individual’s response to illness or injury 8/22/2024 Slide 38  Assessment of the Geriatric Patient  Sensitive to changes in their routines  Rely on a social network for services  ICU psychosis Slide 39 Assessment of the Geriatric Patient  Communication problems are common  All senses on a gradual decline  Complicated by diseases  Dementia 8/22/2024 Slide 40 Assessment of the Geriatric Patient  History taking is a critical skill  Be aware of communications problems  Do not assume that a patient is deaf  Do not shout  Speak slowly and directly at the patient 8/22/2024 Slide 41 Assessment of the Geriatric Patient  Scene size-up  Be alert for clues at the scene  Can they care for themselves  Look for signs of drug or alcohol abuse  Look for signs of elder abuse 8/22/2024 Slide 42 Assessment of the Geriatric Patient  Initial assessment  Peripheral pulses may be difficult to evaluate  Focused exams  Patient may tire quickly from physical exam  Excessive clothing may hamper assessment  Explain what you are doing  Be alert for changes that are related to aging vs. changes that are related to a medical problem 8/22/2024 Slide 43  Medication Considerations  More than 25% of all prescription meds are taken by the elderly  More than 30% of all hospital admissions are for drug-induced illnesses Slide 44 Medication Considerations  Side effects  Interactions  Reactions  Toxicity 8/22/2024 Slide 45 Abuse and Neglect  Neglect more common than abuse  No socioeconomic boundaries  Average age is 80  Often have multiple chronic diseases  Require extensive care 8/22/2024 Slide 46 Abuse and Neglect  Unexplained trauma is the primary finding  Be alert for clues at the scene 8/22/2024 Slide 47 Expanding the Role of EMS  Evaluating ways to capitalize on our role and ability to enter patient homes  Allows for access to information physicians and other providers don’t know  Promote health and prevent illness 8/22/2024 Slide 48 Expanding the Role of EMS  Examples  Home survey  Immunization programs  Social service referrals 8/22/2024 Slide 49 Summary  Anatomy and Physiology  Assessment of the Geriatric Patient  Trauma  Common Medical Emergencies  Special Considerations in the Elderly  Medication Considerations  Abuse and Neglect  Expanding the Role of EMS 8/22/2024 Slide 50