Geriatric patients aren't just "old adults"—they come with their own challenges, which include social, cognitive and physical aspects. As EMS providers, most of our basic patient assessments and interventions need to be tailored for this population. Here are some tips on how to achieve this.
Assess Your Assessment
Although the physical-assessment algorithm of the geriatric patient will not differ from that of patients in younger age groups, there are some useful tips you should implement during your interaction.
Some geriatric patients may be reluctant to tell you what's wrong. They may feel they are being a "burden" or that they "don't want to bother you" with their problem. They may have an extensive history they have related so many times they wonder why they should tell you when you'll only be with them for 20 or so minutes, and then they'll have to tell a nurse, a doctor, and the list goes on. Difficulties in communication are frustrating for those who cannot gather their thoughts, enunciate clearly or understand what is being said to or asked of them. Now, add a medical or traumatic injury, or both. It's the EMS provider's job to coax this information out of his patient to be able to initiate appropriate care that can be maintained throughout the rest of the system.
If at all possible, communicate directly with your patient. Although this may seem obvious, you would be surprised how many people listen to the geriatric patient's relative, friend or neighbor, when that patient can and does communicate quite well for him or herself. If the patient uses glasses, hearing aids or even dentures, make sure they are being used—it will make communication a lot easier for both of you.
Always let the patient know everything you are doing—clinically and otherwise. This communication is all the more important in what are unfamiliar surroundings for them. Even when you step behind them in the ambulance (to grab an additional piece of equipment or speak on the radio), let them know you are still there. Remember, you drive around in an ambulance routinely, they don't, and they may be uncomfortable in your environment.
Ask the patient how she would like to be addressed. For example: "May I call you Bernice, or do you prefer Ms. Smith?" This simple step goes a long way in establishing patient/rescuer rapport. Don't call them "Pops," "Hon," "Sweetie" or any other cute nickname. They didn't live through 70 or more years to be treated like that. They grew up in a different time--a more formal one that we need to understand and respect.
Mind Those Meds
Many elderly patients suffer from what EMS providers call "bag-o'-meds" syndrome, or "meds in a shoebox." You may recognize this from a call you've been on where it seems every medication you've ever heard of is in the patient's home. It is important to note that many meds are kept in weekly organizers that don't show the medication name/dose/strength or regimen. Many times, a family member, visiting nurse or aide sets this up for the patient. Bring it along. Another note about medication bottles: Often, the medication in the old, worn bottle with the label half gone is not what it says it is. The reasons vary as to why the patient reuses the same bottle: It's easier to open, easier to remember, or easier to recognize the color/size/shape. Check every bottle. The patient may have the same prescription from different doctors and/or different pharmacies that are unaware the patient is taking multiple doses.
Check all possible locations for prescription and nonprescription bottles. Take them all with you and don't forget any vitamin supplements or herbal remedies. Many elderly patients who take a large number of pills use pillboxes poured out by their home health aide or other visiting nurse service. Take this with you, as well, as it can indicate whether they have been taking the prescription.