Beyond the Basics: Geriatric Care

While there have been specialized pediatric courses for many years, only recently have we begun to recognize important issues with our geriatric patients.

CEU Review Form Geriatric Care (PDF)Valid until November 6, 2006

While there have been specialized pediatric courses for many years, only recently have we begun to recognize important issues with our geriatric patients. These patients account for a large percentage of our runs and pose some important challenges in patient care. This article highlights some of these issues as they pertain to our day-to-day care of geriatric patients in the field.

Every call is an opportunity for prevention
     Many years ago, the fire service began prevention activities and saw a significant decrease in fires and lives lost due to fire. If EMS were to embrace prevention on geriatric calls, we could literally add years to the lives of our patients, reduce suffering and save millions in healthcare costs.

     Jumping down from the soapbox, let's look at how EMS prevention activities can make a difference in the geriatric population.

     Falls are a leading cause of injury-related emergency department visits across all age groups. In the geriatric population age 75 and older, falls account for 75% of accidental deaths. Ninety percent of hip fractures result from falls. Even falls from a standing height are associated with significant morbidity and mortality in the elderly.

     Falls occur for a number of reasons. Some are due to changes associated with aging, including reduced senses (hearing, eyesight), physical conditions (arthritis, osteoporosis) and poor balance. External factors, such as poor lighting, inappropriate footwear and throw rugs, also increase the risk of falls. Finally, medications can cause dizziness, drowsiness or confusion, further increasing the risk of falls. It is not unusual for some patients to have many, if not all, of these risk factors.

     EMS providers can perform injury prevention on any call-not just when called for a fall. If you are treating a patient with a medical complaint and you notice a hazard, this is the time for prevention. These hazards may include an unsecured throw rug or a stubborn patient who refuses to use a walker. Prevention might mean advising a patient to get up more slowly to prevent dizziness and subsequent falls. Table I lists some prevention tips and observations to make on your next call.

Bodies change with age
     Bodies gradually change through adulthood and into the geriatric years. Systems that were once efficient are no longer so. These inefficiencies result in signs and symptoms of injury and illness earlier and more frequently than seen in younger patients. For example, decreased lung elasticity and increased chest wall stiffness will cause shortness of breath with a lower level of exertion than in a younger patient. Table II on page 130 describes some of the changes that commonly occur in the elderly patient.

Be aware of polypharmacy
     Many geriatric patients take multiple medications. This is referred to as polypharmacy. The term may also imply that the combination of medications may not be ideal or could cause harm to a patient. It is not uncommon for an elderly patient to have hypertension, type II diabetes, arthritis and prostatic hypertrophy-all requiring medications.

     Polypharmacy may result in problems caused by interactions between medications prescribed by different physicians. Compliance with medications is also an issue when elderly patients are easily confused or forgetful. One of the authors recently treated an elderly patient with an altered mental status whose daughter came in several times per week and placed her mother's medications in a container with four compartments for each day of the week. Instead of taking medications out of the container from top to bottom, the patient went across the top, taking morning meds four times per day for almost two days. She had taken dangerously high doses of medications for hypertension, diuresis and depression. (This is another opportunity to help with prevention strategies.)

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