Geriatrics is the assessment and treatment of disease in people 65 years of age or older.
Geriatric patients present a special challenge due to:
Chronic conditions.
Multiple medications.
The physiology of aging.
Generational Considerations
Understand and appreciate the life of older people, which may differ from younger generations.
It takes time and patience to interact with older individuals.
Treat the patient with respect, avoiding ageism.
Avoid stereotypes:
Not all older people have dementia.
Not all are hard of hearing.
Not all are sedentary or immobile.
Communication and Older Adults
Effective verbal communication is essential.
Communication techniques:
Speak respectfully and identify yourself.
Be aware of your presentation.
Look directly at the patient at eye level.
Speak slowly and distinctly.
Have one person talk to the patient at a time.
Ask only one question at a time.
Give the patient time to respond and listen to the answer.
Explain actions before performing them.
Common Complaints and Leading Causes of Death
The geriatric population is predisposed to specific problems.
Hip fractures are common, especially when bones are weakened by osteoporosis or infection.
Sedentary behavior can lead to pneumonia and blood clots.
Changes in the Body
The aging process is accompanied by changes in physiologic function.
All tissues in the body undergo aging.
A decrease in the functional capacity of various organ systems is normal but can affect the way a patient responds to illness.
Changes in the Respiratory System
Age-related changes can predispose older adults to respiratory illnesses.
Airway musculature becomes weakened.
Alveoli in the lung tissue become enlarged, and elasticity decreases.
The body’s chemoreceptors slow with age.
Decreased cough and gag reflexes.
Pneumonia
Inflammation/infection of the lung from bacterial, viral, or fungal causes.
The leading cause of death from infection in Americans older than 65 years.
Aging causes some immune suppression and increases the risk of contracting infections like pneumonia.
Increased mucus production, pulmonary secretions, and infection interfere with the ability of the alveoli to oxygenate the blood.
Management of pneumonia is the same for any patient.
Pulmonary Embolism
Sudden blockage of an artery by a venous clot.
A patient will present with shortness of breath and sometimes chest pain.
Can be confused with a cardiac, lung, or musculoskeletal problem.
Risk factors:
Living in a nursing home.
Recent surgery.
History of blood clots or heart failure.
Presence of a pacemaker or central venous catheter.
Obesity or sedentary behavior.
Recent long-distance travel.
Trauma, cancer, or paralyzed extremities.
Presents with:
Tachycardia.
Sudden onset of dyspnea.
Shoulder, back, or chest pain.
Cough.
Syncope in patients in whom the clot is larger.
Anxiety.
Apprehension.
Low-grade fever.
Hemoptysis.
Leg pain, redness, and unilateral pedal edema.
Fatigue.
Cardiac arrest (worst-case scenario).
Changes in the Cardiovascular System
The heart hypertrophies with age.
Cardiac output declines.
Arteriosclerosis contributes to systolic hypertension.
Geriatric patients are at risk for atherosclerosis:
Accumulation of fat and cholesterol in the arteries.
Major complications include myocardial infarction and stroke.
Older people are at increased risk for the formation of an aneurysm:
Abnormal, blood-filled dilation of the blood vessel wall.
Severe blood loss can occur.
Blood vessels and heart valves become stiff and degenerate.
Heart rate becomes too fast, too slow, or too erratic.
Another vessel-related problem is venous stasis:
Loss of proper function of the veins in the legs that carry blood back to the heart.
Causes blood clots.
Deep vein thrombosis can lead to pulmonary embolism.
People usually exhibit edema of the legs and ankles.
Heart Attack
The classic symptoms of a heart attack are often not present in geriatric patients.
“Silent” heart attacks are particularly common in women and people with diabetes.
Manifestations of acute cardiac disease:
Dyspnea.
Epigastric and abdominal pain.
Loss of bladder or bowel control.
Nausea and vomiting.
Weakness, dizziness, light-headedness, syncope.
Fatigue or confusion.
Other signs and symptoms include:
Issues with circulation.
Diaphoresis.
Pale, cyanotic, or mottled skin.
Abnormal or decreased breath sounds.
Increased peripheral edema.
Heart Failure
The signs and symptoms will differ depending on whether the right or left side of the heart is not functioning correctly.
Right-sided heart failure occurs when fluid backs up into the body:
Causes jugular vein distention, ascites, peripheral edema, and an enlarged liver.
Right-sided heart failure is often caused by left-sided heart failure, so it is common to see signs of both.
With left-sided heart failure, fluid backs up into the lungs:
Causes a condition called pulmonary edema and shortness of breath.
The patient will have severe shortness of breath and hypoxia with crackles in the lungs.
Paroxysmal nocturnal dyspnea:
Characterized by a sudden attack of respiratory distress that wakes the person when he or she is reclining.
Caused by fluid accumulation in the lungs.
Patients report coughing, feeling suffocated, and cold sweats.
You will notice tachycardia.
Stroke
The leading cause of death in older people.
Preventable risk factors: smoking, hypertension, diabetes, atrial fibrillation, obesity, and a sedentary lifestyle.
Uncontrollable factors: age, race, and gender.
Signs and symptoms:
Acute altered level of consciousness.
Numbness, weakness, or paralysis on one side.
Slurred speech, difficulty speaking.
Visual disturbances.
Headache and dizziness.
Incontinence.
Seizure.
Hemorrhagic strokes are less common and more likely to be fatal.
Ischemic strokes occur when a blood clot blocks the flow of blood to a portion of the brain.
The treatment goal is to salvage as much of the surrounding brain tissue as possible.
If the symptoms occurred within the past few hours, the patient will be a candidate for stroke center therapy.
Transient ischemic attack (TIA) can present with the same signs and symptoms as a stroke.
Changes in the Nervous System
Changing in thinking speed, memory, and posture stability are the most common findings.
The brain decreases in weight and volume.
There is a 5% to 50% loss of neurons in older people.
The performance of most of the sense organs declines with increasing age.
Vision
Visual acuity, depth perception, and ability to accommodate to light change with age.
Cataracts interfere with vision.
Decreased tear production leads to drier eyes.
Inability to differentiate colors.
Decreased night vision.
Inability to see up close (presbyopia).
Other diseases:
Glaucoma.
Macular degeneration.
Retinal detachment.
Hearing
Changes in the inner ear make hearing high-frequency sounds difficult.
Problems with balance make falls more likely.
Presbycusis is a gradual hearing loss.
Heredity and long-term exposure to loud noises are the main factors.
Taste
A decrease in the number of taste buds.
Negative result might be a lessened interest in eating, which can lead to:
Weight loss.
Malnutrition.
Complaints of fatigue.
Touch
Decreased sense of touch and pain perception from the loss of the end nerve fibers.
An older person may be injured and not know it.
Decreased sensation of hot and cold.
Dementia
Slow onset of progressive disorientation, shortened attention span, and loss of cognitive function.
Chronic, generally irreversible condition that causes a progressive loss of:
Cognitive abilities.
Psychomotor skills.
Social skills.
Dementia is the result of many neurologic diseases and may be caused by:
Alzheimer disease.
Parkinson disease.
Cerebrovascular accidents.
Genetic factors.
On assessment, patients may:
Have short- and long-term memory loss.
Have a decreased attention span.
Be unable to perform daily routines.
Show a decreased ability to communicate.
Appear confused or angry.
Have impaired judgment.
Be unable to vocalize pain.
Delirium
Sudden change in mental status, consciousness, or cognitive processes.
Marked by the inability to focus, think logically, and maintain attention.
Affects 15% to 50% of hospitalized people aged 70 years or older.
Acute anxiety may be present.
Generally, the result of a reversible physical ailment, such as tumors, fever, or metabolic causes.
In the history, look for:
Withdrawal from alcohol or sedatives.
Medical conditions.
Depression.
Malnutrition or vitamin deficiencies.
Environmental emergencies.
Assess and manage the patient for:
Hypoxia.
Hypovolemia.
Hypoglycemia.
Hypothermia.
You may see changes in circulation, breath sounds, motor function, and pupillary response.
Syncope
Assume this is a life-threatening problem until proven otherwise.
Often caused by an interruption of blood flow to the brain.
Neuropathy
Disorder of the nerves of the peripheral nervous system.
Function and structure of the peripheral motor, sensory, and autonomic neurons are impaired.
Symptoms depend on which nerves are affected and where they are located.
Changes in the Gastrointestinal System
A reduction in the volume of saliva.
Dental loss.
Gastric secretions are reduced.
Changes in gastric motility occur.
The incidence of certain diseases involving the bowel increases.
Blood flow to the liver declines.
Age-related changes in the GI system:
Issues with dental problems.
Decrease in saliva and sense of taste.
Poor muscle tone of the sphincter between the esophagus and stomach.
Decrease in hydrochloric acid.
Alterations in absorption of nutrients.
Weakening of the rectal sphincter.
GI bleeding can be caused by inflammation, infection, or obstruction of the upper or lower GI tract:
Usually heralded by hematemesis.
Bleeding that travels through the lower digestive tract usually manifests as melena.
Red blood usually means a local source of bleeding, such as hemorrhoids.
A patient with GI bleeding may experience weakness, dizziness, or syncope.
Specific GI problems in older patients include:
Diverticulitis.
Bleeding in the upper and lower GI system.
Peptic ulcer disease.
Gallbladder disease.
Bowel obstruction.
When assessing patients, ask about NSAID and alcohol use.
Orthostatic vital signs can help determine if a patient is hypovolemic.
Treatment consists of airway, ventilatory, and circulatory support.
Acute Abdomen—Nongastrointestinal Complaints
Extremely difficult to assess in the prehospital setting.
The most serious threat from abdominal complaints is blood loss.
Abdominal aortic aneurysm (AAA) is one of the most rapidly fatal conditions.
Changes in the Renal System
Age brings changes in the kidneys:
Reduction in renal function.
Reduction in renal blood flow.
Tubule degeneration.
Changes in the genitourinary system:
Decreased bladder capacity.
Decline in sphincter muscle control.
Decline in voiding senses.
Increase in nocturnal voiding.
Benign prostatic hypertrophy (enlarged prostate).
Incontinence is not a normal part of aging and can lead to skin irritation, skin breakdown, and urinary tract infections:
Stress incontinence occurs during activities such as coughing, laughing, sneezing, lifting, and exercise.
Urge incontinence is triggered by hot or cold fluids, running water, or thinking about going to the bathroom.
The opposite of incontinence is urinary retention or difficulty urinating:
In men, enlargement of the prostate can place pressure on the urethra, making voiding difficult.
Bladder and urinary tract infections can also cause inflammation.
In severe cases of urinary retention, patients may experience renal failure.
Changes in the Endocrine System
Reduction in thyroid hormones (thyroxine):
Signs and symptoms:
Slower heart rate.
Fatigue.
Drier skin and hair.
Cold intolerance.
Weight gain.
Other endocrine changes include:
An increase in the secretion of antidiuretic hormone, causing fluid imbalance.
Hyperglycemia.
Increases in the levels of norepinephrine, possibly having a harmful effect on the cardiovascular system.
Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is a type 2 diabetic complication in older people:
On assessment, you may see:
Warm, flushed skin.
Poor skin turgor.
Pale, dry, oral mucosa.
Furrowed tongue.
Signs of shock.
Assessment of the patient should include:
Obtaining blood pressure.
Distal pulses.
Auscultation of breath sounds.
Temperature.
Assessment of blood glucose level (if permitted by local protocol).
Treatment should include airway, ventilatory, and circulatory support.
Changes in the Immune System
Infections are commonly seen in older people because of their increased risk:
Less able to fight infections.
Anorexia, fatigue, weight loss, falls, or changes in mental status may be the primary symptoms.
Pneumonia and UTIs are common in patients who are bedridden.
Signs and symptoms may be decreased because of loss of sensation, lack of awareness, or fear of being hospitalized.
Changes in the Musculoskeletal System
Decrease in bone mass, especially in postmenopausal women.
Bones become more brittle and tend to break more easily.
Joints lose their flexibility.
A decrease in the amount of muscle mass often results in less strength.
Changes in physical abilities can affect older adults’ confidence in mobility.
Muscle fibers become smaller and fewer.
Motor neurons decrease in number.
Strength declines.
Ligaments and cartilage of the joints lose their elasticity.
Cartilage goes through degenerative change.
Osteoporosis is characterized by a decrease in bone mass:
Reduction in bone strength and greater susceptibility to fracture.
The extent of bone loss depends on:
Genetics, body weight.
Smoking, alcohol consumption.
Level of activity, diet.
Osteoarthritis is a progressive disease of the joints that destroys cartilage, promotes the formation of bone spurs, and leads to joint stiffness:
Results from wear and tear.
Affects joints in the hands, knees, hips, and spine.
Changes in Skin
Proteins that make the skin pliable decline with age.
The layer of fat under the skin becomes thinner.
Bruising becomes more common.
Sweat glands do not respond as readily to heat.
Pressure ulcers become a problem:
Sometimes referred to as bedsores or decubitus ulcers.
The pressure from the weight of the body cuts off the blood flow to the area of skin.
With no blood flow, a sore develops.
Stages of ulcer development:
Stage I: Nonblanching redness with damage under the skin.
Stage II: Blister or ulcer that can affect the dermis and epidermis.
Stage III: Invasion of the fat layer through to the fascia.
Stage IV: Invasion to muscle or bone.
Toxicology
Older people are more susceptible to toxicity.
Kidneys undergo many changes with age.
Decreased liver function makes it harder for the liver to detoxify the blood and eliminate medications and alcohol.
Typical OTC medications can have negative effects when mixed with each other or with herbal substances, alcohol, and prescription medications.
Polypharmacy refers to the use of multiple prescription medications by one patient:
Negative effects can include overdosing and negative medication interaction.
Medication noncompliance occurs due to:
Financial challenges.
Inability to open containers.
Impaired cognitive, vision, and hearing ability.
Depression
Depression is not part of normal aging, but a medical disease, treatable with medication and therapy.
If depression goes unrecognized or untreated, it is associated with a higher suicide rate in the geriatric population.
Risk factors include a history of depression, chronic disease, and loss.
The following conditions contribute to the onset of significant depression:
Substance abuse.
Isolation.
Prescription medication use.
Chronic medical condition.
Suicide
Older men have the highest suicide rate of any age group in the United States.
Older persons choose much more lethal means than younger victims.
Generally have diminished recuperative capacity to survive an attempt.
Common predisposing events and conditions include:
Death of a loved one.
Physical illness.
Depression and hopelessness.
Alcohol abuse.
Alcohol dependence.
Loss of meaningful life roles.
When assessing the patient who is displaying signs of depression, it is appropriate to ask if he or she is considering suicide.
If the answer is “yes,” the next question should be, “Do you have a plan?”
Include this information in your report.
The GEMS Diamond
Created to help you remember what is different about older patients.
Not intended to be a format for the approach to geriatric patients or replace the ABCs of care.
Serves as an acronym for the issues to be considered when assessing every older patient.
Geriatric patient:
Older patients may present atypically.
Be familiar with the normal changes of aging.
Environmental assessment:
The environment can help give clues to the patient’s condition and the cause of the emergency.
Medical assessment:
Older patients tend to have a variety of medical problems and numerous medications.
Obtain a thorough medical history.
Social assessment:
Older people may have less of a social network.
They may need assistance with activities of daily living.
Consider obtaining information pamphlets about some of the agencies for older people in your area.
Special Considerations in Assessing a Geriatric Medical Patient
Assessing an older person can be challenging because of:
Communication issues.
Hearing and vision deficits.
Alterations in consciousness.
Complicated medical histories.
Effects of medications.
Scene Size-Up
Geriatric patients are commonly found in their own homes, retirement homes, or skilled nursing facilities.
Many older people live alone.
Access may be hampered if their condition prevents them from getting to the door.
Take note of negative or unsafe conditions.
Mechanism of injury/nature of illness:
May be difficult to determine in older people with altered mental status or dementia.
Ask the family member, caregiver, or bystander why he or she called.
Multiple and chronic disease processes may also complicate the determination of the NOI.
Chest pain, shortness of breath, and an altered level of consciousness should always be considered serious.
Primary Assessment
Address life threats.
Determine the transport priority.
Form a general impression.
You should be able to tell if the patient is generally in stable or unstable condition.
Use the AVPU scale to determine the patient’s level of consciousness.
Airway and breathing:
Anatomic changes that occur as a person ages predispose geriatric patients to airway problems.
Ensure that the patient’s airway is open and not obstructed by dentures, vomitus, fluid, or blood.
Anatomic changes affect a person’s ability to breathe effectively.
Loss of mechanisms that protect the upper airway cause a decreased ability to clear secretions.
Airway and breathing issues should be treated with oxygen as soon as possible.
Circulation:
Poor perfusion is a serious issue in the older adult.
Physiologic changes may negatively affect circulation.
Vascular changes and circulatory compromise might make it difficult to feel a pulse.
Transport decision:
Any complaints that compromise the ABCs should result in prompt transport.
Determine conditions that are life-threatening.
Treat them to the best of your ability.
Provide transport to priority patients.
History Taking
Investigate the chief complaint.
Find and account for all medications.
Obtain a thorough patient history.
Determine early whether the altered LOC is acute or chronic.
Multiple disease processes and multiple and/or vague complaints can make assessment complicated.
Collect a SAMPLE history.
You may have to rely on a relative or caregiver to help you.
List the patient’s medications or take the medications with you to the hospital.
The last meal is particularly important in patients with diabetes.
Transport to a facility that knows the patient’s medical history, if possible.
Secondary Assessment
Physical examinations:
An older patient may not be comfortable with being exposed.
Protect his or her modesty.
Consider the need to keep your patient warm during the exam.
Vital signs:
The heart rate should be in the normal adult range but may be compromised by medications such as beta-blockers.
Weaker and irregular pulses are common.
Circulatory compromise may make it difficult to feel a radial pulse; consider other pulse points.
Blood pressure tends to be higher.
Capillary refill is not a good assessment.
The respiratory rate should be in the same range as in a younger adult.
Be sure to auscultate breath sounds.
Carefully assess pulse oximetry data.
Reassessment
Reassess the geriatric patient often.
Reassess the vital signs.
Reassess the patient’s complaint.
Recheck interventions.
Identify and treat changes in the patient’s condition.
Communication and documentation:
Communicate your findings and the interventions you used to emergency department personnel.
Document all history, medication, assessment, and intervention information.
Trauma and Geriatric Patients
Conditions that create risk and complicate assessment:
Slower homeostatic compensatory mechanisms.
Limited physiologic reserves.
Normal effects of aging on the body.
Existing medical issues.
Physical findings in an older adult may be more subtle and easily missed.
Mechanisms are much more minimal.
Recuperation from trauma is longer and often less successful.
Many injuries are under-triaged and under-treated.
Older pedestrians are more likely to have life-threatening complications after being struck by a vehicle:
Commonly suffer injury to the legs and arms.
Secondary impacts can also cause serious injuries.
Older people are more likely to experience burns because of altered mental status, inattention, and a compromised neurologic status.
The risk of mortality is increased when:
Preexisting medical conditions exist.
The immune system is weakened.
Fluid replacement is complicated by renal compromise.
Higher mortality from penetrating trauma in older adults, especially gunshot wounds.
Falls are the leading cause of fatal and nonfatal injuries in older adults:
Nearly half of fatal falls in geriatric patients result in traumatic brain injury.
Anatomic changes and trauma:
Changes in pulmonary, cardiovascular, neurologic, and musculoskeletal systems make older patients more susceptible to trauma.
A geriatric patient’s overall physical condition may lessen the body’s ability to compensate for simple injuries.
Osteoporosis predisposes older people to hip and pelvic fractures:
Contributing factors:
Stresses of ordinary activity.
A standing fall.
Vitamin D and calcium deficiencies.
Metabolic bone diseases.
Tumors.
With age, the spine stiffens as a result of shrinkage of disk spaces, and vertebrae become brittle:
Compression fractures of the spine occur.
Because brain tissue shrinks with age, older patients are more likely to sustain closed head injuries:
Acute subdural hematomas are among the deadliest of all head injuries.
Serious head injuries are often missed because the mechanism may seem relatively minor.
Other factors that predispose an older patient to a serious head injury include:
Long-term abuse of alcohol.
Recurrent falls or repeated head injury.
Anticoagulant medication.
Environmental Injury
Internal temperature regulation is slowed.
Half of all deaths from hypothermia occur in older people:
Including most indoor hypothermia deaths.
Death rates from hyperthermia are more than doubled in older people:
People older than 85 years are at the highest risk.
Special Considerations in Assessing Geriatric Trauma Patients
Trauma is never isolated to a single issue when you are assessing and caring for a geriatric patient.
Scene Size-Up (Trauma)
Look for clues that indicate your patient’s traumatic incident may have been preceded by a medical incident.
Bystander information may help.
MOI is important in establishing whether an injury is considered critical, and it affects treatment and transport considerations.
Primary Assessment (Trauma)
Address life threats.
Determine the transport priority:
Recommended that older trauma patients be transported to a trauma center.
Form a general impression:
Is the patient’s condition stable or unstable?
Use AVPU and the Glasgow Coma Scale to determine mental status.
Airway and breathing:
Older patients may have a diminished ability to cough, so suctioning is important.
Assess for the presence of dentures.
Circulation:
Manage any external bleeding immediately.
Drinking alcohol and taking anticoagulant medications can make internal bleeding worse or external bleeding more difficult to control.
Older patients can more easily go into shock.
Patients who were hypertensive prior to injury may have a normal blood pressure when they are actually in shock.
History Taking (Trauma)
Investigate the chief complaint.
Considerations in your assessment must include past medical conditions, even if they are not currently acute or symptomatic.
Secondary Assessment (Trauma)
Physical examinations:
Performed in the same manner as for any adult but with consideration of the higher likelihood of damage from trauma.
Any head injury can be life-threatening.
Check lung sounds.
Look for bruising and other evidence of trauma.
Vital signs:
Assess the pulse, blood pressure, and skin signs.
Capillary refill is unreliable because of compromised circulation.
Remember that some older people take beta-blockers, which will inhibit their heart from becoming tachycardic.
Reassessment (Trauma)
Repeat the primary assessment:
A geriatric patient has a higher likelihood of decompensating after trauma.
Interventions:
Broken bones are common and should be splinted.
Do not force a patient with joint flexion or kyphosis into a “normal” position.
Provide blankets and heat to prevent hypothermia.
Communications and documentation:
Communication can be challenging.
Provide psychological support as well as medical treatment.
Response to Nursing and Skilled Care Facilities
Many calls will occur at a nursing home or other skilled care facility.
Calls can be challenging.
Patients often have an altered level of consciousness.
Staff may be spread thin and may not know how to assist you.
Ask, “What is wrong with the patient that is new or different today?”
Infection control needs to be a high priority for EMTs:
Methicillin-resistant Staphylococcus aureus (MRSA) infections are common.
Many infections in hospitals are caused by vancomycin-resistant enterococci.
The respiratory syncytial virus causes an infection of the upper and lower respiratory tracts.
Clostridium difficile is a bacterium responsible for the most common cause of hospital-acquired infectious diarrhea.
Typical alcohol-based hand sanitizers do not inactivate or kill C difficile.
SARS-CoV-2:
Affects older, more vulnerable people.
Spreads from person-to-person through airborne droplets created by speaking, coughing, and sneezing.
Dying Patients
More patients are choosing to die at home rather than in a hospital.
Dying patients receive palliative care.
Be understanding, sensitive, and compassionate.
Determine if the family wishes for the patient to go to the hospital or stay in the home.
Advance Directives
Specific legal papers that direct relatives and caregivers about what kind of medical treatment may be given to patients who cannot speak for themselves.
May take the form of a do not resuscitate (DNR) order:
Gives you permission not to attempt resuscitation for a patient in cardiac arrest.
DNR does not mean “do not treat.”
Basic ABCs should still be provided.
Another type of order is the POLST (Physician Orders for Life Sustaining Treatment), which gives medical orders in addition to the advanced directives.
If there is any question regarding orders or when there are no written orders, initiate resuscitation.
Elder Abuse and Neglect
Any action on the part of an older person’s family member, caregiver, or other person that takes advantage of the older person’s:
Person
Property
Emotional state
Includes acts of commission and acts of omission.
Has been largely hidden from society.
Definitions of abuse and neglect among the geriatric population vary.
Victims are often hesitant to report the problem.
The abused person may feel traumatized by the situation or be afraid that the abuser will punish him or her for reporting the abuse.
Elder abuse occurs more often in women older than 75 years.
Abusers of older people are sometimes products of child abuse themselves.
Take note of the environment and conditions a patient lives in, and of soft- tissue injuries that cannot be explained by the person’s lifestyle and physical condition.
Suspect abuse when answers are concealed or avoided.
Suspect abuse when you are given unbelievable answers.
Information that may be important in assessing abuse includes:
Caregiver apathy about the patient’s condition.
Overly defensive reaction by the caregiver.
The caregiver does not allow the patient to answer questions.
Repeated visits to the ED or clinic.
A history of being accident-prone.
Unbelievable or vague explanations of injuries.
Psychosomatic complaints.
Chronic pain without medical explanation.
Self-destructive behavior.
Eating and sleep disorders.
Depression or a lack of energy.
Substance and/or sexual abuse history.
Signs of Physical Abuse
Inflicted bruises are usually found on the buttocks and lower back, genitals, inner thighs, face, and ears.
Pressure bruises caused by the human hand may be identified by oval grab marks, pinch marks, or handprints.
Human bites are typically inflicted on the upper extremities and can cause lacerations and infection.
Typical abuse from burns is caused by contact with:
Cigarettes.
Matches.
Heated metal.
Forced immersion in hot liquids.
Chemicals.
Electrical power sources.
Check for signs of neglect, such as:
Lack of hygiene.
Poor dental hygiene.
Poor temperature regulation.
Lack of reasonable amenities in the home.
Regard injuries to the genitals or rectum with no reported trauma as evidence of sexual abuse in any patient.
Geriatric patients with altered mental status may never be able to