Ch 18 Geriatric Emergencies

Geriatric Patients: Introduction

Geriatric patient: >65 years; fastest growing segment in the US.
By 2060, the geriatric population is expected to double.
Aging leads to decline in body systems, influenced by heredity and lifestyle.
Avoid prejudging; health varies among older adults.
Complete full-body exams are essential; skin is more fragile and prone to pressure sores.
Loss of bowel/bladder control can occur.
Inform the patient's spouse to alleviate anxiety.

Common sensory losses: hearing and sight.
Vision issues: need for glasses, cataracts, macular degeneration.
Hearing loss can be from noise exposure or heredity; affects high frequencies.
Inner ear disorders increase risk of falls. Use hearing aids if required.
Communicate clearly: speak slowly, maintain eye contact, and write down questions if needed.
Introduce yourself by name and title.
Describe the emergency situation to the patient in clear and simple language.
Visually impaired patients rely on other senses; describe surroundings, use their name, and offer supportive touch.

Muscle strength decreases; vertebral disks narrow causing loss of height and flexibility.
Bones lose calcium, leading to osteoporosis, especially in postmenopausal women.
Increased falls due to muscle weakness, weakened bones, and balance issues increase risk of brain injuries.
Movements slow with age; offer support and avoid rushing them.
Fractures are common due to osteoporosis and falls; wrists, spine, and hips are most affected.
Hip fractures: injured leg is shortened and externally rotated.
Parkinson's disease affects mobility: slowed movements, tremors, unsteady balance.
Geriatric patients may have a reduced awareness of pain.

Cardiovascular and respiratory diseases are major causes of death.
Immune systems weaken, making it harder to fight off diseases.
Cardiovascular diseases: heart attacks, angina, congestive heart failure; blood vessels stiffen.
Respiratory diseases: alveoli lose elasticity, reducing lung capacity; weaker respiratory muscles.
COPD and pneumonia are common; minor symptoms can quickly become major.
Cancer complications: acute pain, shortness of breath, shock.
Altered mental status can result from lack of oxygen, low blood glucose, or hypothermia; not necessarily baseline.

Older patients often take multiple medications with potential interactions and side effects.
Determine medications including over-the-counter drugs and supplements.
Infections: older adults are more susceptible due to weakened immune systems.
Sepsis: life-threatening inflammatory response; common in older adults and those with weakened immune systems.
Recognize signs of infection (fever, fatigue, cough) for prompt evaluation by a physician.

Assess the patient's environment for safety and ability to perform daily activities.
Referrals to social services may be necessary for unsafe conditions.
Patients may require long-term care with complex medical devices; focus on basic life support.
Depression: common psychiatric condition; be alert for signs of sadness or despair.
Suicide: older men have the highest rate; listen for hopelessness or suicidal thoughts.
Dementia/Alzheimer's: progressive decline in mental function; estimated 20-40% of people older than 85 suffer from it. When caring for patients use their name and let the patient know what you are doing.

Hospice care: provides physical, emotional, spiritual, social, and economic care for terminally ill patients.
Advance directives: DNR orders or MOLST forms request to withhold resuscitation.
Elder abuse: physical, sexual, emotional, financial abuse, or neglect; report suspected abuse to authorities.