Chapter 36: Geriatric Emergencies

Introduction

• Understand physiological and psychological changes in aging.
• Learn common illnesses and injuries in the geriatric population.
• Understand the GEMS triangle, advanced directives, and signs of elder abuse.

Geriatrics Overview

• Geriatrics: Assessment and treatment of disease in people aged 65+.
• Aging population expected to double between 2012 - 2050.
• Challenges include chronic conditions, multiple medications, and altered illness presentations.

Generational Considerations

• Appreciate lifestyle differences of older adults.
• Treat with respect and avoid ageism.

Communication with Older Adults

• Effective communication is essential; challenges include dementia.
• Techniques: Use patient’s name, establish trust, and speak clearly. Be patient and listen.

Common Complaints and Leading Causes of Death

• Physiology changes can lead to unique issues, e.g., rib fractures leading to pneumonia.
• Hip fractures often have severe consequences.

Changes in the Body

• Respiratory System: Weakened airway muscles, enlarged alveoli, reduced elasticity.
  • Pneumonia: Increased risk due to immune suppression.
  • Pulmonary Embolism: Risk factors include recent surgery, smoking, and obesity.
• Cardiovascular System: Heart enlarges, cardiac output declines, risk of atherosclerosis and aneurysm.
  • Myocardial Infarction: Symptoms often atypical in the elderly.
  • Heart Failure: Different signs for right and left-sided failure.
  • Stroke: Major cause of death, risk factors include smoking and hypertension.
• Nervous System: Slower thinking, memory issues, brain weight/volume decreases.
  • Dementia vs. Delirium: Dementia is chronic, delirium is sudden and often reversible.
• Gastrointestinal System: Decreased saliva, slower digestion, increased risk of bleeding.
• Renal System: Reduced renal function, bladder capacity, and increased risk of UTIs.
• Endocrine System: Decreased metabolism, risk of HHNS in diabetics.
• Immune System: Reduced ability to develop fevers, increased risk of pneumonia, and UTIs.
• Musculoskeletal System: Decreased bone mass, risk of fractures due to osteoporosis.
• Skin: Thinner, easily bruised, prone to pressure ulcers.

Toxicology

• Older adults more susceptible due to decreased liver/kidney function.
• Be cautious of polypharmacy and medication non-compliance.

Behavioral Emergencies

• Depression is common and treatable but can lead to high suicide rates.
• Elderly may use more lethal methods for suicide attempts.

GEMS Triangle

• G: Geriatric assessment, understand normal aging changes.
• E: Environmental assessment, identify risks in the living environment.
• M: Medical assessment, account for various medical issues and medications.
• S: Social assessment, understand social network and support.

Assessment of Geriatric Medical Patient

• Scene safety, communication issues, and considerations for altered consciousness.
• Primary Assessment: Address life threats, evaluate A, B, C, D, and transport decision.
• History Taking: Thorough medication review, determine if mental/LOC issues are chronic or acute.
• Secondary Assessment: Protect modesty, keep warm, check vitals carefully.
• Reassessment: Monitor for quick deterioration.

Trauma in Older Adults

• Higher risk of serious injury or death in trauma; slower compensatory mechanisms.
• Common issues: falls, head injuries, burns, and fractures.

Nursing Facility and Infection Control

• Identify current issues, avoid infection risks like MRSA, VRE, C. diff, and COVID-19.

Palliative Care and Advance Directives

• Understand patient wishes regarding treatment limitations.
• Advance directives include DNR, living wills, and healthcare power of attorney.

Elder Abuse and Neglect

• Recognize and report signs of elder abuse.
• Abuse may be physical, emotional, or neglectful; often hidden by victims.

Review

• Summarize key takeaways with review questions provided in the lecture.