Chapter 34 Geriatric Assessment 34 Geriatric Assessment Objectives
Chapter 34 Geriatric Assessment
34: Geriatric Assessment Objectives (1 of 2) • Define the term “elderly. ” • State the leading causes of death of the elderly. • Describe the basics of patient assessment for the elderly. • Describe response to the elderly in nursing homes and skilled care facilities. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 2
34: Geriatric Assessment Objectives (2 of 2) • Describe trauma assessment in the elderly. • Describe acute illness assessment in the elderly. • State the principles and use of advance directives. • Define and discuss elder abuse. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 3
34: Geriatric Assessment Geriatrics (1 of 2) • Geriatric patients are individuals older than 65 years of age. • In 2000, the elderly population was almost 35 million. • By 2030, the elderly population will be greater than 70 million. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 4
34: Geriatric Assessment Geriatrics (2 of 2) • The elderly are major users of EMS and health care in general. • Effective treatment will require an increased understanding of geriatric care issues. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 5
34: Geriatric Assessment Risk Factors Affecting Elderly Mortality • • Age greater than 75 years Living alone Recent death of significant other Recent hospitalization Incontinence Immobility Unsound mind Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 6
34: Geriatric Assessment Common Stereotypes • • Mental confusion Illness Sedentary lifestyle Immobility Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 7
34: Geriatric Assessment Physiologic Changes (1 of 3) • Skin • Susceptible to injury; longer healing time • Senses • Dulling of the senses • Respiratory system • Decreased ability to exchange gases Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 8
34: Geriatric Assessment Physiologic Changes (2 of 3) • Cardiovascular system • Increased risk of cardiovascular disease • Renal system • Decline in kidney function • Nervous system • Memory impairment, decreased psychomotor skills Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 9
34: Geriatric Assessment Physiologic Changes (3 of 3) • Musculoskeletal system • Decrease in muscle mass and strength • Gastrointestinal system • Decrease in ability of body to digest food properly Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 10
34: Geriatric Assessment Scene Size-up • Be keenly aware of the environment and why you were called. • Look for signs of activities of daily living. • The general condition of the home will provide clues. • Does someone else live there who could help answer questions? Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 11
34: Geriatric Assessment Initial Assessment • Never assume altered mental status is normal. • May have to rely on family or caregiver to establish patient’s baseline LOC. • Assess the patient’s chief complaint and ABCs. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 12
34: Geriatric Assessment Focused History and Physical Exam (1 of 2) • History is usually the key in helping to assess a patient’s problem. • Patience and good communication skills are essential. • Treat the patient with respect. • Face the patient and speak in a normal tone. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 13
34: Geriatric Assessment Focused History and Physical Exam (2 of 2) • Obtain a list of all medications and dosages. • Sensations of pain may be diminished. • Be aware that elderly are more prone to hypothermia during assessment. • Remove only necessary clothing during the examination. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 14
34: Geriatric Assessment Response to Nursing and Skilled Care Facilities • Important information to know from staff: • What is the patient’s chief complaint today? • What initial problem caused the patient to be admitted to the facility? • Ask the staff about the patient’s overall condition. • Obtain any type of transfer papers. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 15
34: Geriatric Assessment Geriatrics and Trauma • Falls are the leading cause of trauma death and disability in the elderly. • Motor vehicle trauma is the second cause. • The body’s ability to isolate simple injury decreases. • Medical conditions can result in falls. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 16
34: Geriatric Assessment Cardiovascular Emergencies • Syncope • Interruption of blood flow to the brain • Many underlying causes • Heart attack • Classic symptoms often not present Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 17
34: Geriatric Assessment Acute Abdomen (1 of 2) • Acute abdominal aneurysm • Walls of the aorta weaken. • Treat for shock and provide prompt transport • Gastrointestinal bleeding • Blood in emesis • May cause shock Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 18
34: Geriatric Assessment Acute Abdomen (2 of 2) • Bowel obstructions • Vagus nerve is stimulated and produces vaso-vagal syndrome. • Vaso-vagal syndrome can cause dizziness and fainting. • Patient requires transport to rule out other conditions. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 19
34: Geriatric Assessment Altered Mental Status • Delirium • Recent onset • Usually associated with underlying cause • Dementia • Develops slowly over a period of years Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 20
34: Geriatric Assessment Advance Directives • Do not resuscitate (DNR) orders give you permission not to attempt to resuscitate. • DNR orders may only be valid in the health care facility. • You should know state and local protocols regarding advance directives. • When in doubt, initiate resuscitation. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 21
34: Geriatric Assessment Elder Abuse • This problem is largely hidden from society. • Definitions of abuse and neglect among elderly vary. • Victims are often hesitant to report an incident. • Signs of abuse are often overlooked. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 22
34: Geriatric Assessment of Elder Abuse (1 of 2) • Repeated visits to the emergency room • A history of being “accident-prone” • Soft-tissue injuries • Vague explanation of injuries • Psychosomatic complaints Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 23
34: Geriatric Assessment of Elder Abuse (2 of 2) • • • Chronic pain Self-destructive behavior Eating and sleeping disorders Depression or a lack of energy Substance and/or sexual abuse Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 24
34: Geriatric Assessment Signs of Physical Abuse • Signs of abuse may be obvious or subtle. • Obvious signs include bruises, bites, and burns. • Look for injuries to the ears. • Consider injuries to the genitals or rectum with no reported trauma as evidence of abuse. Emergency Care and Transportation of the Sick and Injured, 8 th Edition AAOS 25
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