EMT 7-2: Geriatrics

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EMT 7-2: Geriatrics

Welcome to the geriatrics presentation of the special patient populations segment Once completed with this module, you should be able to: explain why geriatric patients need varying approaches to assessment and care; define the term “geriatrics”; recognize the pathophysiological changes that contribute to toxicological emergencies; list the sensory changes in the elderly; list the common emotional and psychological reactions of the geriatric patient; describe the anatomical and physiological changes in the geriatric patient along with the pathophysiology of the following systems: cardiovascular system, Respiratory system, neurovascular system, gastrointestinal system, genitourinary system, endocrine system, and musculoskeletal system; explain the importance of including family members in the assessment and management of a geriatric patient; explain the rationale for having knowledge and skills appropriate for dealing with a geriatric patient; attend to the feelings of the family when dealing with an ill or injured geriatric patient; conduct a patient interview for a geriatric patient; and, demonstrate the assessment of a geriatric patient who is hearing impaired, vision impaired, confused, or unable to speak Our discussion begins with outlining some of the basic differences found in the geriatric population It is important for the EMT to understand these differences as a knowledge base upon which to build further throughout this module A significant portion of the geriatric population live independently, continue to work, and remain active It would not be fair to generalize a population, so think of each patient as an individual with varying degrees of physical and mental ability Medical needs vary with age As we age, our body systems slowly decline in function Geriatric patients may be very healthy or they may suffer from numerous medical conditions, take multiple medications, have special nutritional needs, or exhibit varying stages of memory impairment Injury patterns also vary with age Geriatric patients are susceptible to injury for reasons including sensory impairment, disease processes, dementia, and a weakening musculoskeletal system Injuries that are more commonly seen in geriatric patients verses younger patients include hip fractures, spinal injuries, and injuries involving replaced joints As an EMT, your assessment approach will probably vary when caring for members of the geriatric population Impairments may be present requiring different assessment approaches, along with patience and additional time For example, if a patient has a speech impairment, the EMT may need to involve the caregiver and use the “show me” approach Keep the conversation simple, speaking to the patient like an adult, and try techniques such as using multiple choice questions as opposed to long, open-ended questions To provide quality patient care to geriatric patients, it is beneficial for the EMT to acquire a special knowledge of the geriatric population This includes understanding anatomical and physiological changes that occur with aging, as well as the pathophysiology of geriatric body systems These components will be discussed throughout this module Please be aware that this module is not intended to teach the anatomy, physiology, and pathophysiology of the body systems; there is another module in this course designed for that Rather, this module will highlight information pertaining to and commonly affecting the geriatric patient Lastly, when providing emergency medical care to the geriatric population, it is important to remember that there may be times when it is prudent to ask if they have advanced directives, such as a living will or power of attorney for health care In the event of patient incapacitation, these documents would provide insight into the patient’s care wishes As discussed in the legal module of this course, these documents do apply to EMTs and the care we provide The term geriatrics, as it applies to the EMS field, is defined as the assessment and treatment of disease in a person who is 65 years of age or older With people now living longer than they ever have before, the number of people over the age of 65 is increasing proportionately to the rest of the population These older individuals may have social and environmental concerns Some of these concerns may include being socially isolated, having limited resources, and changes in their living environment As the normal functions of the body decline with age, the geriatric patient’s performance and independence is commonly affected Retirement or unemployment may result in difficult financial situations and additional stress as well These concerns can ultimately result in anxiety, fear, low self esteem, isolation, and a decrease in the quality of life for those in their proverbial golden years Growing older need not be all doom and gloom, however With improvements in wellness, exercise, diet, and other factors, there are many geriatric

individuals who manage to retain much of their independence, remain active, live independently in their home, have stable financial situations, and have strong social support networks As an EMT, you may encounter special challenges when interviewing and physically assessing patients in the geriatric population The geriatric patient may have vision or hearing impairments, making it difficult for them to see and hear you You may encounter patients with dementia or problems speaking (such as aphasia), making it difficult for you to communicate with the patient and obtain an adequate history It’s important to listen to the patient, allow them time to explain without interrupting, and pay attention to their nonverbal forms of communication Remember that each patient is an individual; do not automatically assume every geriatric patient has an impairment Remember as well to include family members in the assessment and care process, and be aware they may become emotional if their loved one is sick Be compassionate, inform the patient and family of what you are doing, and ask permission when appropriate Be respectful of the patient’s dignity and protect it as much as you can during your physical assessment Our discussion of the anatomical, physiological, and pathophysiological changes in the geriatric population begins with the cardiovascular system as many changes occur in the cardiovascular system over a person’s lifespan Over time, the heart becomes hypertrophic The cardiac muscle becomes enlarged or thickened, resulting in decreased cardiac function Slow degeneration of the valves within the heart may cause the valves to become floppy, allowing them to leak They may also harden, leading to narrowing and decreased blood flow Decreased blood flow, in turn, can cause orthostatic hypotension, decreased brain perfusion, and decreased activity tolerance Vascular changes occur as well, such as the hardening of blood vessels These changes decrease the heart’s ability to increase the heart rate, increase the force of contraction, and constrict blood vessels This may lead to an irregular heart rate, decreased oxygen delivery to tissues, and a decreased ability to adequately compensate for drops in blood pressure Cells in the sinoatrial node decrease in number and function over time, which may result in dysrhythmias The heart rate can be abnormally slow and may not increase in response to events such as blood loss Inversely, the heart may beat too fast, resulting in poor stroke volume and additional stress on the cardiac muscle It is not uncommon for geriatric patients to be on medications for heart problems or high blood pressure, which subsequently affects the heart’s ability to respond to stress Stroke volume, which was just mentioned, is the amount of blood ejected from the left ventricle of the heart with each cardiac contraction An individual’s stroke volume is affected by the anatomical and physiological changes that occur with aging and disease Cardiac output (the amount of blood pumped through the circulatory system in one minute) is also negatively impacted by these changes A decrease in stroke volume and cardiac output subsequently increases the workload on the geriatric heart A sedentary lifestyle, smoking, poor dietary habits, and many other factors also increase the risk for myocardial infarctions, strokes, and cardiovascular disease A myocardial infarction (otherwise known by the lay public as a heart attack) occurs when heart muscle itself is no longer receiving the oxygen it needs to function In many instances, this is due to a blockage in one or several coronary arteries that supply blood and, subsequently, oxygen to the heart The geriatric patient may complain of typical chest pain described as a heaviness, squeezing, or a crushing sensation Geriatric patients having a heart attack, especially women, may also present with atypical chest pain or no chest pain at all (which are called “silent MIs”) Other associated symptoms may include referred pain (typically into the shoulder, jaw, or back), dyspnea (shortness of breath), epigastric or abdominal discomfort, nausea, vomiting, fatigue, confusion, dizziness, feeling lightheaded, or a fainting episode (known as a syncopal episode) Depending on the number of blockages, the severity of the blockages (whether partial or complete), and the areas of the heart affected, a heart attack could be mild or horribly catastrophic Myocardial infarctions result in death by causing cardiac dysrhythmias or arrests, which obviously impacts the normal flow of blood and oxygen through the circulatory system Patients suffering from an MI may present with circulation changes; diaphoresis (excessive sweating); and, cyanotic (blue or purple-ish), pale, or mottled skin The EMT may hear abnormal or diminished breath sounds, commonly due to a backup of fluid in the lungs Further examination may reveal peripheral edema, which is the swelling of tissues due to an accumulation of fluid in the body because the heart is no longer pumping efficiently Patients sufferings from an MI must be treated rapidly and efficiently to minimize damage

to the cardiac muscle of the heart Treatment includes airway, ventilatory, and circulatory support The delivery of oxygen is warranted If your service allows for the transmission of 12-leads to the receiving facility, be sure to acquire and transmit the 12-lead as soon as possible Aspirin should be administered for the patient experiencing chest pain If the patient has nitroglycerine for chest pain, the EMT may assist the patient in taking it if appropriate (again, follow your local protocols) Advanced life support should also be considered if included within your local EMS guidelines and protocols Frequent reassessment of these patients during transport is critical Be sure to monitor for changes, especially after taking an intervention or providing a treatment Heart failure occurs when the heart is unable to adequately supply blood to the body This may lead to the buildup of fluid in the lungs and/or other parts of the body (especially in the lower extremities if the person is routinely sitting) Geriatric patients with heart failure may have the following signs and symptoms: dyspnea, orthopnea (shortness of breath while lying flat), tachypnea (which is rapid breathing), pulmonary edema (fluid in the lungs), accessory muscle use, chest pain, anxiety, and fatigue The geriatric patient with heart failure may present with circulation changes, diaphoresis, cyanosis, adventitious breath sounds (such as wheezing or crackles/rales), tachycardia, hypertension (commonly early in the disease process), and/or hypotension Treatment includes airway, ventilatory, and circulatory support Oxygen administration, additional interventions as included in your local protocols (such as CPAP), and the consideration for advanced life support should also be included in your treatment plan for these patients As with the MI patient, frequent reassessment is important for patients in heart failure Anatomical, physiological, and pathophysiological changes that occur in the respiratory system over time include the following: Loss of elastic recoil in the chest wall, resulting in air trapping and an increase in dead space within the lungs and residual volume; loss of alveoli; reduction in oxygen and carbon dioxide exchange; an inability to increase the respiratory rate and a decrease in the size and strength of the respiratory muscles, leading to a decreased ability for the patient to compensate; a decreased cough reflex that increases the risk of aspiration; and, decreased function of the cilia, resulting in ineffective removal of bronchial sections and a decreased ability to cough, both of which can increase the likelihood of infections Pneumonia is an infection caused by bacteria, virus, of fungi that can occur in one or both lungs Patients with respiratory diseases, such as chronic obstructive pulmonary disease, or chronic health problems are at a higher risk for developing pneumonia The pathophysiology and physiological changes that occur over time or with certain conditions and risk factors may result in a patient being more susceptible to pneumonia as well Chronic disease processes, immune system compromise, chronic obstructive pulmonary disease, cancer, inhalation of toxins, and aspiration are some of these conditions Additionally, institutionalized geriatric patients are at a higher risk of developing nosocomial (hospital-acquired) pneumonia given an increased likelihood of exposure to many of these conditions and other factors Signs and symptoms of pneumonia include: dyspnea on exertion; a productive cough (with green, yellow, or bloody sputum); chest pain, usually described as sharp that worsens on inhalation (known as pleuritic chest pain); adventitious breath sounds such as wheezing, rales, rhonchi, or diminished; headache; nausea; vomiting; musculoskeletal pain; chills; shaking; weight loss; and, confusion The geriatric patient with pneumonia may present with circulation changes; cyanosis or pallor; dry skin and poor turgor; fever; tachycardia; adventitious breath sounds, such as wheezing, rales, rhonchi, or diminished; and, possibly hypotension Assessment should include listening to breath sounds, obtaining a temperature, and checking a pulse oximetry reading if equipment is available Treatment includes airway, ventilatory, and circulatory support Oxygen administration, additional interventions, and an ALS intercept should be considered as proscribed by your local protocols Also be certain to provide supportive measures while reassessing frequently A pulmonary embolism is a sudden blockage in a pulmonary artery, which supplies blood to the lungs for gas exchange and oxygenation The most common cause is a blood clot that starts in the vein of a leg or the pelvis Such a clot, called a deep vein thrombosis or DVT, travels from the leg, through the

heart, into the lung where the blockage occurs Signs and symptoms may vary making it a difficult condition to detect at times The typical geriatric patient may complain of a sudden onset of difficulty breathing with chest, shoulder, or back pain In addition, syncope, anxiety, apprehension, fever, leg pain, leg redness, pedal edema, fatigue, and cardiac arrest are also associated signs and symptoms A geriatric patient with a pulmonary embolism may present with circulation changes; tachycardia; adventitious breath sounds such as wheezing, rales, or diminished; decreased pulse oximetry reading of 70% or lower; and, hypotension Your assessment should include obtaining a blood pressure and pulse oximeter reading if the equipment is available Prehospital treatment for a suspected pulmonary embolism includes airway, ventilatory, and circulatory support Oxygen administration, additional interventions, and ALS intercept should be considered as dictated by your local protocols If the patient goes into respiratory or cardiac arrest, management should follow American Heart Association standards or your local protocols Be sure to frequently reassess the patient for any changes in his or her status As we have seen with other body systems, the nervous system deteriorates over time as well, which can impact the rate and depth of breathing, heart rate, blood pressure, hunger and thirst, temperature, and sensory perception including audio, visual, olfactory, touch, and pain Atrophy of the brain tissue itself occurs, leading to cognitive and short-term memory effects, along with a delay in verbal responses Neuropathy occurs as a result of gradual damage to nerves over time and geriatric patients may occasionally complain of a numbness, tingling, and/or burning pain in their hands or feet (referred to as peripheral neuropathy) as a result Given these neurological changes, geriatric patients are at an increased risk for developing dementia, which is a chronic, generally irreversible condition that causes a progressive loss of cognitive abilities, psychomotor skills, and social skills Dementia affects a person’s memory, thinking, language, judgment, and behavior to varying degrees Geriatric patients with dementia are at a higher risk for injury, abuse, self neglect, wandering, and can be taken advantage of by others without realizing anything is wrong Pertinent medical history that increases a person’s susceptibility for developing dementia includes cerebrovascular accidents, Alzheimer’s disease, encephalitis, alcohol use or abuse, and exposure to toxins (including metals and organic materials) When caring for a person with dementia, assess the patient’s level of orientation, be aware of signs of abuse, and determine if the patient is able to follow commands Accidental or intentional medication overdoses can make a patient appear as if he or she has dementia, so keep that in mind during your assessment process Chronic dementia develops over a period of years, which may give you a clue as to whether or not another pathology may be at work Some causes of dementia-like symptoms that may resolve themselves include drug overdoses, emotional disorders, metabolic and endocrine disorders, tumors, trauma, and infections The geriatric patient with dementia may present with progressive loss of cognitive function, including short and long-term memory problems, and a decreased attention span He or she may be unable to perform daily routines, have trouble communicating, and may be confused about their environment Mood swings may include frustration, withdrawal, paranoia, irritability, or restlessness The EMT may encounter difficulty obtaining a history due to the patient’s memory deficits and impaired judgment The patient may be unable to vocalize areas of pain and other symptoms they are experiencing They may be unable to follow commands and may be anxious or fearful of treatment The patient may become frustrated due to difficulty remembering people and events Geriatric dementia patients may also have anxiety leaving the familiar confines of their home It is important to involve family members, caregivers, and other health care personnel when caring for geriatric patients with dementia These individuals may be able to provide you with a medical history and list of medications, along with the patient’s baseline functioning status At times, dementia can be difficult for family members and caregivers to deal with, especially when the patient no longer recognizes them When communicating with a patient suffering from dementia, remember these following tips: Use clear, simple language; refrain from using medical jargon; use short sentences; if the patient appears frightened, try to touch the patient gently on the arm and reassure them

you are there to help; be patient, allowing the patient time to answer your questions (the patient may have a delay in reaction time during conversation); and, repeat questions as needed without becoming frustrated Again, remember that advanced age does not always correlate into the development of dementia True, some elderly patients may have some slight problems with their memory, but that does not mean they have dementia Perform a thorough patient assessment and refrain from making assumptions Delirium is a sudden change in behavior, consciousness, or cognitive processes, generally due to a reversible physical ailment The delirious patient is unable to focus, think logically, and maintain attention Delirium has an acute onset, generally within minutes, hours, or days By comparison, dementia usually develops over a significantly longer period of time If left untreated, this condition can progress rapidly and be fatal History and risk factors that predispose a geriatric patient for developing delirium include intoxication or alcohol withdrawal; use of medications or illicit drugs; medical conditions, such as urinary tract infections, bowel obstruction, dehydration, cardiovascular disease, or febrile episodes; hyper or hypoglycemia; psychiatric disorders, including depression; malnutrition and vitamin deficiencies; and, environmental emergencies The geriatric patient with delirium may have the following signs and symptoms: disorganized thoughts, such as inattention, memory loss, and disorientation; hallucinations; delusions; and, decreased level of consciousness The patient may present with circulation changes, changes in pupillary and motor response, and adventitious breath sounds Assessment of this patient would include listening to breath sounds and obtaining a blood pressure Assess for hypoxia, hypovolemia, and hypoglycemia If left untreated, these conditions can prove fatal to the patient As delirium patients may act out violently, be certain to keep your safety, as well as that of your crew and others on the scene, in mind at all time Do not hesitate to utilize law enforcement if the scene is or becomes unsafe These patients have the potential to suddenly display unpredictable behavior at any time, especially if agitated Remain calm and empathetic during your interaction with the patient suffering from delirium Listen to the patient and limit interruptions Respect their territory and be wary of physical contact that may provoke a violent reaction Delirium patients should be transported to a medical facility for evaluation and treatment Provide airway, ventilatory, and circulatory support Oxygen administration, additional interventions, and calling for advanced life support should be considered as dictated by your local protocols Be certain to reassess this patient frequently The anatomical, physiological, and pathophysiological changes in the gastrointestional system that take place as the body ages include: dental problems, which affects the chewing of food; a decrease in saliva causes dryness in the mouth, making it difficult to chew and digest food; decreased taste buds and diminished olfactory receptors may alter the enjoyment of food, contributing to malnutrition; poor muscle tone of the sphincter between the esophagus and stomach can cause regurgitation leading to heartburn and acid reflux; poor rectal sphincter tone can result in fecal incontinence; decreased hydrochloric acid in the stomach inhibits digestion; there is an alteration in the absorption of nutrients; slowing peristalsis causes constipation; and, decreased blood flow and metabolism in the liver negatively affects the detoxification of drugs and alcohol A common gastrointestinal complaint in geriatric patients is that of gastrointestinal bleeding Such bleeding can be caused by disease processes, inflammation, infection, or obstruction of either the upper or lower gastrointestinal tract Signs and symptoms of gastrointestinal bleeding include hematemesis (vomiting blood), melena (black, “tarry” stools), dyspepsia (indigestion), hepatomegaly (an enlarged liver), jaundice (a yellow discoloration of the skin and whites of the eyes), constipation, diarrhea, agitation, and dizziness The geriatric patient with gastrointestinal bleeding may present with circulation changes; thin, pale or yellow skin; a frail musculoskeletal system; peripheral, sacral, and/or periorbital edema; hypertension; fever; tachycardia; and, dyspnea Assessment includes listening to breath sounds as well as obtaining as set of orthostatic vital signs (obtain blood pressures and pulse rates with the patient lying down, sitting up, and standing.)

As the patient moves to a more upright position during the orthostatic evaluation, the EMT should make special note of any decrease in the systolic blood pressure of ten millimeters of mercury or more, or an increase of the pulse rate of ten beats per minute or more Precautions should be taken in patients that complain of feeling weak, dizzy, or lightheaded to prevent the geriatric patient from falling due to syncope If it would present a safety risk to the patient, do not have him or her stand to obtain the last set of orthostatic vital signs Treatment for these patients includes airway, ventilatory, and circulatory support Oxygen administration, additional interventions, and an advanced life support intercept should be considered as governed by your local protocols Be certain to reassess frequently as geriatric patients can lose a tremendous amount of circulating blood volume given significant gastrointestinal bleeding Changes in patient presentation, mental status, or vital signs may be indicative of a significant medical problem Over time, the genitourinary system also deteriorates The effects of such changes over time include: a reduction in renal function, a fifty percent reduction in renal blood flow, tubule degeneration, decreased bladder capacity, a decline in sphincter muscle control, a decline in voiding senses, an increase in nocturnal voiding, and benign prostatic hypertrophy In the geriatric patient, these changes may lead to a decreased ability to filter wastes; fluid, electrolyte, and acid-base imbalances; less efficient drug elimination; and, bladder incontinence Common genitourinary pathologies in geriatric patients include urinary tract infections, cancer, and kidney failure EMS response and treatment to patients experiencing genitourinary emergencies includes airway, ventilatory, and circulatory support Oxygen administration, additional interventions, and advanced life support should be considered as addressed by your local protocols Frequent reassessment during transport is also warranted Endocrine system changes in the geriatric patient may include a decreased metabolism and blood glucose imbalances Those individuals with blood glucose imbalances are said to be diabetic Unless properly managed, diabetics have more glucose (sugar) in their bloodstream than their bodies can handle If left unmanaged, hyperosmolar hyperglycemic nonketonic coma (HHNC) can result Patients with HHNC have high blood glucose levels that do not result in elevated ketones in the body Given this high level of glucose, the body tries to expel it through diuresis (increased urine excretion), which can lead to dehydration Geriatric patients with HHNC are hyperglycemic and may present with polydipsia (excessive thirst), polyuria (excessive urination) with dark-colored urine, dizziness, confusion, altered mental status, and even seizures The patient with HHNC may present with tachycardia, hypotension, pale skin, poor skin turgor, dry oral mucosa, in shock, or with a blood glucose greater than 500 milligrams per deciliter HHNC typically takes some time to develop Patients who present with these signs and symptoms are indeed sick and need medical care Assessments for HHNC patients should include obtaining a blood pressure, feeling for distal pulses, listening to breath sounds, obtaining a temperature, and obtaining a blood glucose (if equipment is available) Treatment includes airway, ventilatory, and circulatory support Oxygen administration, additional interventions, and advanced life support should be considered as per your local protocols Reassessments are also vital to ensure the continued status of the patient As we age, our musculoskeletal system also changes Some common musculoskeletal degenerative processes in the geriatric patient include: atrophy of muscles and muscle wasting, loss of bone, loss of strength, and joint problems resulting from the loss of elasticity in ligaments and tendons, thinning of cartilage, and thickening of synovial fluid These changes lead to conditions such as arthritis, osteoporosis, and kyphosis Osteoporosis is a bone disease that decreases bone density, increasing a patients susceptibility for various bone fractures and disability Kyphosis is a curving of the spine, sometimes described as a humpback or hunchback This condition may cause disabling back pain in the geriatric patient and may also make spinal immobilization more challenging for EMS providers In addition, these changes and conditions lead to an increased risk for falls and vertebral disk problems Treatment for musculoskeletal injuries can vary given the specific type of problem or injury encountered A broken hip or femur can result in significant internal blood loss

Musculoskeletal injuries can also cause significant pain The use of oxygen, adequate splinting, and transporting in a position of comfort when possible are all very important Remember to assess circulation, motion, and sensation distal to any injuries both before and after splinting the affected area Depending on the patient and his or her presentation, advanced life support may be warranted for things such as fluid replacement and pain control Be sure to reassess these patients at regular intervals, especially after treatments Toxicological emergencies are usually related to intentional or unintentional medication overdoses or poison ingestion, although other factors can lead to a geriatric toxicological emergency as well Given decreased kidney function, altered gastrointestinal absorption, decreased vascular flow in the liver, slowing metabolism, and decreased excretion, toxicological emergencies are commonly much more pronounced in the geriatric population Taking a medication dosage twice, essentially doubling the prescribed dosage, is a common therapeutic cause of toxicological emergencies in the geriatric population The patient may be forgetful or someone else may inadvertently repeat a dosage Non-compliance (not taking the medication as prescribed) can result from financial inability to afford medications, a motor inability to open containers, impaired memory, or vision and hearing deficits EMS providers should check prescription dates and the number of pills remaining to assess compliance with prescribed medications Polypharmacy is the use of multiple medications, often prescribed by different doctors, which causes adverse reactions in the patient Many patients do not realize that taking certain over the counter medications can create problems with their prescription medications Adverse reactions occur when incompatible medications taken together change the pharmacokinetics or pharmacodynamics within the body Obtaining a thorough history and medication list is important in the treatment of these patients As always, be ever mindful of airway, breathing, and circulation concerns Oxygen administration, additional interventions, and the use of advanced life support may be warranted given the application of your local protocols Contacting a local poison control center may also be prudent for these patients, depending on the medications or substances involved Given the nature of toxicological emergencies, frequent reassessment is essential for these patients Sensory changes in the geriatric patient commonly impact their vision, hearing, and pain perception Approximately one-half of the geriatric population has vision problems with cataracts and glaucoma being the most common These vision problems can result in decreased visual acuity and inability to compensate, decreased night vision, decreased tear production, inability to differentiate colors, development of cataracts, and disease processes such as glaucoma, macular degeneration, and retinal detachment Cataracts is the clouding of the lens of the eye or its surrounding membranes Glaucoma patients have increased intraocular pressure, which negatively impacts their vision Macular degeneration is the deterioration of the central portion of the retina All of these conditions may make it difficult for geriatric patients to read and sign consent forms It also places them at an increased risk for falls and medication errors Despite the likelihood of these vision problems in the geriatric population, never assume that your geriatric patient has poor vision or depends on others for assistance You might ask the patient or caregiver if they have any visual, hearing, or cognitive deficits If they have a visual deficit let them know you are there, describe what you are doing, verbalize your actions and treatments, explain environmental information, and treat them like any other patient Most of the time, the patients or caregivers will let you know what accommodations they need, if any Before you transport, it is a good practice to ensure the patient has assistive devices such as eyeglasses or a cane with them Hearing degeneration is also likely in the geriatric population, especially the ability to hear high pitched sounds The geriatric patient may compensate for this hearing deficit by using hearing aids, reading lips, or by asking people to speak into their “good” ear When assessing a patient with hearing loss, face them, speak clearly, control background noise, and utilize family members and the patient’s assistive devices, if they have any Use a slightly louder than normal voice but do not shout Lean closer to the patient and speak into their ear and use short sentences Remember transport any assistive devices along with the patient Geriatric patients may also have altered pain perception, leading to problems such as the inability to differentiate hot from cold With such problems, it may not be possible for a geriatric patient to tell you if something hurts and may not even realize they have injuries, such as sores on their feet

(This is also why some geriatric patients may not experience pain with a heart attack, resulting in what is known as a silent MI.) When assessing and moving geriatric patients, use caution as they may have underlying issues without even being aware of them To conclude this presentation on geriatrics, we need to discuss emotional and psychological responses for geriatric patients All of us have a limited life span and the older a person is, the less time he or she has before an inevitable death The older a person is, there is a greater likelihood that he or she will have to contend with the loss of other geriatric family members and friends as well How the geriatric patient responds emotionally and psychologically to these challenges obviously depends on various factors Many people find their life fulfilling, satisfying, and are at peace with the knowledge that they lived a good, full life They are adaptable given various changes in their lives and persevere through stressful events Others, on the other hand, may have financial and living condition concerns, disabilities, difficulty dealing with lifestyle changes, or the inability to recover emotionally from the loss of a loved one This can lead to feelings of uselessness and hopelessness, which can result in depression Other contributing factors for depression in this population may include multiple medical conditions, limited social interaction, and the loss of independence Physical changes from illness or injury may also contribute to a change in a patient’s emotional or psychological status Regardless of the cause, the geriatric patient suffering from emotional or psychological problems needs evaluation at a medical facility Geriatric patients are less likely to make suicidal gestures or seek help for depression There are no proverbial “cries for help.” This population has a high rate of successful suicides, especially elderly males, compared to younger populations EMS providers should always be on the lookout for signs and symptoms of depression, such as geriatric patients who state that they just want to die Follow-up with an appropriate healthcare provider versed in geriatric psychological and emotional issues is vital for these patients When interfacing with geriatric patients, a caring and compassionate attitude can have a very positive effect Take care of their emergent needs, but also recognize potential social, psychological, and environmental problems, and serve as an advocate for the patient As an EMT, you have the opportunity to improve the quality of life and facilitate positive outcomes for the geriatric patient Keep in mind that, if you live long enough, you too will be a geriatric patient someday Be sure to treat your geriatric patient as you would like to be treated if the roles were reversed With this module complete, you should now be able to: explain why geriatric patients need varying approaches to assessment and care; define the term “geriatrics”; recognize the pathophysiological changes that contribute to toxicological emergencies; list the sensory changes in the elderly; list the common emotional and psychological reactions of the geriatric patient; describe the anatomical and physiological changes in the geriatric patient and pathophysiology of the following systems: cardiovascular system, respiratory system, neurovascular system, gastrointestinal system, genitourinary system, endocrine system, and musculoskeletal system; explain the importance of including family members in the assessment and management of a geriatric patient; explain the rationale for having knowledge and skills appropriate for dealing with a geriatric patient; attend to the feelings of the family when dealing with an ill or injured geriatric patient; conduct a patient interview for a geriatric patient; and, demonstrate the assessment of a geriatric patient who is hearing impaired, vision impaired, confused, or unable to speak That completes this module on geriatrics Be sure to read the appropriate sections in your textbook for additional information and contact your instructor with any questions This presentation was created by Waukesha County Technical College with grant funding from the Wisconsin Technical College System