Transcript Elder Abuse
Andy Johnson, NYS AEMT-P CIC Objectives Describe the concept of the GEMS diamond. Discuss the social aspects of aging. Describe negative stereotyping of older people. Describe the living arrangements of older people. The GEMS Diamond Remember the following when caring for older people: Geriatric patients Environmental assessment Medical assessment Social assessment Aging Statistics 13% of people in the US are over age 65. “Baby Boomers” will increase this number. Expect to see an increase in emergency calls involving older patients. Epidemiology 35 million people were over 65 years of age at the turn of this last century Projections estimate this will double by 2030 A.D. Of the 35 million, less than 20% have some type of significant disability This estimate includes those with disability severe enough to warrant institutionalization Caring for those with disabling fractures alone costs upwards of $10 billion pear year How old do you have to be? General age range for the “elderly” General age range for the “old old” Anyone between 75 an 85 years old General age range for the “oldest of old” Anyone 65 years of age or older Anyone greater than 85 years old Any individual age 62 or older OR Any individual with physical problems that mimic the physiology of aging “As organisms age, they accrue functional impairments in virtually every physiologic system.” Geriatric Medicine, Copyright 2003 Spring-Verlag New York, Inc. In other words, it’s not the age that gets you but the wear and tear ! Case Study Dispatched to a residence for an 84-year-old woman who has fallen Patient, Mrs. Reed, cannot get up. Mrs. Reed Case Study (continued) En route your partner says, “Oh no, not another ‘I can’t get up’ call!” Is this attitude healthy? Mrs. Reed Case Study (continued) Mrs. Reed is on the kitchen floor. She is alert but weak. States she fell last night Has pain in left hip Vital signs are normal. Mrs. Reed Case Study (continued) You conduct a GEMS exam: Small amounts of food, home is warm and clean No significant medical history, no medications Son reports that mother lives alone, no regular contact with friends Mrs. Reed Case Study Conclusion Mrs. Reed is transported to ED. Report to Social Services for potential follow up. Mrs. Reed Ageism Stereotyping and discrimination of older people Categorizing people as senile, eccentric, or stubborn “Geezer,” “Lizard,” and “GOMER” perpetuate ageism Use of “honey” or “dear” is a milder form Living Arrangements Most live at home. Women are more likely to live alone. Less than 5% are institutionalized. Access to Essential Services Transportation Meal preparation Health care Social activities Objectives Describe normal and abnormal assessment findings. Recognize common emotional and psychological reactions. Describe common complaints in the older patient. General Patient Assessment Scene size-up includes environmental assessment: General appearance, cleanliness Temperature, food Drugs, alcohol, signs of abuse Initial assessment looks for life threats: Airway cannot be protected as well. Breathing can be complicated by previous disease. Circulatory system has slowed responses. Mental Status Assessment Confusion is not normal. Distinguish chronic changes from new ones. Enlist help from family. Establish a baseline mental status. Don’t be misled. Assessment Prioritize patient status. Detailed physical exam Ongoing assessment is required. Case Study 1 Dispatched for an 82-year-old woman acting strangely; patient does not know why you are there. Daughter states mother has Alzheimer’s. Mrs. Randish Case Study 1 (continued) Daughter tells you that her mother is not listening today. She tells you that her mother has had a cold. Mrs. Randish is febrile, pale, and dry. How would you approach assessment of this patient? Mrs. Randish Case Study 1 (continued) Pulse = 96 beats/min Respirations = 24 breaths/min BP = 110/70 mm Hg Pulse Ox = 90% Lungs have crackles in the lower left side. Hands are cold. Mrs. Randish Case Study 1 (continued) • Signs include increasing agitation per daughter. • Allergic to sulfa Mrs. Randish • Medications include: Aricept, Paxil • Past history of Alzheimer’s disease • Last meal was breakfast • Events are increasing agitation since this morning. Case Study 1 (continued) Mrs. Randish is becoming irritated with your questions. Daughter is able to calm patient down. Patient agrees to treatment and transport. Mrs. Randish Case Study 1 Conclusion • Mrs. Randish is given oxygen to bring saturation into mid 90’s. • IV, cardiac monitor, 200 mL fluid bolus • Transported to the hospital, diagnosed with pneumonia • Treated and released after 1 week Mrs. Randish Case Study 2 Dispatched to a park to evaluate a 79-year-old man, Mr. Peterson, for difficulty breathing He was taking his daily walk, became short of breath Mr. Peterson Case Study 2 (continued) Is there a respiratory problem? Does the problem always match the complaint? Mr. Peterson Assessing the Chief Complaint Determining the chief complaint can be hard. Start with what is bothering the patient most. Chief complaints may not be the life threat. Communication is a big component. Chief Complaint: Shortness of Breath Frequently life threatening Often respiratory or cardiac in origin Can occur for other reasons such as pain, bleeding, medications Are there associated signs and symptoms? Does patient have a history of respiratory complaints? Chief Complaint: Chest Pain Often cardiac in nature Many experience pain differently. Medication history is important. Have the patient locate the pain. Expose the chest: scars, pacemaker, medication patches Chief Complaint: Altered Mental Status Some causes manifest quickly, others over days Medication reactions are a frequent issue. Determine LOC and orientation to person, place, and time. Check motor and sensory response. Get an ECG and blood sugar reading. Chief Complaint: Abdominal Pain More likely to be hospitalized Potential causes change with age. Overall pain response is decreased. Patient history is key. Look for additional signs. Chief Complaint: Dizziness or Weakness Factors: balance, injury, oxygen, and energy History will help clarify the complaint. Check ECG, orthostatic changes, blood sugar Check for signs of stroke. Assess for signs of head trauma. Chief Complaint: Fever Normal response to infection Suspect serious infection when accompanied by changed LOC. Look for immediate life threats. Fever means illness until proven otherwise. Chief Complaint: Trauma Exam follows the ABCs. Look for potential medical causes. Past history may change the needs of the patient. Find the patient’s baseline status. Fractures are serious injuries. Chief Complaint: Pain Unpleasant sensory or emotional experience Use open-ended questions to evaluate. Pain scale can be helpful. Interpret vital sign changes as medical issues. Older patients may hesitate to complain of pain. Chief Complaint: Falls Generally result from contributing factors Look for medical reason for fall. Assess for injury and life threats. ECG, blood glucose, pulse oximetry Chief Complaint: Nausea, Vomiting, and Diarrhea Can originate in or out of GI tract Check for changes in diet or medications. Look for signs of dehydration or electrolyte abnormalities. Assess for GI bleeding. Summary Changes with age affect assessment findings in older patients. Emotional or psychological findings in the older patient should be evaluated. Common complaints fall into ten main areas. Leading Causes of Death in Older People Disease of the heart Cancer CVA/Stroke COPD Pneumonia Case Study Dispatched for 79-year-old man with difficulty breathing Says he always gets winded easily and cannot catch his breath today Environment is clean and warm. Mr. Brophy Case Study (continued) History of AMI, CHF, COPD, hypertension, diabetes Pulse = 112 beats/min Respirations = 28 breaths/min Blood pressure = 160/96 mm Hg ECG = A-fib Pulse Ox = 92% on oxygen Mr. Brophy Case Study (continued) What factors influence how well Mr. Brophy can compensate for his illness? How will aging affect these factors? Mr. Brophy The Aging Body: Integumentary System Wrinkles Thinner skin Decreased fat Gray hair Decubitis Ulcers (bedsores) The result of circulatory failure due to pressure resulting in dead tissue (necrosis) May indicate that a bed-ridden patient is not being properly cared for and/or moved by the caregiver Note: can also result from insufficient circulation due to medical conditions (e.g. diabetes) Suspect neglect if: Deep decubiti, multiple sites Foul smelling dead tissue Decubitus Ulcers Bed sore Immobility Skin over bony surfaces Vasculature compression Vascular insufficiency Tissue necrosis Inflammation Infection Sepsis Shock Skin Ulcers in Diabetic with Severe Vascular Insufficiency General Condition •Edges •Centers •Smell •Surrounding Skin The Aging Body: Respiratory System Changes in airway Decreasing muscles of ventilation Increased residual volume Decreased sensitivity of chemoreceptors The Aging Body: Cardiovascular System Development of atherosclerosis Decreasing cardiac output Development of arrhythmias Changes in blood pressure The Aging Body: Nervous System Brain shrinkage Slowing of peripheral nerves Slowed reflexes Decreasing pain sensation Case Study (continued) Mr. Brophy appears to have a hard time hearing your questions. Does not respond to all of your requests What are the sensory changes found in older patients? Mr. Brophy The Aging Body: Sensory Changes Vision distorts and eye movement slows. Hearing loss is more common. Taste decreases. Case Study (continued) Mr. Brophy reports feeling “down” lately. Lives alone and has few friends still around Is this patient at risk for depression? Mr. Brophy The Aging Body: Psychological Changes Depression Anxiety Adjustment disorders Case Study (continued) When asked about medications, Mr. Brophy directs your attention to a shoebox. How does the body react to medications with aging? Mr. Brophy General rule of thumb is that seniors often require lower starting doses medications due to the potential for adverse events and toxicity “START LOW AND GO SLOW” The Aging Body: Renal, Hepatic, and GI Systems Kidneys become smaller. Hepatic blood flow decreases. Production of enzymes declines. Salivation decreases. Gastric motility slows. The Aging Body: Musculoskeletal System Decreased muscle mass Changes in posture Arthritic changes Decrease in bone mass The Aging Body: Immune System Less effective immune response Pneumonia and UTI are common. Increase in abnormal immune system substances Case Study Conclusion Mr. Brophy is treated for exacerbation of COPD. Admitted to hospital, found to be on interacting medications On discharge, Mr. Brophy was given follow-up visits with a home care service. Mr. Brophy Summary Diseases common to the older population are familiar to EMS. Organ systems decline in the aging body. Summary Aging body has: Decrease in muscle and bone Change in body structure Less ability to compensate for stress Psychological changes: Often caused by stress encountered in older population Summary • • • • Number of people over age 65 is rising Older people have many social and environmental concerns. We must understand and accept aging. Family remains the most common residence for the older population. Remember……………………. All is not always what it appears to be Thank You!