Transcript Geriatrics
Geriatrics Geriatrics • Assessment and treatment of disease in a person 65 years or older Generational Considerations • • • • • Many on fixed incomes Coping with loss of loved ones Struggling to maintain independence Be patient / respectful Avoid stereotyping the elderly – Assuming all elderly people are • Hard of hearing • Have dementia • Lead sedentary lives Communications • Introduce self and address the patient with formal greeting such as Mr. or Mrs. Smith • Body language speaks as loud as words • Make eye contact when speaking and listening • Speak clear and concise • One question at a time Communications Cont. • Give time for them to respond • Listen to their answer • Explain what you are doing, don’t use technical jargon • Don’t speak with crew or other family members about the patient as if they are not there. Common Complaints • Simple injuries in a 20-30 year old may be life threatening in elderly Common Conditions • Hypertension • Arthritis • Heart disease • Cancer • Diabetes • Sinusitis / respiratory issues Leading Causes of Death • • • • • • • Heart disease Cancer Stroke COPD Pneumonia / Influenza Diabetes Trauma Assessment Challenges Communications Altered mental status Complicated medical history Previous injuries or illnesses unrelated to current problem Medications Use OPQRST for chest pain Use PASTE for shortness of breath Progression / Associated Chest Pain / Sputum / Talking Tiredness / Exercise Tolerance SAMPLE History can be challenging and may have to be obtained from family or caregiver GEMS Diamond • Geriatrics are different from younger patients and may present atypically • Environmental issues – Home condition/ safety issues • Medical assessment – Medical problems – Medications • Social Assessment – Activities of Daily Living are independent or require assistance Changes in Body • Respiratory system – Muscles are weaker – Decreased breathing capacity – Less recoil of chest • Pneumonia • Influenza Cardiovascular System Atherosclerosis Arteriosclerosis Decreased Coronary artery profusion Decrease in cardiac output Aneurysms HTN MI Blood clots Heart failure Stroke Nervous System Brain decreases in size and weight Longer retrieval times for long and short term memory Loss of neurons effects sensory organs Vision Hearing Taste Touch Increased chance of head injuries Dementia Delirium Syncope Neuropathy Gastrointestinal System Slower motility leads to slower gastric emptying Sphincter muscles weaken Heart burn Incontinence GI bleeding Upper Lower Gall Bladder Diverticulitis Bowel obstructions Ulcers Renal System • Bladder capacity decreases • Sphincters weaken – Incontinence stress / urge • Voiding sense declines • Prostate enlargement in males causes incomplete emptying and retention • Nocturnal voiding • Reduced filtering / renal failure • UTIs Endocrine System • Hormone producing system that controls all aspects of body – – – – – Body temperature Growth Heart rate Fluid balance Glucose levels Immune System • Less effective making elderly more prone for infections – Pneumonia – UTIs Musculoskeletal System • • • • • • Bone mass decreases Osteoporosis Decrease muscle mass Decrease in flexibility of ligaments and tendons. Lack of confidence leads to inactivity Higher risk of fractures Skin • Skin elasticity declines • Pressure ulcers become a risk for those who are immobile • Decubitus ulcers can lead to more serious infections Toxicology • Due to reduced liver and kidney function medications are not filtered from body and levels can increase to toxic levels • Often take multiple meds or polypharmacy. Polypharmacy is common in 40% of elderly patients and pertains to those taking four or more prescription medications. • Sometimes don’t take meds properly Psychiatric Emergencies • Depression • Loss of independence • Loneliness • Suicide • Substance abuse Trauma in Elderly More prone to injuries Fractures Soft tissue injuries Head injuries Higher mortality rate Complications from immobility Risk factors Falls Burns Less compensatory mechanisms for shock Abuse Medical emergencies resulting in falls Facilities • Nursing facilities • Long term care • Assisted living • Age specific apartments Advanced Directives • Living wills • Do not resuscitate • Medical power of attorney • People wishing to die at home – Terminally ill – Hospice patients • When in doubt resuscitate. Elder Abuse and Neglect Physical Assault Neglect Dietary Home maintenance poor Poor hygiene Psychological Verbal Deprivation of sensory stimulation Financial Theft of valuables Embezzlement