Geriatrics

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Geriatrics
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Geriatrics

• Assessment and treatment of disease in a person
  65 years or older

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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

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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

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Communications Cont.

• Give time for them to respond
• Listen to their answer
• Explain what you are doing, dont use technical
  jargon
• Dont speak with crew or other family members
  about the patient as if they are not there.

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Common Complaints

• Simple injuries in a 20-30 year old may be life
  threatening in elderly

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Common Conditions

• Hypertension
• Arthritis
• Heart disease
• Cancer
• Diabetes
• Sinusitis / respiratory issues

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Leading Causes of Death

• Heart disease
• Cancer
• Stroke
• COPD
• Pneumonia / Influenza
• Diabetes
• Trauma

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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

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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

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Changes in Body

• Respiratory system
• Muscles are weaker
• Decreased breathing capacity
• Less recoil of chest
• Pneumonia
• Influenza

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Cardiovascular System

• Atherosclerosis
• Arteriosclerosis
• Decreased Coronary artery profusion
• Decrease in cardiac output
• Aneurysms
• HTN
• MI
• Blood clots
• Heart failure
• Stroke

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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

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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

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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

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Endocrine System

• Hormone producing system that controls all
  aspects of body
• Body temperature
• Growth
• Heart rate
• Fluid balance
• Glucose levels

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Immune System

• Less effective making elderly more prone for
  infections
• Pneumonia
• UTIs

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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

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Skin

• Skin elasticity declines
• Pressure ulcers become a risk for those who are
  immobile
• Decubitus ulcers can lead to more serious
  infections

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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 dont take meds properly

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Psychiatric Emergencies

• Depression
• Loss of independence
• Loneliness
• Suicide
• Substance abuse

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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

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Facilities

• Nursing facilities
• Long term care
• Assisted living
• Age specific apartments

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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.

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Elder Abuse and Neglect

• Physical
• Assault
• Neglect
• Dietary
• Home maintenance poor
• Poor hygiene
• Psychological
• Verbal
• Deprivation of sensory stimulation
• Financial
• Theft of valuables
• Embezzlement