Medical and Obstetrics/​Gynecology Study Guide for the EMT Test

Geriatric Emergencies

Geriatric emergencies involve caring for adults age 65 or older. Geriatric patients may present with a wide variety of medical conditions which are similar to younger adults. But it is important to understand the unique aspects of caring for older adults.

Generational Considerations

It is essential to understand that not all geriatric patients are the same. It is helpful to approach each patient with an open mind and to not rely on stereotypes. There are factors to keep in mind, however. For example, geriatric patients may be more likely to be living on fixed incomes, which may lead to skipping medications to save money.

Communication

Although not all geriatric patients may have the same issues, talking with older adults may present some challenges. Some adults may have trouble hearing or have memory issues. It is helpful to use clear communication and make eye contact. Speak slowly and allow time for your patient to answer questions. As with any patient, be respectful and explain procedures before you do them.

Common Illnesses and Causes of Death

Geriatric patients are more likely to suffer complications from common illnesses than younger adults. For example, conditions such as pneumonia may lead to respiratory failure and even death. In addition, the leading causes of death in the geriatric population include heart disease, stroke, and cancer.

Body Changes

The process of aging is gradual and varies from person to person. Several changes may occur as a person ages. Some changes may depend on how well people take care of themselves and their lifestyle choices, but, in general, various body systems (lungs, heart, and bones) are likely to have age-related changes.

Respiratory Changes and Common Problems

Changes to the respiratory system may include a loss of elasticity in the lung tissue. The muscles that support breathing may also become weaker, which affects how deeply a person breathes. The changes in the lungs and respiratory system may make geriatric patients more likely to develop certain conditions, such as pneumonia. Some older adults may become less active, which may also put them at risk for a pulmonary embolism.

Cardiovascular Changes and Problems

Cardiovascular changes that may occur in older adults include a thickening of the arteries, which contributes to high blood pressure and heart disease. Due to the changes in the arteries, geriatric patients may experience emergencies such as a heart attack, stroke, or heart failure.

Nervous System Changes and Problems

Nervous system changes that may occur in geriatric patients include a decrease in sense functioning, such as hearing, vision, and smell. Some adults may also develop cognitive issues, such as memory problems. Problems with balance may also occur. Dementia is one issue that many older adults face.

Gastrointestinal Changes and Problems

Changes to the gastrointestinal system in older adults include decreased gastric juices and saliva, which can contribute to other problems, such as a higher risk of aspiration. Some geriatric patients may also develop ulcers, diverticulitis, and constipation.

Renal System Changes and Problems

The kidneys may not function as well as an adult ages. Some geriatric patients also develop urinary incontinence. In other cases, urinary retention may develop. Men may develop an enlarged prostate, which can lead to urinary problems. Bladder infections also increase in the geriatric population.

Endocrine System Changes and Problems

The endocrine system controls several body functions, including metabolism and body temperature. As a person ages, hormone production may change, which can affect the endocrine system and, in turn, body functions. Certain conditions, such as diabetes, are common in older adults.

Immune System Changes and Problems

Geriatric patients generally are more susceptible to infection and disease. They also may have a decline in their immune system function, which makes it harder to fight an infection when it develops. Weight loss, falls, fever, and an altered mental status are common signs and symptoms of infection in geriatric patients.

Toxicology and Older Patients

Older adults metabolize medication differently than younger adults. Changes in an older adult’s kidney function and gastrointestinal system may alter the way medication is excreted from the body. In addition, they are at risk of medication errors, including taking too much medication or from interactions among multiple medications.

Behavioral Emergencies

Although many older adults lead fulfilling lives, some may develop emotional problems that lead to behavioral emergencies. Depression is common in geriatric patients for a variety of reasons, from poor health to a loss of purpose. As with any depressed patient, suicide is a risk and needs to be taken seriously.

The GEMS Diamond

The GEMS diamond is intended to be a reminder of things to keep in mind when assessing a geriatric patient. It is not meant to replace the basics or the ABCs of care. Instead, it involves important factors to consider. “G” stands for geriatric patients. “E” stands for the environment, which involves assessing the patient’s environment for clues about their condition. “M” stands for medical conditions, which reminds you to assess for medical conditions and medications. Lastly, “S” stands for social assessment, which involves determining if the patient can care for themselves and perform daily living skills.

Patient Assessment

As always, assess for scene safety. Geriatric patients may live alone, and it is essential to make sure nothing is hampering you from entering the home, such as clutter. If conditions appear unsafe for the patient to live in, additional assistance is needed. Complete the primary assessment as you would with any patient, paying special attention to level of consciousness. Older adults may be more likely to have an ALOC due to infection and illness. Taking a medical history is critical with the geriatric patients, since they may have a history of conditions that could help you evaluate the current problem. Continue with a secondary assessment, including taking vital signs. Keep in mind, vital signs may be different in geriatric patients due to changes that occur with aging. Lastly, continue to reassess during transport and watch for signs of instability that will require immediate treatment.

Trauma and Geriatric Assessment

In general, older adults may experience fractures and serious injuries more frequently than younger adults. Changes in an older adult’s systems, including skeletal, put them at higher risk for complications if they sustain a trauma. Pelvic and hip fractures are common in older adults and suspected injuries should be thoroughly assessed.

Falls and Geriatric Assessment

Falls are the leading cause of trauma in older adults. Changes to the bones and muscles make geriatric patients at a higher risk of fracture when they fall. Issues with balance are more common in older adults as well, which puts them at a higher risk of trauma. When an older patient falls, it’s also important to determine why he/she fell. Determine if the fall was due to a medical condition or environmental factors so future falls can be prevented.

Geriatric Care Facilities

Geriatric care facilities vary and include assisted living facilities as well as nursing homes. The level of care also ranges from medication and daily living skills assistance to skilled nursing care. You may be called to either facility to treat and transport a patient to the hospital. Staff at geriatric care facilities can be a great source of information on the patient’s condition and medical history.

Dying Patients

At some point, you will have to deal with a geriatric patient who is dying. Some patients may choose to go to hospice and may have a Do Not Resuscitate (DNR) in place. Before limiting resuscitation efforts, it is critical to verify a DNR. When dealing with a patient who is dying, it’s essential to show respect and compassion for both the patient and family members.

Elder Abuse and Neglect

Elder abuse and neglect is a serious problem that should be reported, per your agency’s policy. Signs of abuse or neglect in the elderly include chronic pain without an underlying cause, overly defensive answers about injuries, repeated soft tissue injuries, and self-destructive behavior. Physical signs of abuse may include pressure bruising, burns, and multiple injuries in varied states of healing.

Terms/Concepts to Know: elder abuse, advanced directives, VRE, MRSA, polypharmacy, decubitus ulcer, osteoporosis, syncope, delirium, dementia