CHAPTER 24

OBJECTIVE 1

• MAJOR STAGES OF LIFESPAN DEVELOPMENT OF THE ADULT PATIENT:
• Early adulthood
• Middle adulthood
• Late adulthood

EARLY ADULTHOOD

• 18-40 years old
• Starting families
• Being healthy and active
• Traumatic injuries and accidents

MIDDLE ADULTHOOD

• Physiological changes occur
• Decrease in ability to see and hear well
• Height shorter
• Hair begins to turn grey
• More permanent wrinkles appear in the skin
• Ages 40-60 years old

LATE ADULTHOOD

• Decline in the ability to see, hear, taste, and smell
• Characteristics common to late adulthood
• Decrease in the ability to perceive pain
• Accurately assess illness and injury during the patient assessment
• Ages 60-end of life

OBJECTIVE 2

• Alzheimer's Disease: a progressive, degenerative disease that attacks the brains and results in imparted memory, thinking, and behavior.
• Elder Abuse: the physical, sexual, or emotional abuse of an elderly person, usually one who is disabled or frail.
• Elder Neglect: the neglect by caregivers of the needs of an elderly person.

OBJECTIVE 2 CONT..

• Elderly: a person age 65 or older.
• Geriatric: of or relating to an elderly person.
• Self-Neglect: a condition whereby an individual fails to attend to his or her own basic needs, such as hygiene, appropriate clothing, medical care, etc.

OBJECTIVE 3

• GENERAL CHARACTERISTICS COMMONLY ASSOCIATED WITH GERIATRIC PATIENTS:
• Multiple Illnesses, Medications, Mobility, Difficulty with Communication, Incontinence, and Confusion or Altered Mental Status.

MULTIPLE ILLNESSESS

• Suffer From The Same Illnesses And Disorders As Others.
• Their Bodies Are Less Able To Defend Against Them And Recover Afterward.
• Have More Than One Disorder/Illness/Disease.

MEDICATION

• Many Geriatric Patients Take Numerous Prescriptions And Over-The-Counter Medications Each Day; Patients Over 65 Take An Average Of 4.5 Medications Per Day; Incorrect Medication Usage (caused by forgetfulness or confusion about instructions); Overdosing (result in toxic medication levels in a patient's system); Under-Dosing (causes the patient's illness/condition to progress and worsen).

MOBILITY

• Limited Mobility Can Cause Many Problems For The Elderly Person:
• Isolation, Poor Nutrition, Depression, Difficulty Using The Bathroom, Loss Of Independence, Higher Likelihood For Falls Or Other Injuries.

DIFFICULTY WITH COMMUNICATION

• It Is Normal For Elderly People To Experience A Lower Sensitivity To Pain Or Touch, Altered Sence Of Smell Or Taste, Certain Amount Of Hearing Loss, Impaired Vision Or Blindness.
• Affects Your Ability To Assess And Communicate With The Patient.

INCONTINENCE

• Inability To Retain Urine Or Feces.
• 15%–60% Suffer From Some Form Of Incontinence.
• Important To Maintain The Dignity Of Any Patients; For Elderly Patients, Respect And Dignity Are Extremely Vital.

CONFUSION (ALTERED MENTAL STATUS)

• Determine Whether The Elderly Patient Who Seems Confused Or Is Presenting With An Altered Mental Status If It's Normal Behavior.

OBJECTIVE 4

• MOST COMMON AGE-RELATED PHYSICAL CHANGES FOUND IN GERIATRIC PATIENTS:
• Changes in: Respiratory System, Cardiovascular System, Nervous System, Musculoskeletal System, and Integumentary System.

RESPIRATORY SYSTEM

• Age Creates Many Changes And In The Respiratory System, Leads To A Decrease In The Number Of Cilia In The Airway, Pneumonia.
• Other Respiratory Changes Due To Aging Include:
• Reduced Strength And Endurance Of Respiratory Muscles, Decreased Chest Wall Flexibility, Loss Of Lung Elasticity, Collapse Of Smaller Airway Structure.

CARDIOVASCULAR SYSTEM

• Enlargement Of The Left Ventricle (can decrease the amount of blood moved by the heart), Stiffening And Elongation Of The Aorta (making it more susceptible to tearing), Degeneration Of The Heart's Electrical System (causes dysthymia), Loss Of Elasticity In The Blood Vessels (can result in high blood pressure and poor circulation).

NERVOUS SYSTEM

• Brain Loses About 10% Of Its Overall Weight Between The Ages Of 20 And 90 Years.
• Deteriorations Mean That Elderly Patients May Experience Some Of The Following Changes Over Time: Decreased Reaction Times, Difficulty With Recent Memory, Psychomotor Slowing.

MUSCULOSKELETAL SYSTEM

• Can Lead To Changes In Posture, Range Of Motion, And Balance; Can Lose Up To 3 Inches Of Overall Height Due To Deterioration Of The Discs Between The Vertebrae, And Osteoporosis; Spine Curvatures (affect your ability to manage a patient's airway or effectively immobilize them following the injury).

INTEGUMENTARY SYSTEM

• Skin Loses Its Elasticity And Thickness (causes it to be easily torn or injured).
• Notice Dark Areas Of Pigment On The Skin (age spots; liver spots).
• Skin May Be Dry And Flaky Due To Decrease In Production Of Oils.

OBJECTIVE 5

• DESCRIBE THE COMMON MEDICAL PROBLEMS OF GERIATRIC PATIENTS:
• Illness, Injuries, Elder Abuse/Neglect.
• Advocate for the elderly.

ILLNESS

• Pneumonia, Chronic Obstructive Pulmonary Diseases, Cancer, Heart Failure, Aneurysm, High Blood Pressure, Stroke, Dementia, Parkinson's Disease, Diabetes, Bleeding In The Stomach/Esophagus/Intestines, Urinary Tract Infections, Reactions To Medications.

INJURIES

• Traumas caused by falls
• Can lead to death if severe.

ELDER ABUSE/NEGLECT

• Types Include:
• Physical, Emotional, Sexual, and Financial.

ADVOCATE FOR ELDERLY

• Common signs of suspected abuse:
• Unrealistic or vague explanations for injuries.
• An obvious delay in care.
• Unexplained injuries (past or present).
• Poor interaction between patient and caregiver.

OBJECTIVE 6

• SOME UNIQUE CHALLENGES AN EMR FACES WHEN ASSESSING AND CARING FOR A GERIATRIC PATIENT ARE:
• Sensitive/Dry Skin, Signs Of Shock Are Harder To Recognize, Decrease In Ability To Sweat (making heat-related emergencies more common)
• With The Cell Production Slowing Down, It Makes Skin Injuries Worse And Healing Times Longer.

OBJECTIVE 7

• DESCRIBE CHANGES IN THE APPROACH TO CARE WHEN CARING FOR A GERIATRIC PATIENT:
• Make Eye Contact At Patient's Eye Level, Speak Slowly And Clearly, Handle Patients Gently, Explain What Is Going To Happen Beforehand, Respect The Modesty And Privacy, Can Minimize Or Deny Their Symptoms, Fear Being Hospitalized.

OBJECTIVE 8

• DESCRIBE COMMON SIGNS AND SYMPTOMS OF ABUSE AND NEGLECT:
• Sores/Bruises/Other Wounds, Unkept Appearance, Poor Hygiene, Malnutrition, And Dehydration.

OBJECTIVE 9

• EXPLAIN THE ROLE OF THE EMR IN CASES OF ABUSE AND NEGLECT:
• Emergency responders often are the first professionals at a scene where maltreatment may have occurred or where others may be at risk for being abused or neglected. When medical responders encounter such a case, their initial objectives are to evaluate and address immediate medical and psychological needs, to assess and ensure the safety of victims, and to assess the scene in order to collect evidence.

OBJECTIVE 10

• DEMONSTRATE THE ABILITY TO PROPERLY ASSESS AND CARE FOR THE GERIATRIC PATIENT: Put The Patient At Ease By Explaining A Brief Overview Of How You'll Proceed, Find Out When The Present Illness Began, Ask About Past Illnesses That Required Medical Attention (such as hospitalizations, past procedures, if the patient has a history of disorders, diabetes, cancer), Be Sure To Document All Prescriptions And Non-Prescriptions The Patient Takes (names, dosage).

OBJECTIVE 11

• DEMONSTRATE VARIOUS TECHNIQUES THAT CAN BE EMPLOYED TO MAXIMIZE SUCCESSFUL ASSESSMENT OF THE GERIATRIC PATIENT:
• Pay Attention To The Position The Patient Is Sitting In; If They Are Responsive, They Have A Clear Airway; If They Are Unresponsive, You Must Confirm That The Patient Has A Clear Airway; Confirm That The Patient Has A Adequate Pulse And Has No Immediate Threats To Life.

OBJECTIVE 12

• VALUE THE ROLE OF THE EMERGENCY MEDICAL RESPONDER WITH RESPECT TO PATIENT ADVOCACY:
• A Responder Should Always Be Looking Out For Potential Dangers While In The Homes Of A Geriatric Patient.
• Dangers Such As: Unsecured Rugs, Loose Handrails, Unsafely Stacked Items, etc.
• Make A Caregiver Or Family Member Aware Of The Safety Concerns.

DEATH AND DYING

• Stages: Denial/Isolation, Anger, Bargaining, Depression, Acceptance.
• As Death Approaches, The Role Of The Caregiver Becomes More Of Being Present, Providing Comfort, Reassuring Your Loved One With Soothing Words And Actions That Help Maintain Their Comfort And Dignity As He/She Approaches Death.

DEATH AND DYING CONT...

• One To Three Months Prior To Death, Patient Is Likely To:
• Sleep Or Doze More, Eat And Drink Less, Withdraw From People And Activities Previously Found Pleasurable.

DEATH AND DYING CONT...

• One To Two Weeks Prior To Death, Patient May Be Bed Bound And Experiencing:
• Increased Pain, Changes In Blood Pressure/Respiratory Rate/And Heart Rate, Continued Loss Of Appetite And Thirst, Difficulty Taking Medications By Mouth, Decline In Bowel And Bladder Output, Temperature Fluctuations (skin is cool, warm, moist, or pale), Constant Fatigue, Congested Breathing (build-up of secretions at the back of the throat), Disorientation (seeing and talking to people who aren't there).