Changes of normal aging

The physiological changes of normal aging are important considerations in the approach to the geriatric patient. Aging itself is not a disease. Age should be viewed as a risk factor, but not sufficient in and of itself to cause disease. Aging produces a diminished physiological capacity; therefore, older adults may not have the same functional reserve in organ systems to recover from injury or illness. Even healthy and active older adults may need prolonged periods to recover from acute illness or trauma due to this reduced physiological capacity.

Assessment of the geriatric patient

For EMS professionals caring for the geriatric patient, the initial steps are unchanged. A primary survey should be completed, evaluating the patient’s ABCs. Vital signs should be obtained and considered while accounting for existing medical problems and medications. Any immediate interventions necessary should be completed. A full history should be taken, including the symptoms the patient has experienced, allergies, medications (including over-the-counter and herbal medications, and medications that the patient is not taking despite prescription), and past medical history. A full examination should be completed. Although not traditionally considered, an environmental assessment should also be completed because the environment can provide clues as to the extent of the disease or the precipitating factors for disease. Finally, a social history should be obtained because psychosocial issues could either be the primary reason for the request for assistance or could precipitate or exacerbate medical issues.

Communication with older patients is key in performing an effective assessment. A common error is to assume that an older patient is deaf, has dementia, or is otherwise unable to communicate or participate in medical evaluation or care. It is common for medical personnel to rely on family members of older patients to contribute collateral information regarding current illness or medical history. However, this often comes at the cost of speaking exclusively to others and entirely excluding the older patient. The general rule of thumb when caring for older patients is to always speak to the patient first and establish his or her level of understanding and participation. Use a strong, clear voice, but avoid shouting as this tends to distort words and makes it more difficult to understand. If hearing aids or eyeglasses are available and practical for the patient to use in the situation, these can make a dramatic difference in communication.

When obtaining the history, it is important to establish the baseline cognitive and physical functioning of the patient. If EMS is responding to a patient with reported “confusion” or “weakness,” does this patient have a history of dementia or physical limitations from a prior stroke or other condition? It is also relevant to consider the social context of the patient. Does he or she reside in an assisted living facility, nursing home, or his or her own home? This may influence the decision to transport a patient to the hospital if there are other caregivers available to be with the patient compared with one who lives alone without support. Family members and caregivers can also provide valuable information about the patient. A report by those present during a fall, episode of syncope, or witnessed seizure becomes a crucial element of the medical history, and it is important to communicate this information to subsequent emergency personnel.