Chapter 43: Geriatiric Emergencies

Elderly- a person 65< Old-old- elderly person 80< Gerontology- scientific study of the effects of aging and of age related diseases on humans. Geriatrics- the study and treatment of diseases of the aged. Ageism- discrimination against aged or elderly people. -In treating the elderly, the best intervention is prevention. Functional impairment- decreased ability to meet daily needs on an independent basis. Comorbidity- having more than one disease at a time. -elderly often suffer from more than one illness or disease at a time. Common Complaints in the Elderly Fatigue/weakness Dizziness/vertigo/syncope Falls Headaches Insomnia Dysphagia- inability to swallow or difficulty swallowing. Loss of appetite Inability to void Constipation/diarrhea Polypharmacy- multiple drug therapy in which there is a concurrent use of a number of drugs. Incontinence- inability to retain urine or feces because of loss of sphincter control or cerebral or spinal lesions. TIA (Transient Ischemic Attacks)- reversible interruptions of blood flow to the brain; often seen as a precursor to a stroke. Factors in Forming a General Assessment Living situation Level of activity Network of social support Level of independence Medication history Sleep patterns Anorexia nervosa- eating disorder marked by excessive fasting. By-Products of Malnutrition Vitamin deficiencies Dehydration Hypoglycemia Cataracts- medical condition in which the lens of the eye loses its clearness. Glaucoma- medical condition where the pressure within the eye increases. Tinnitus- subjective ringing or tingling sound in the ear.

Menieres disease- a disease of the inner ear characterized by vertigo, nerve deafness, and a roar or buzzing in the ear. AMS (Altered Mental Status)- possible reasons for AMS in the elderly Dementia Infection Medication related Decreased Blood Volume (dehydration) Respiratory disorders and Hypoxia Hypothermia or hyperthermia Decreased Blood Sugar Level Medical or Traumatic Head Injury Respiratory System Kyphosis- exaggeration of the normal posterior curvature of the spine. Anoxic hypoxemia- an oxygen deficiency due to disordered pulmonary mechanisms of oxygenation. -in treating respiratory disorders in the elderly patient, DO NOT FLUID OVERLOAD, because of a danger of Pulmonary Edema. Cardiovascular System Hypertrophy- an increase in the size of bulk of an organ. Fibrosis- the formation of fiber like connective tissue, also called scar tissue in an organ. Nervous System Difficulty w/recent memory Psychomotor slowing forgetfulness Decreased reaction times Endocrine System Many endocrine emergencies encountered in the field present as AMS, especially w/insulin related disorders. Marfans Syndrome- hereditary condition of connective tissue, bones, muscles, ligaments, and skeletal structures characterized by irregular and unsteady gait, tall lean body type w/long extremities, flat feet, stooped shoulders. The aorta is usually dilated and may become weakened enough to allow an aneurysm to develop. Gastrointestinal System Hiatal hernia- protrusion of the stomach upward into the mediastinal cavity through the esophageal hiatus of the diaphragm. -a common drug toxicity problem for EMS personnel is the use of Lidocaine. Thermoregulatory System -age-related alterations in the temperature-regulating mechanism, coupled with changes in the sweat glands, make the elderly more prone to environmental thermal problems. Musculoskeletal System Osteoporosis- softening of bone tissue due to the loss of essential minerals, principally calcium. Renal System

Nephrons- the functional units of the kidneys. Immune System Immune senescence- diminished vigor of the immune response to the challenge and rechallenge by pathogens. Common Medical Problems in the Elderly Pulmonary/Respiratory Disorders o Pneumonia o COPD o Pulmonary Embolism o Pulmonary Edema o Lung Cancer Cardiovascular Disorders o Angina Pectoris o Myocardial Infarction o Heart Failure o Dysrhythmias o Aortic Dissection/Aneurysms o Hypertension o Syncope Neurological Disorders o Cerebrovascular Disease (Stroke/Brain Attack) o Seizures o Dizziness/Vertigo o Delirium, Dementia, Alzheimers Disease Delirium- an acute alteration in mental functioning that is often reversible. Dementia- a deterioration of mental status that is usually associated w/structural neurological disease. It is often progressive and irreversible. Alzheimers Disease- a progressive, degenerative disease that attacks the brain and results in impaired memory, thinking, and behavior. It affects 4million American adults. o Parkinsons Disease- chronic, degenerative nervous disease characterized by tremors, muscular weakness and rigidity, and a loss of postural reflexes. Metabolic and Endocrine Disorders o Diabetes Mellitus o Thyroid disorders Gastrointestinal Disorders o Upper GI Bleed Peptic ulcer disease- injury to the mucous lining of the upper part of the gastrointestinal tract due to stomach acids, digestive enzymes, and other agents, such as anti-inflammatory drugs.

Gastritis- an inflammation of the lining of the stomach. Esophageal Varices- an abnormal dilation of veins in the lower esophagus; a common complication of cirrhosis of the liver. Mallory-Weiss Tear- a tear in the lower esophagus that is often caused by severe and prolonged retching. o Lower GI Bleed Diverticulosis- the presence of small pouches on the colon that tend to develop w/age; causes 70% of life-threatening lower GI bleeds. Tumors- of the colon can cause bleeding when the tumor erodes into blood vessels within the intestine or surrounding organs. Ischemic Colitis- an inflammation of the colon due to impaired or decreased blood supply. Arterio-Venous Malformations- an abnormal link between an artery and a vein. o Bowel Obstruction o Mesenteric Infarct Skin disorders o Skin diseases o Pressure Ulcers Musculoskeletal Disorders o Osteoarthritis- a degenerative joint disease, characterized by a loss of articular cartilage and hypertrophy of bone. o Osteoporosis- softening of bone tissue due to the loss of essential minerals, principally calcium. Renal Disorders Urinary Disorders Environmental Emergencies o Hypothermia o Hyperthermia (Heat Stroke) Toxicological Emergencies Substance Abuse- misuse of chemically active agents such as alcohol, psychoactive chemicals, and therapeutic agents; typically results in clinically significant impairment or distress. Behavioral/Psychological Disorders o Depression o Suicide Common Fractures Among the Elderly Hip or pelvis Fx Proximal Humerus Distal radius Proximal tibia Thoracic and lumbar bodies