Integumentary SystemAs persons age, skin gradually becomes dry, transparent, wrinkledThese integumentary changes are associated withLoss of elasticityUneven pigmentationVarious benign and malignant lesionsCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.1Integumentary SystemAs persons age, skin gradually becomes dry, transparent, wrinkledAging results in gradual decrease in epidermal cellular turnover and reduced rate of nail and hair growthAssociated loss of deep, dermal vessels and capillary circulation leads to common complaints such asDry, itchy skinChanges in thermal regulationSkin-related complicationsCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.2Integumentary SystemComplications include Slow healingIncreased risk of secondary infectionIncreased risk of fungal or viral infectionsIncreased susceptibility to abrasions and tearsCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.3Integumentary SystemAlways be gentle with skin of a geriatric patientUse of aseptic technique during wound managementGentle placement and removal of ECG electrodesUsing careful taping procedures when securing IV catheters or tubingCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.4Pressure UlcersPressure ulcers are common Often develop on skin of patients who are bedridden or immobile (e.g., decubitus ulcers)Most occur in lower legs, back, buttocks, and over bony areas such as greater trochanter or sacrumOften affect victims of brain or spinal cord injury, stroke, or other illnesses that result in loss or change in sensation of painCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.5Pressure UlcersFactors for developing pressure ulcersSkin exposure to moisturePoor nutritionFriction or shearVascular and metabolic disorders TraumaCancerCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.6

Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.7 Figure 49-2. Pressure ulcers.7Pressure UlcersResult from tissue hypoxiaGenerally start as red, painful areas that become purple before skin breaks downDevelop into open soresOnce integrity of skin has been breached, sores often become infectedSlow to healPressure ulcers should be covered with sterile dressing using aseptic techniqueTransport for physician evaluation and wound care to facilitate healingCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.8OsteoarthritisCommon form of inflammatory arthritis in geriatric patientsDegenerative condition that results from cartilage loss and wear and tear on jointsCondition leads to pain, stiffness, and sometimes loss of function of affected jointOften affected joint becomes large and distorted from outgrowths of new bone (osteophytes) that tend to develop at margins of joint surfaceCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.9OsteoarthritisEvolves in middle yearsOccurs to some extent in almost all persons over 60 years of ageSome persons have no symptomsAfter physician evaluation, treatment may includeMedicationsPhysical therapySometimes joint replacement surgeryCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.10OsteoarthritisNewer drugs relieve inflammation and pain associated with arthritisHave less risk of causing stomach irritation than traditional medications Example of newer drugs is celecoxib (Celebrex)Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.11

Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.12 Figure 49-3. Osteoarthritis.12OsteoporosisDisease that decreases bone densityIt is natural part of aging and is especially is common in older women after menopauseBecause of decrease in estrogen hormone that helps maintain bone massCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.13OsteoporosisPresent in most persons by 70 years of age, by which time density of skeleton has diminished by 1/3Most persons with osteoporosis have some degree of kyphosisRisk factors that may affect progression of diseaseGeneticsSmokingExercise habitsDiets poor in calcium and vitamin DCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.14OsteoporosisLoss of bone density causes bones to become brittleCan fracture easily, which often is first sign of osteoporosisTypical sites for fracturesJust above wristHead of femurOne of several vertebrae (often spontaneous fracture)Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.15Osteoarthritis15OsteoporosisTreated with preventive measuresDiet high in calciumCalcium supplementsExerciseHormone replacement therapy after menopause (controversial)Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.16Problems with VisionVision changes begin to occur at around 40 years of ageGradually increase over timeCan severely limit daily activitiesCan lead to a loss of independenceCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.17Problems with VisionEffects of aging on visionReading difficultiesPoor depth perceptionPoor adjustment of eyes to variations in distanceAltered color perceptionSensitivity to lightDecreased visual acuityCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.18Problems with VisionTwo common eye conditions that develop with age are cataracts and glaucomaCataract is loss of transparency of lens of eyeResults from changes in delicate protein fibers within lensCataract never causes full blindnessClarity and detail of image progressively are lostCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.19Problems with VisionCataracts usually occur in both eyesIn most cases, though, one eye is affected more severely than otherAlmost everyone over 65 years of age has some degree of cataractMost persons over 75 years of age have minor visual deterioration from disorderSurgery to remove cataract is common procedure in U.S.Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.20

Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.21 Figure 49-4. Appearance of an eye with a cataract.21Problems with VisionGlaucomaCondition in which intraocular pressure increasesPressure causes damage to optic nerveResult is nerve fiber destruction and partial or full loss of peripheral and central vision Glaucoma may result fromAging (rarely seen before 40 years of age)Congenital abnormalityTrauma to eyeCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.22Problems with VisionGlaucoma is most common major eye disorder in persons over 60 years of age and is leading cause of preventable blindness in U.S.Symptoms of acute glaucomaDull, severe, aching pain in and above eyeFogginess of visionPerception of rainbow rings (halos) around lights at nightTesting is part of most eye examinations in adultsIf detected early, condition can be treated with oral medications and eye drops to relieve pressureCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.23Consider the patient who has glaucoma. What prehospital cardiac medication should not be given to this patient?

Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.24 Atropine can worsen narrow-angle glaucoma and should not be given unless a life-threatening condition exists.24

Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.25 Figure 49-5. Glaucoma. (A) Open-angle glaucoma. The obstruction to aqueous flow lies in the trabecular meshwork. (B) Closed-angle glaucoma. The trabecular meshwork is covered by the root of the iris. (From Stein HA, Slatt BJ, Stein RM: The ophthalmic assistant fundamentals in clinical practice, St Louis, 1988, Mosby.)25Problems with HearingNot all geriatric patients have hearing lossOverall hearing tends to decrease with ageResults from degeneration of hearing mechanism (sensorineural deafness)CausesMenieres disease (increased fluid pressure in labyrinth)Certain drugsTumorsSome viral infections

Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.26Problems with HearingCan interfere with the ability to perceive speechCan limit ability to communicateHearing aid devices and surgical implants sometimes can restore or improve hearingCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.27Problems with HearingTinnitusPerception of noise in ear (e.g., ringing, buzzing, or whistling)Can occur as symptom of many ear disordersNoise in ear sometimes may change in nature and intensityIn most cases is present at all times with intermittent awareness by personAlmost always associated with hearing loss, especially hearing loss that develops from agingCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.28What common analgesic, when taken in excess, can cause tinnitus?

Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.29 Aspirin overdose can cause ringing in the ears.29Problems with SpeechSpeech is most often used method of communicationCommon problems with speech often are associated withDifficulty in word retrievalDecreased fluency of speechSlowed rate of speechChanges in voice quality

Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.30Problems with SpeechDisorders may occur fromDamage to language centers of brain (usually as result of stroke, head injury, brain tumor)Degenerative changes in nervous systemHearing lossDisorders of larynxPoor-fitting denturesCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.31ToxicologyGeriatric patients are at increased risk for adverse drug reactionsResult of age-related changes inBody compositionDrug absorptionDistributionMetabolismExcretionCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.32ToxicologyAge-related changes that affect absorption include increased gastric pH and decreased gastrointestinal motilityBoth may increase or decrease absorption of various drugs (depending on chemical properties of drug)Drug distribution may be affected byDecreased cardiac output (e.g., as seen in CHF)Total body waterChanges in ratio of lean mass to fatIncreased body fatCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.33ToxicologyMetabolic changes may result fromDecreased liver blood flowDiseases such as thyroid disease, CHF, and cancerSmokingDrug interactionsRenal function decreases with age in majority of adultsCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.34ToxicologyCan lead to accumulation of drugs that normally are cleared through renal systemIn addition, action of drugs affecting CNS and cardiovascular system often is altered in older adultsBecause of these changes, drugs may not produce desired effect or may cause major drug toxicity in older adultsCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.35ToxicologyDrugs that commonly cause toxicity in geriatric patientsAnalgesicsAngiotensin-converting enzyme inhibitorsAntidepressantsAntihypertensivesBeta-blockersDigitalisDiureticsPsychotropicsCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.36ToxicologyAdverse reactions associated with these and other drugs often result from accidents or mishaps in prescribed drug regimenOther common reasons for drug-induced illness in geriatric patientDispensing errorsNoncomplianceConfusionForgetfulnessVision impairmentSelf-selection of drugsCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.37ToxicologyOlder adults commonlyHave several prescriptions from more than one physicianImproperly resume old medication in addition to newly prescribed oneTake prescribed medications along with over-the-counter drugs that may have synergistic or cumulative effectsCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.38ToxicologyChanges in habits regarding alcohol, diet, and exercise also can affect drug metabolismCan increase risk for adverse drug reactionsEmergency care variesCare may range from transport only to full advanced cardiac life support measuresCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.39Substance AbuseSubstance abuse involving alcohol and other drugs is common in elderly populationUp to 17 percent of U.S. citizens over age 60 are estimated to be addicted to substancesExpected to rise as baby boomer population enters older ageCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.40Substance AbuseSubstance abuse is attributed to severe stress as primary risk factorAge-related changes in health or appearanceLoss of employmentLoss of spouse or life partnerIllnessMalnutritionLonelinessLoss of independent living arrangementsCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.41Substance AbuseIf paramedic suspects substance abuse, friends and family members at scene should be discretely interviewed about patients alcohol or other drug useCornerstones of therapy are identifying the problem and arranging referral to physician for treatmentTreatment for acutely intoxicated patient is may include resuscitative measures to manage patients airway, ventilation, circulationCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.42Substance AbuseCarefully assess geriatric patient who has signs and symptoms of alcohol or other drug intoxication for occult trauma and any underlying medical conditionsHypoglycemiaCardiomyopathy and dysrhythmias (such as atrial fibrillation)GI bleedingPolydrug use (especially barbiturates and tranquilizers)Ethylene glycol or methanol ingestionCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.43Environmental ConsiderationsElderly patients are at risk for developing illness from extremes in environmentResult of aging process and other factorsTwo emergencies that relate to environment are most common in geriatric patientsHypothermia HyperthermiaCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.44HypothermiaPatients who are younger often develop hypothermia from extremes in environmentOlder patient may develop hypothermia while indoorsMay occur as result of cold surroundings and/or an illness that alters heat production or conservationCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.45HypothermiaPatients who are younger often develop hypothermia from extremes in environmentDue in part to following characteristics of older adultsLess able to make up for environmental heat lossHave decreased ability to sense changes in temperatureHave less total body water to store heatLess likely to develop tachycardia to increase cardiac output in response to cold stressHave decreased ability to shiver to increase body heatCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.46HypothermiaMore prone to develop hypothermia as result of socioeconomic factorsFixed income may inhibit older person from paying for cost of properly heating and insulating homePoor nutrition that results in decrease in fat stores may contribute to hypothermia in geriatric patients who live aloneCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.47HypothermiaMedical causes of hypothermia in geriatric patientsArthritisDrug overdoseHepatic failureHypoglycemiaInfectionParkinsons diseaseStrokeThyroid diseaseUremiaCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.48HypothermiaSigns and symptomsAltered mental stateSlurred speechAtaxiaDysrhythmiasComa without signs of lifeCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.49HypothermiaHypothermia in geriatric patient carries a high mortality rateRapid and gentle transport for in-hospital rewarming and life support measures is crucial for patients survivalCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.50HyperthermiaLess common than hypothermiaCarries significant mortality rateMost likely results from exposure to high temperaturesMost likely continue for several days (e.g., during a heat wave)Geriatric patients are unable to control body temperature even in moderate heatCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.51HyperthermiaMay result from medical conditions such asHypothalamic dysfunction Spinal cord injuryCertain medications can lead to hyperthermiaInhibits heat dissipation, increasing motor activity, and impairing cardiovascular functionCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.52HyperthermiaHyperthermic illness may present as heat cramps, heat exhaustion, or heat strokeEmergency careRemoving patient from warm environmentCooling patientEnsuring patients vital functions through airway, ventilatory, and circulatory supportRapid transport for physician evaluation is indicated to manage problems resulting from serious heat-related illnessCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.53Behavioral and Psychiatric Disorders15 million elderly persons are expected to suffer from some kind of psychiatric illness by the year 2030In addition to neurological disorders such as dementia and Alzheimers disease, depression and suicide are common in geriatric patientsCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.54DepressionDepression is serious illness that requires physician evaluationIn geriatric patient, depression can result from physiological and psychological causesExamples Cognitive disorders with physical causes (e.g., dementia) Various personality disorders such as schizophreniaSigns and symptoms of depression vary by individualCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.55DepressionSigns and symptomsDecreased libidoDeep feelings of worthlessness and guiltExtreme isolationFeelings of hopelessnessIrritabilityLoss of appetite

Loss of energy (fatigue)Recurrent thoughts of deathSignificant weight lossSleeplessnessSuicide attempts

Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.56DepressionMajor goal of care is to identify patient who may be depressedPatients need to be evaluated by physicianWill rule out medical illness, especially thyroid disease, stroke, malignancy, and dementia, medication that may be responsible for depressionTry to establish rapport with patient Should be encouraged to talk openly about feelings, especially any thoughts of suicideIf possible, interview family about patients mental state and question family members about any history of depression in patientCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.57Suicide Rate of completed suicides for geriatric patients is higher than that of general populationMost of these persons visited their primary care physician in month before suicideMost were suffering from their first episode of major depressionWas only moderately severe, yet depressive symptoms went unrecognized and untreatedBe aware of increased risk for suicide when evaluating geriatric patients who are depressedCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.58Clues and indicators for suicide in geriatric patient that may be obtained through patient history or observed by friends and family includeTalking about or seemingly preoccupied with death and getting affairs in orderGiving away prized possessions Taking unnecessary risks Increased use of alcohol or other drugsNonadherence to medical regimen Acquiring weapon, especially firearmsSuicide Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.59No evidence that questions about suicidal thoughts and feelings increase risk of suicideMany depressed persons are willing to discuss their suicidal thoughtsQuestion patient about suicidal thoughts if he or she suspects the patient is at high riskFollowing questions are appropriate for paramedic to ask patientDo you have thoughts about killing yourself?Have you ever tried to kill yourself?Have you thought about how you might kill yourself?Suicide Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.60Most suicides committed by older adults involve firearmsSafety of those at scene and EMS crew is priority when caring for patient with suicidal tendenciesWhen indicated, law enforcement personnel should be available at sceneAfter assessing risk for suicidal tendencies, patient should be transported for physician evaluationWhile en route to hospital, paramedic should encourage patient to discuss feelings and reassure patient that he or she can be helped through crisisSuicide Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.61Trauma Trauma is fifth leading cause of death for persons over 65 years of age1/3 of traumatic deaths in persons 65 to 74 years of age are caused by vehicular trauma25 percent result from fallsIn those over 72 years of age, falls is leading cause of unintentional injury deathBurns are major cause of disability and death in geriatric patientsCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.62TraumaContributing factors that increase the severity of traumatic injury in geriatric patientsOsteoporosis and muscle weakness that increase the likelihood of falls and fracturesReduced cardiac reserve that decreases the ability to compensate for blood lossDecreased respiratory function that increases the likelihood of adult respiratory distress syndromeImpaired renal function that decreases the ability to adapt to fluid shiftsCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.63Vehicular Trauma 15+ million licensed drivers are over 65 years of ageIn 2008, 2,700+ deaths in this age group were attributed to motor vehicle crashesMost are not related to high speed or alcoholRelated to errors in perception or judgment or to delayed reaction timeLarge number of older adults are injured as drivers or passengers in moving vehiclesMore than 2,000 pedestrian fatalities among older adults occur each year in U.S. Accounts for 20 percent of all pedestrian deaths from traumaCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.64Risk of death from multiple trauma is estimated to be three times greater at 70 years of age than at 20 years of ageGeriatric patient is more susceptible to serious injury from equivalent degrees of traumaPatient also is less capable of an appropriate, protective physiological responsePrompt identification of injuries and sources of hemorrhage is critical Geriatric patient has much less cardiac reservePatient will succumb more quickly to shockVehicular Trauma Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.65Head injury with loss of consciousness in geriatric patients often has poor outcomeBrain becomes smaller in size with age (cerebral atrophy)Atrophy produces increase in distance between surface of brain and skullAs veins are stretched across this space, more easily are tornResults in subdural hematomataExtra space within skull often allows large amount of bleeding to occur before signs and symptoms of increased intracranial pressure are seenHead TraumaCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.66Consider geriatric patients with head trauma. What home medications also can lead to an increased risk of intracerebral bleeding in these patients?

Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.67 Coumadin, heparin, aspirin, Plavix, or other antiplatelet drugs can increase the risk of bleeding. Alcoholism is also associated with an increased risk of intracerebral bleeding.67Geriatric patients are at high risk for injuries of cervical spine because of arthritic and degenerative changes associated with agingStructural changes lead to increased stiffening and decreased flexibility of spine with narrowing of spinal canalMakes spinal cord much more at risk for damage from fairly minor traumaHead TraumaCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.68Chest InjuriesAny mechanism of injury that produces thoracic trauma in geriatric patient can be potentially lethalAged thorax is less elasticMore susceptible to injuryPulmonary system also has marginal reserve because ofReduced alveolar surface areaDecreased patency of small airwaysDiminished chemoreceptor responseCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.69Chest InjuriesInjuries to heart, aorta, and major vessels are greater risk to geriatric patientsDue to decreased functional reserve in older patientsAnatomical changes make injury in these areas of greater significanceMyocardial contusion may be complication of blunt injury to chestIf severe, myocardial contusion may result in pump failure or life-threatening dysrhythmiasRarely, cardiac tamponade occurs after blunt thoracic traumaCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.70Chest InjuriesCardiac rupture, valvular injury (e.g., flail valves), and aortic dissection also may occur with significant blunt chest injuryFirst two entities are rare but rapidly fatalWhen mechanism of injury produces rapid deceleration, paramedic should always consider possibility of dissecting aortic aneurysmAortic dissections often are not immediately fatalProper evaluation and treatment can be lifesavingCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.71Chest InjuriesIn geriatric patients, the heart cannot respond as effectively to increased demand for oxygen as in younger peopleThis coupled with slowed conduction system may cause ischemia and dysrhythmias when geriatric patients have significant traumaThese problems may occur even if heart has not been damaged directly by traumaOxygenation and circulatory status must be closely monitoredCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.72Abdominal InjuriesAbdominal injuries in geriatric patients have more serious consequences than injuries to any other body areaOften are less obviousCall for a high degree of suspicionGeriatric patient is less likely to tolerate abdominal surgery wellMore likely to develop pulmonary complications and infection following surgeryCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.73Musculoskeletal InjuriesOsteoporotic bones of geriatric patients are more at risk for fractures, even with mild traumaPelvic fractures are highly lethal in this age groupCan cause severe hemorrhage and soft tissue injuryWhen assessing for skeletal trauma, recall that geriatric patient may have decreased pain perceptionOften these patients have amazingly little tenderness with major fracturesCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.74Musculoskeletal InjuriesEven with proper care, mortality rate for geriatric patients with musculoskeletal injury is increased by delayed complicationsAdult respiratory distress syndromeSepsisRenal failurePulmonary embolismCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.75FallsFalls are major cause of morbidity and mortality in older adults, with overall fatality rate of 7.0 percentAbout 1/3 of older adults living at home fall each year1 in 40 of these persons is hospitalizedMajor cause of falls in older adults results from use of prescribed sedative-hypnoticsAffect balance and postural controlAlprazolamDiazepamChlordiazepoxideFlurazepamCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.76Consider geriatric patients who have fallen. What common problems may contribute to an increased death rate in these patients?

Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.77 Immobility from fall-related fractures can cause pneumonia or pulmonary embolus leading to death. 77FallsFractures are most common fall-related injuries, hip being fracture that most often results in hospitalizationIn those who survive hip fracture, most will have significant problems with walking and moving aboutMay become more dependent on others for helpFalls that do not result in physical injury may lead to self-imposed immobility from fear of falling againCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.78FallsWhen immobility is strict and prolonged, result inJoint contracturesPressure soresUrinary tract infectionMuscle atrophyDepressionFunctional dependencyCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.79FallsAssume that any fall indicates an underlying problem until proved otherwiseAttempts should be made to uncover any medical, psychological, and environmental factors that may have been responsible for fallPatient history should includeFull review of all medical problems and medicationsPrecise details of fallEvaluate patient's cardiovascular, neurological, and musculoskeletal systemsCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.80BurnsMore than 1,000 older adults die from fires and burns in United States each yearIncreased risk of morbidity and mortality from burn trauma in older adults is due toPreexisting diseaseSkin changes that result in increased burn depth, altered nutrition, decreased ability to fight infectionCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.81BurnsGeriatric burn patients need special approaches to fluid therapy to prevent damage to kidneysPatients fluid status will need to be assessed in initial hours after burn injury byMonitoring pulse and BPStriving to maintain urine output of at least 50 to 60 mL per hourCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.82Trauma ManagementPriorities of trauma care for geriatric patients are similar to those for all trauma patientsGive special consideration to transport strategies and geriatric patients cardiovascular, respiratory, and renal systemsCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.83Cardiovascular SystemSpecial considerations for cardiovascular problemsRecent or past MI contributes to risk of dysrhythmias and CHFAdjustment of heart rate and stroke volume may be decreased in response to hypovolemiaGeriatric patients may need higher arterial pressures than younger patients for perfusion of vital organsBecause of atherosclerotic peripheral vascular disease

Copyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.84Cardiovascular SystemSpecial considerations for cardiovascular problemsRapid IV fluid administration to geriatric patients may cause volume overloadTake care not to overhydrate Older adults as group are more susceptible to CHFHypovolemia and hypotension are also poorly toleratedConsider hypovolemia in any geriatric patient whose systolic BP less than 120 mm HgTachycardia may not occur if patient takes beta-blockersMonitor lung sounds and vital signs carefully and frequently during fluid administrationCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.85Respiratory SystemSpecial considerations for respiratory problemsPhysical changes decrease chest wall compliance and movementDiminish vital capacity PaO2 decreases with ageLower Po2 at same fractional inspired oxygen concentration occurs with each passing decadeAll organ systems have less tolerance to hypoxiaCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.86Respiratory SystemSpecial considerations for respiratory problemsCOPD (common in geriatric patients) requires paramedic carefully adjust airway management and ventilation support for appropriate oxygenation and carbon dioxide removalHigh-concentration oxygen may suppress hypoxic drive in some patientsOxygen should never be withheld from patient with clinical signs of cyanosisMay need to remove patients dentures for adequate airway and ventilation managementCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.87Renal SystemSpecial considerations for renal problemsKidneys have decreased ability to maintain normal acid-base balanceHave decreased ability to compensate for fluid changes Kidney disease may decrease ability of kidneys to compensateDecreased kidney function (along with decreased cardiac reserve) places injured geriatric patient at risk for fluid overload and pulmonary edema following IV fluid therapyCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.88Transportation StrategiesSpecial considerations for transportation of geriatric patientsPositioning, immobilization, and transport of a geriatric trauma patient may require modifications to accommodate physical deformities (e.g., arthritis or spinal abnormalities)Packaging should include bulk and extra padding to support and give comfort to patientPrevent hypothermia by keeping patient warmCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.89Elder AbuseInfliction of physical pain, injury, debilitating mental anguish, unreasonable confinement, or willful deprivation by caregiver of services that are necessary to maintain mental and physical health of geriatric personElder abuse has become more and more recognized as growing problem in U.S. Estimated to affect between 1 and 2 million older adults each yearCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.90Elder AbuseElder abuse takes many formsPhysical abuseSexual abuseEmotional or psychological abuseNeglectAbandonmentFinancial or material exploitationSelf-neglectCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.91Elder AbuseAll 50 states have elder abuse statutesReporting of suspected elder abuse is mandatory under law in most statesIf paramedic suspects abuse or neglect of older adult, medical direction should be advisedFollow procedures established by local protocolEmergency care is aimed at managing injuries that pose threat to life and transporting patient for physician evaluationCopyright 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.92