Geriatric care

[JamesBlack]

Also, does anyone have any tips/advice on Geriatric care? I need to do a small 5 minute powerpoint on Geriatric Care, must include: Communication, assessment and A&P considerations. What are some good highlights to hit, since it's so short? Communication can be difficult, due to lack of hearing. And assessment can be hard, due to a 101 year old having pain everywhere...

 

[EMT-IT753]

Polypharmacy is also a big issue with the elderly. Also, the elderly do not feel pain as well as younger people. The elderly also have temperature regulation issues as well. Just a few more things to consider

 

[Steam Engine]

Also, does anyone have any tips/advice on Geriatric care? I need to do a small 5 minute powerpoint on Geriatric Care, must include: Communication, assessment and A&P considerations. What are some good highlights to hit, since it's so short? Communication can be difficult, due to lack of hearing. And assessment can be hard, due to a 101 year old having pain everywhere...

I'm assuming this is for an EMT-B class...I'd strongly suggest re-reading the chapters in your text regarding geriatrics and obtaining your info from there.

With that said, there are a number of considerations to take into account. As you mentioned, many can be hard of hearing. Speaking slowly, enunciating clearly, allowing the patient to clearly see your face as you speak and elevating your volume (to an extent) can be be helpful. Writing things down also works in some cases. Dementia can also make communications difficult, as can an unfamiliarity with some of the technology and terminology you may be using...explaining your steps as you go along will often make things easier.

As for assessment, many geriatric patients will be taking multiple rx drugs, so a complete list will be important to obtain. Some will have normal vitals (for them) that differ from the textbook examples. Many will have advanced directives, DNR's, etc. As mentioned above, some will suffer from dementia and poor memory to varying degrees as well, so an accurate history may be difficult to obtain.

 

[TyBigz]

As for assessment, many geriatric patients will be taking multiple rx drugs, so a complete list will be important to obtain. Some will have normal vitals (for them) that differ from the textbook examples. Many will have advanced directives, DNR's, etc. As mentioned above, some will suffer from dementia and poor memory to varying degrees as well, so an accurate history may be difficult to obtain.

Also keep in mind with a lack of feeling in their hands and the higher possibilities of poor memory and mental health status, that they might not be taking all of their meds as prescribed. Elderly also often tend to wear extra clothes so if they need to be removed for any means (such as to take a bp or examine a wound) consider covering them in a blanket to keep them warm. As noted hearing may be an issue so speaking loud and clear is key. If sight is a problem give them their glasses or stand where they can see you and ALWAYS tell them what you are doing.

If you wanted to have a hands on experience for your class bring in a pair of winter gloves, skittles, M&Ms and a pill container (either Rx bottle or a daily reminder container) and have them try to take out only the skittles wearing gloves. A cheap pair of sunglasses with the lenses replaced with wax paper is also a good simulation of glaucoma, or if you replace the lenses with a clear sheet and draw a dot with a marker you can simulate another common sight problem with the elderly that i cannot seem to remember right now.

Hoped this helped!

 

[Tigger]

All of the above are good points.

I might also add that depending upon where you work, you may transport the same elderly patient quite frequently in both emergent and non-emergent settings. Take the time fully assess the patient every time. It really doesn't take much for an elderly person to start a quick slide into terrible health. If you're in a position where you notice a subtle decline in a regular patient's health, attempt to bring it to someone's attention in addition to the patient's, if appropriate. Many patients are headstrong and refuse to accept that they are sick, sometimes it's going to take a trusted family member to really get through to them.

 

[Handsome Robb]

A cheap pair of sunglasses with the lenses replaced with wax paper is also a good simulation of glaucoma, or if you replace the lenses with a clear sheet and draw a dot with a marker you can simulate another common sight problem with the elderly that i cannot seem to remember right now.

Hoped this helped!

Macular Degeneration?

Inability to compensate the way younger people will. Atypical presentations. ie normothermic sepsis or MI without chest pain.

 

[Shishkabob]

Just because they don't have a fever, doesn't mean they aren't fighting an infection/ sepsis/ SIRS/ etc etc.

 

[Tigger]

I also cannot stress temperature regulation enough. During my transports I will ask several times if the patient is warm enough and comfortable. Don't just keep adding blankets if they're cold, suck it up and crank the heat. If you think it's a little hot in back, it's probably about right for your elderly patient (on a cold day obviously).

This is why I wear short sleeved uniforms year round. It seems like the back of the truck is always too hot since even in the summer the patients often don't want the A/C.

 

[cruiseforever]

Treat them with respect. Do not honey or dear them. Ask them how they would like to be addressed, Mr. Smith, Kim, or a nick name.

I agree big time with the blankets.

 

[TyBigz]

Macular Degeneration?

Yes that would be it!

 

[Tigger]

Since so many of patients are geriatric (not that I am unique here haha), I'm trying to come up with a list of considerations.

I try to warn the patient before I move the stretcher, this extra-important when unloading them as you don't want the bumps to suddenly unsettle them and cause a weight imbalance. Have them hug themselves or give them something to hold on to. Obviously this can happen with anybody, it just seems more prevalent with the elderly.

Make extra sure that you place the BP cuff on their arm with minimal bunching of the skin. If they ask you to remove a bandaid (maybe from an old IV site on a discharge), ensure that you keep the skin taught when pulling the bandage off so you don't tear the skin.

Speaking of BPs, someone geriatric patients arms may be too small for the adult cuff, bust out the child one.

Ask them how they're doing every now and them and remind them that you're willing to do whatever you can to make them comfortable. Some patients do not want to "trouble you" to get them a pillow, do the asking for them.

Always look for a Foley bag and colostomy bag.

Do not be afraid to help clean them up before or after transport. Would you want to sit in urine or feces for any amount of time?

 

[JamesBlack]

Wow, thanks everyone for all the great help! I was worried no one would post.

Does anyone have any suggestions for A&P considerations? I can't thank you enough for all the help!

 

[jjesusfreak01]

Everything Tigger said. Couldn't have put it better.