Chapter 34

Chapter 34

Geriatric Assessment

Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

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34: Geriatric Assessment

• Define the term “elderly.”

• State the leading causes of death of the elderly.

• Describe the basics of patient assessment for the elderly.

• Describe response to the elderly in nursing homes and skilled care facilities.

Objectives (1 of 2)


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• Describe trauma assessment in the elderly.

• Describe acute illness assessment in the elderly.

• State the principles and use of advance directives.

• Define and discuss elder abuse.

Objectives (2 of 2)


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Geriatrics (1 of 2)

• Geriatric patients are individuals older than 65 years of age.

• In 2000, the elderly population was almost 35 million.

• By 2030, the elderly population will be greater than 70 million.


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Geriatrics (2 of 2)

• The elderly are major users of EMS and health care in general.

• Effective treatment will require an increased understanding of geriatric care issues.


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Risk Factors Affecting Elderly Mortality

• Age greater than 75 years• Living alone• Recent death of significant other• Recent hospitalization• Incontinence• Immobility• Unsound mind


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Common Stereotypes

• Mental confusion

• Illness

• Sedentary lifestyle

• Immobility


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Physiologic Changes (1 of 3)

• Skin• Susceptible to injury; longer

healing time• Senses

• Dulling of the senses • Respiratory system

• Decreased ability to exchange gases


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• Cardiovascular system• Increased risk of cardiovascular disease

• Renal system• Decline in kidney function

• Nervous system

• Memory impairment, decreased psychomotor skills


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• Musculoskeletal system

• Decrease in muscle mass and strength

• Gastrointestinal system

• Decrease in ability of body to digest food properly


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Scene Size-up• Be keenly aware of the environment

and why you were called.

• Look for signs of activities of daily living.

• The general condition of the home will provide clues.

• Does someone else live there who could help answer questions?


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Initial Assessment• Never assume altered

mental status is normal.• May have to rely on

family or caregiver to establish patient’s baseline LOC.

• Assess the patient’s chief complaint and ABCs.


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Focused History and Physical Exam (1 of 2)

• History is usually the key in helping to assess a patient’s problem.

• Patience and good communication skills are essential.

• Treat the patient with respect.• Face the patient and speak in

a normal tone.


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Focused History and Physical Exam (2 of 2)

• Obtain a list of all medications and dosages.

• Sensations of pain may be diminished.

• Be aware that elderly are more prone to hypothermia during assessment.

• Remove only necessary clothing during the examination.


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Response to Nursing and Skilled Care Facilities

• Important information to know from staff:• What is the patient’s chief complaint

today?• What initial problem caused the patient to

be admitted to the facility?• Ask the staff about the patient’s overall

condition.• Obtain any type of transfer papers.


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Geriatrics and Trauma

• Falls are the leading cause of trauma death and disability in the elderly.

• Motor vehicle trauma is the second cause.

• The body’s ability to isolate simple injury decreases.

• Medical conditions can result in falls.


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Cardiovascular Emergencies

• Syncope

• Interruption of blood flow to the brain

• Many underlying causes

• Heart attack

• Classic symptoms often not present


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Acute Abdomen (1 of 2)

• Acute abdominal aneurysm• Walls of the aorta weaken.• Treat for shock and provide

prompt transport• Gastrointestinal bleeding

• Blood in emesis • May cause shock


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Acute Abdomen (2 of 2)

• Bowel obstructions

• Vagus nerve is stimulated and produces vaso-vagal syndrome.

• Vaso-vagal syndrome can cause dizziness and fainting.

• Patient requires transport to rule out other conditions.


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Altered Mental Status• Delirium

• Recent onset

• Usually associated with underlying cause

• Dementia

• Develops slowly over a period of years


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Advance Directives

• Do not resuscitate (DNR) orders give you permission not to attempt to resuscitate.

• DNR orders may only be valid in the health care facility.

• You should know state and local protocols regarding advance directives.

• When in doubt, initiate resuscitation.


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Elder Abuse• This problem is largely

hidden from society.

• Definitions of abuse and neglect among elderly vary.

• Victims are often hesitant to report an incident.

• Signs of abuse are often overlooked.


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Assessment of Elder Abuse (1 of 2)

• Repeated visits to the emergency room

• A history of being “accident-prone”

• Soft-tissue injuries

• Vague explanation of injuries

• Psychosomatic complaints


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Assessment of Elder Abuse (2 of 2)

• Chronic pain

• Self-destructive behavior

• Eating and sleeping disorders

• Depression or a lack of energy

• Substance and/or sexual abuse


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Signs of Physical Abuse

• Signs of abuse may be obvious or subtle.

• Obvious signs include bruises, bites, and burns.

• Look for injuries to the ears.

• Consider injuries to the genitals or rectum with no reported trauma as evidence of abuse.

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Chapter 34

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