What is geriatrics?

Geriatrics by: Jonalyn Chewacheo. GERIATRICS. by: Jonalyn Chewacheo.

Geriatrics is a specialized care for older adults (60-65 years old and older). Older adults have unique needs, a higher likelihood of complex conditions, and are a growing patient population that benefits from specialized prehospital care. Through adapting protocols, performing geriatric specific assessments, and communicating effectively, appropriate treatment is ensured..

[Audio] Geriatric demographics U-S-A vs Philippines Age structure: U-S-A more established elderly population with high proportion of those over 65 Philippines a younger population overall, though rapidly aging; half of population is under 25 Growth rate: U-S-A elderly population share has been increasing due to factors like declining fertility rates Philippines rapid growth in the elderly population is expected to continue due to declining fertility and increasing life expectancy. Projected transition: U-S-A already an aging society (graying America) Philippines projected to transition to aging society by 2030.

[Audio] The 5 Ms of Geriatrics are: Mind: This addresses the cognitive and mental health of the patient, including screening for delirium, dementia, and depression. Paramedics should be mindful of altered mental status and atypical presentations of illness in older adults. Mobility: This focuses on the patient's ability to move, balance, and perform daily activities. A key consideration in paramedicine is assessing fall risks and ensuring patient safety during movement and transport, avoiding unnecessary restraints when possible..

[Audio] Medications: This involves a careful review of all medications to identify polypharmacy (the use of multiple drugs), potential adverse effects, and opportunities for deprescribing (reducing or stopping inappropriate medications). Multicomplexity: This acknowledges that older adults often have multiple chronic conditions, advanced illnesses, and complicated biopsychosocial needs. Care plans must integrate these complexities rather than addressing single issues in isolation. Matters Most: This central principle emphasizes incorporating the individual patient's health outcome goals, care preferences, and values into all treatment decisions, guiding care to align with what is most important to the patient..

[Audio] General Principles in Assessment of Geriatric Patient Geriatric patients are likely to experience more than one illness at a time. Chronic problems can make assessment for acute problems difficult. Signs or symptoms of chronic illness can be confused with signs or symptoms of an acute problem. Aging can affect a person’s response to illness or injury. Pain may be diminished or absent. The patient or paramedic can underestimate the severity of a condition. Social and emotional factors may have a greater influence in health in geriatric patients than in any other age group. The patient fears losing autonomy. The patient fears the hospital environment. The patient has financial concerns about health care..

[Audio] Patient History Always identify yourself. Speak at eye level to ensure that the patient can see you as you communicate. Locate a hearing aid, eyeglasses, and dentures (if needed). Turn on lights. Speak slowly, distinctly, and respectfully. Use the patient’s surname, unless the patient requests otherwise. Listen closely. Be patient. Preserve dignity. Use gentleness..

[Audio] Physical Examination The patient may tire easily. Geriatric patients often wear many layers of clothing for warmth. This may hamper the examination. Respect the patient’s modesty and need for privacy unless it interferes with the care. Explain actions clearly before examining all geriatric patients. Keeping the patient informed of what is happening is important with patients with diminished sight. 5. Be aware that the patient may minimize or deny their symptoms. Denial may be caused by a fear of being bedridden or institutionalized or losing self sufficiency. 6. Try to distinguish symptoms of chronic disease from acute problems..

[Audio] Cognitive Function: it is important to establish patient’s cognition early in the examination.

[Audio] Pulmonary System Pneumonia 5X-10X greater risk of death in 65 years and older fever, productive cough, dyspnea, pleurisy, chest pain, sweating and signs of pulmonary congestion may be absent or diminished in geriatric. Confusion or delirium may be the only early indicator..

[Audio] Breath sounds in geriatric patients may be misleading in geriatric patients with pneumonia because of preexisting emphysema or chronic heart failure. Tachycardia and tachypnea often are the most reliable indicators of pneumonia in prehospital setting. Emergency care Maintain oxygenation Providing transport for physician evaluation.

[Audio] Prehospital Management: -administration of oxygen, nippv, and drug therapy. -Maintaining an Spo2 level of at least 90% thorough medical history regarding medication use, home oxygen use, and drug allergies. -IV line should be established 12 lead E-C-G -If the patient has a productive cough, clearing the airway of phlegm and mucus should be encouraged..

[Audio] Cardiovascular System Myocardial Infarction Atypical symptoms is more common in elderly patients *confusion, fatigue, nausea, abdominal pain, dyspnea If chest pain occurs it may feel like discomfort, pressure, squeezing or heaviness that may radiate to arms, back , neck or jaw. Prehospital Management: Paramedic must maintain high index for 1001 in older patients with unusual warning signs. 12 lead E-C-G transport for physician evaluation.

[Audio] Heart Failure leading cause of hospitalization for people age 65 and older. Older patients with heart failure and those with lower levels of anxiety are less likely to report dyspnea. Paramedics must learn to evaluate symptoms other than dyspnea as signs of heart failure severity and potential exacerbations. Dysrythmias Abdominal and thorasic aneurysms Hypertension These are also common in geriatric patients.

[Audio] Paramedics caring for older adults with problems related to cardiovascular system must consider the patient's complex comorbidities, potential for atypical symptoms, polypharmacy, and the need to preserve self determination and dignity. Clinical Assessment and Treatment Atypical Presentation of Symptoms: Older adults may not present with classic symptoms like severe chest pain or dyspnea. Instead, they may exhibit non specific signs such as malaise, fatigue, or confusion, making diagnosis difficult in the prehospital setting..

[Audio] Standard Emergency Interventions: Paramedics should prioritize standard emergency care tailored to the patient's condition, which may include: Administering oxygen. Assisting with nitroglycerin or aspirin if a heart attack is suspected and no contraindications exist. Performing and transmitting a 12-lead E-C-G to the receiving hospital to speed up definitive care. Positioning the patient upright, especially in cases of heart failure with congestion. Avoiding intravenous fluids in heart failure patients despite hypotension, as this can worsen their condition. Rapid Transport and Coordination: Due to the difficulty in prehospital diagnosis and advanced diagnostic tool limitations, rapid coordination with the nearest appropriate medical facility and timely transport are critical..

[Audio] Nervous System Stroke was previously discussed as leading cause of death and higher risk with age ( increasing after 55) Delirium a sudden onset of confusion, inattention, disordered thinking and altered mentation it usually includes hallucinations in hyperactive patient, other patients are hypoactive and tend to present with altered level of consciousness or coma. Paramedic can quickly asses by using Richmond Agitation Sedation Scale then asking questions such as the following: * Can you spell the word lunch backwards? or list months backward from December? (this assess inattention) * will a stone float on water? (this assess for disorganized thinking).

[Audio] I watch death mnemonic of conditions that can cause delirium.

[Audio] Delirium can be life threatening and requires emergency care. Prehospital care: Ensure an adequate airway, breathing and circulatory support, including assessment of blood glucose level. Identify and manage the underlying cause, when possible. Reduce agitation and anxiety *Manage pain if present *Minimize visual and auditory stimuli 4. Avoid patient injury and ensure personal safety. *Restrain the patient if needed, per protocol. *Sedate the patient in consultation with medical direction and with careful monitoring of oxygenation , ventilation and hemodynamic status..

[Audio] *Recall that dose reduction is often needed for older adults 5. Monitor carefully and transport for physician evaluation. Note: The preferred medication for sedation determined by medical oversight may vary in the older adult. For example haloperidol is sometimes recommended over lorazepam..

[Audio] Dementia formally known as major neurocognitive disorder a significant decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual motor and social cognition) that interfere with independence in everyday activities. usually slow and progressive not a disease itself , but rather a group of symptoms that may accompany certain diseases or physical conditions. The more well known diseases that produce dementia include Alzheimer disease, Parkinson disease, diffuse Lewy body disease, frontotemporal disease, vascular (multi infarct) dementia and depression..

[Audio] Dementia can be difficult to differentiate from delirium in the prehospital setting..

[Audio] Azheimer Disease a condition in which nerve cells in the cerebral cortex die and the brain substance shrinks. Risk factors age family history history of head trauma vascular disease some brain infections.

[Audio] Treatment for Alzheimer disease No specific treatment medications such as cholinesterase inhibitors, rivastigmine or N-methyl d aspartate receptor antagonists may help delay progression and lessen associated symptoms 2 monoclonal antibody treatment that targets beta amyloid plaques in patients with early onset dementia; aducanumab (aduhelm) and lecanemab (leqembi) is now F-D-A approved treatment primarily consist of nursing and social care for the patient and relatives.

[Audio] Vascular Dementia ‎ -is a reduction in cognitive function aused by conditions that block or reduce circulation ‎in the brain. Lewy Body Disease ‎ Lewy bodies are abnormal deposits of a protein called lpha synuclein in the brain. The formation of these ‎proteins can cause Lewy body disease (L-B-D--). There are wo types of L-B-D--: dementia with Lewy bodies (D-L-B--) nd Parkinson disease dementia (P-D-D--). Both types cause the depletion of neurotransmitters (acetylcholine and dopamine) in the brain, and, over time, they an cause similar symptoms to one another. Frontotemporal Dementia ‎ F-T-D (formerly called Pick disease and frontotemporal lobe dementia) refers to a group of disorders caused by progressive nerve cell loss in the brain’s ‎frontal lobes..

[Audio] Endocrine System the most common in older adults is type 2 diabetes mellitus and thyroid disease. Diabetes Mellitus Key Principles of Paramedic Care Recognition of Atypical Presentations: Geriatric patients may not exhibit typical signs of high or low blood sugar. Paramedics are trained to consider diabetes in any older adult with altered mental status, falls, or general deterioration..

[Audio] Comprehensive Assessment: This includes point of care glucose testing, a thorough medical history (including all medications), and assessment for frailty, cognitive impairment, and social support. Locating hearing aids or eyeglasses can improve communication. Individualized Treatment Goals: For some elderly and frail patients, strict glucose control may be less important than avoiding severe hypoglycemia (dangerously low blood sugar). Treatment goals are often individualized based on the patient's overall health and life expectancy. Airway Management: Patients with severe D-K-A (diabetic ketoacidosis) or hypoglycemia may have decreased consciousness, potentially requiring advanced airway management techniques to ensure adequate oxygenation and ventilation..

[Audio] Thyroid Disease Hypothyroidism Hypothyroidism is common in geriatric patients and may be related to the aging process.The classic signs and symptoms of thyroid disorders (eg, fullness in the neck, goiter, cold intolerance, paresthesias or muscle cramps) often are not present in the geriatric patient. Thus, the paramedic should suspect thyroid dysfunction in any geriatric patient who complains of fatigue and weakness.The older patient often attributes the signs and symptoms of hypothyroidism to “growing old.” Emergency care mainly is supportive to ensure vital functions. The physician evaluates the patient with thyroid disease and treats the patient with various thyroid drugs, radioactive iodine treatments, and sometimes surgery.

[Audio] GI System ‎GI emergencies are common in older adults. The paramedic should always consider abdominal pain a serious complaint in a geriatric patient. ‎ ‎ GI Hemorrhage ‎ bleeding most commonly affects patients older than 60 years and increases with age. ‎The older the patient, ‎the higher the risk of death. This high risk is related to ‎the following: ‎ Geriatric patients are less able to compensate for ‎acute blood loss. ‎ They are less likely to feel symptoms and therefore seek treatment at later stages of disease. ‎ They are more likely to be taking nonsteroidal anti inflammatory drugs (NSAIDs), which ‎places them at higher risk for ulcer disease and ‎bleeding. ‎ They are at higher risk for colon cancer, intestinal vascular abnormalities, and diverticulitis. ‎ They are more likely to be taking antiplatelet ‎agents such as aspirin or anticoagulants such as warfarin or dabigatran..

[Audio] Signs and symptoms of GI bleeding vomiting of blood or coffee ground emesis blood tinged ‎or black, tarry stools agitation weakness syncope pain jaundice constipation or diarrhea -GI hemorrhage should be investigated as a potential cause for ‎patients who complain of weakness or who have had ‎a syncopal episode. If the paramedic suspects or confirms bleeding in a patient with signs and symptoms of ‎shock, ensure the patient has an adequate airway, ventilatory, and circulatory support. The paramedic also ‎should transport the patient rapidly for definitive care..

[Audio] Bowel Obstruction ‎Bowel obstruction generally occurs in patients with ‎prior abdominal surgeries related to adhesions (scar ‎tissue that forms between abdominal organs) or hernias. Obstruction occurs in those with colon cancer as ‎well. ‎ Prehospital care mainly is supportive to ensure vital functions. After physician evaluation, patient care ‎may include bowel rest, nasogastric suction, and volume replacement. Some patients may need surgery ‎to lyse the offending adhesions. ‎ ‎ ‎ Problems with elimination ‎-can cause acute pain and anxiety for geriatric patients. ‎The paramedic should take their complaints seriously. ‎These conditions call for physician evaluation to identify the cause and to select the appropriate therapy. ‎.

[Audio] Integumentary System ‎As people age, the skin gradually becomes dry, transparent, and wrinkled. ‎ ‎Paramedics should always be gentle with the ‎skin of a geriatric patient. Examples include use of ‎aseptic technique during wound management, gentle ‎placement and removal of E-C-G electrodes, and selection of the appropriate device for securing 4 catheters ‎or tubing..

[Audio] Pressure Ulcers ‎ Pressure ulcers are common in geriatric patients . They often develop on the skin of patients who are bedridden or immobile; those who are ‎frail are at particularly high risk. ‎ ‎ Management: Pressure ulcers should be covered with a sterile dressing using aseptic technique. The paramedic hould transport the patient for physician evaluation ‎and wound care to facilitate healing. The patient is assessed for pain; analgesics are administered if indicated. ‎.

[Audio] Musculoskeletal System ‎Musculoskeletal changes occur as part of the aging process. ‎ ‎Osteoarthritis is a common form of arthritis in geriatric patients. It is a degenerative condition that results ‎from cartilage loss and wear and tear on the joints. Treatment may include medications (analgesics, NSAIDs, corticosteroids), physical ‎therapy, and sometimes joint replacement surgery. ‎ Osteoporosis ‎ is a disease that decreases bone density. ‎It is especially common in older women after menopause. This is because of a decrease in the hormone ‎estrogen, which helps maintain bone mass..

[Audio] Toxicology ‎ Geriatric patients are at increased risk for ades(adverse drug events). This vulnerability is the result of age related changes in body composition as well as drug absorption, distribution, metabolism, and excretion. ‎ ‎ Emergency care for geriatric patients with A‎DEs may range from transport only to full advanced c‎ardiac life support measures. When transporting the ‎older adult, all of the patient’s medicines should be d‎elivered to the ED with the patient or brought by a ‎family member. A hospital pharmacist will often i‎dentify an accurate list of the patient’s medications ‎medication reconciliation) to confirm that drugs and ‎doses are appropriate and to avoid ades. The patient’s p‎hysician is then consulted to make any necessary ‎adjustments to the list. ‎ ‎.

[Audio] Community paramedics often ‎perform task when making home visits to patients ‎ho have a chronic illness. --Identifying symptoms of drug toxicity a‎nd adverse reactions that can occur in the geriatric p‎atient include the following: ‎ Dysrhythmias ‎ Balance/gait disturbances, movement disorders ‎ Cognitive changes, confusion, psychological ‎disturbances ‎ Neurologic dysfunction (eg, parkinsonism) ‎ Constipation ‎ Cutaneous reactions, rash ‎ GI bleeding ‎ Hypertension or hypotension ‎.

[Audio] Environmental Considerations ‎ Older adults are at risk for the development of illness ‎from extremes in the environment as a result of the ‎aging process and other factors. ‎ Hypothermia ‎ hypothermia may develop in an older patient while ‎indoors. ‎This increased risk of hypothermia is due in part to the following characteristics ‎of older adults: ‎ They are less able to compensate for environmental heat loss. ‎ They have a decreased ability to sense changes ‎in temperature. ‎ They have less total body water to store heat. ‎ Tachycardia is less likely to develop to increase ‎cardiac output in response to cold stress. ‎.

[Audio] *They have a decreased ability to shiver to increase body heat ‎ ‎The following are other medical causes of hypothermia in geriatric patients: Arthritis ‎ Drug overdose ‎ Hepatic failure ‎ Hypoglycemia ‎ Infection ‎ Parkinson disease ‎ Stroke ‎ Thyroid disease ‎ Uremia ‎Paramedic care for an older adult with hypothermia focuses on gentle handling, preventing further heat loss, and initiating rewarming using passive and active external methods, with careful monitoring for cardiac complications. Older adults are at increased risk due to impaired thermoregulation..

[Audio] Hyperthermia ‎ Hyperthermia in the geriatric patient is less common ‎than is hypothermia; however, hyperthermia carries ‎a significant mortality rate. The condition most likely ‎results from exposure to high temperatures. ‎ ‎ Emergency care includes removing the patient from the warm environment, cooling the patient, and ensuring the patient’s ‎vital functions through airway, ventilatory, and circulatory support. Rapid transport for physician evaluation is indicated to manage the problems resulting ‎from serious heat related illness. ‎.