CHAPTER 50: Geriatric Patients

INTRODUCTION

Adults aged 65 years and older are the foremost utilizers of EMS and are at excess risk for adverse events.¹ Studies overwhelmingly agree this high level of use by older adults is appropriate.^2-6 Elders have greater needs for emergency care than other age groups.⁷ They are often acutely ill and nearly 30% of elder EMS patients require high intensity care. The potential exists for the elder population to overwhelm EMS networks due to their numbers and their complex interwoven needs that do not fit neatly into our systems design. EMS was designed for acute emergent action not for the multifaceted nuanced concerns experienced by our nation's elders. Understanding the full scope of this issue is essential to define opportunities for targeted improvements in practice and policy, thereby preparing EMS providers and systems for the oncoming geriatric tsunami.

OBJECTIVES

• Describe common physiological differences in geriatric patients.

• Describe common causes of altered mental status in geriatric patients.

• Describe key physiological differences in elderly patients relating to the prehospital care of trauma-related emergencies.

• Discuss blood thinning medications and the prehospital evaluation and management of geriatric patients.

• Describe common social and economic issues affecting overall health and well-being of geriatric patients.

• Describe the special features of the prehospital evaluation and management of nursing home and long-term care facility patients.

• Describe the initial prehospital evaluation and management of suspected elder abuse and neglect.

The aging demographic is well documented. In 2012, over 40 million people in the United States are aged 65 and older. This number is projected to more than double to 89 million in 2050. By 2050 fully one-fifth of the US population will be ages 65 and older.⁸ Otherwise stated, from 2000 to 2050 the number of older adults is projected to increase by 135%, with those aged 85 years and older increasing by 350%.⁹ This is particularly crucial since those over 85 have the highest rate of EMS transport.¹⁰ The proportion of elder EMS use increases from 27% among those aged 65 to 84 years to 48% among those older than 85 years.¹¹ This could result in even greater proportions of the older and most complex EMS patients.¹²

Medicine's improving ability to treat disease has increased illness prevalence in elders,¹³ augmenting demand for EMS beyond those of population numbers alone. Our health care workforce has a shortage of paraprofessional providers to meet this demographic need.¹⁴ With age come illnesses not seen in younger persons, and atypical presentations of many diseases. Medical diagnosis and management of elders is complex and significantly different than in younger individuals. Symptoms are nonspecific and mask severe problems with high morbidity and mortality; comorbidities are common, and treatments vary. This requires existing providers to master geriatric issues.

The impact of the elder population on EMS can be anticipated and ...