15.2 Geriatric patient care and common emergencies

Caring for older adults requires special attention to their unique health challenges. From managing multiple medications to preventing falls, healthcare providers must consider age-related changes that affect treatment. Recognizing atypical symptoms and addressing cognitive impairments are crucial for effective geriatric care.

Cardiovascular and cerebrovascular emergencies are common in the elderly. Quick identification of stroke symptoms and proper management of heart conditions are vital. Environmental factors like hypothermia risk and social issues such as elder abuse also play key roles in geriatric patient care.

Geriatric Assessment and Risk Factors

Polypharmacy and Medication Considerations

Top images from around the web for Polypharmacy and Medication Considerations

• 

  Building interpretable models for polypharmacy prediction in older chronic patients based on ... View original

  Is this image relevant?

• 

  Prevalence of Poly-pharmacy in the Elderly: Implications of Age, Gender, Co-morbidities and Drug ... View original

  Is this image relevant?

• 

  Building interpretable models for polypharmacy prediction in older chronic patients based on ... View original

  Is this image relevant?

• 

  Prevalence of Poly-pharmacy in the Elderly: Implications of Age, Gender, Co-morbidities and Drug ... View original

  Is this image relevant?

1 of 2

Top images from around the web for Polypharmacy and Medication Considerations

• 

  Building interpretable models for polypharmacy prediction in older chronic patients based on ... View original

  Is this image relevant?

• 

  Prevalence of Poly-pharmacy in the Elderly: Implications of Age, Gender, Co-morbidities and Drug ... View original

  Is this image relevant?

• 

  Building interpretable models for polypharmacy prediction in older chronic patients based on ... View original

  Is this image relevant?

• 

  Prevalence of Poly-pharmacy in the Elderly: Implications of Age, Gender, Co-morbidities and Drug ... View original

  Is this image relevant?

1 of 2

• Polypharmacy involves the use of multiple medications by a patient, which increases the risk of drug interactions, adverse effects, and medication errors in geriatric patients
  • Geriatric patients often have multiple chronic conditions requiring various medications (antihypertensives, antidiabetics, anticoagulants)
  • Age-related changes in pharmacokinetics and pharmacodynamics can alter drug absorption, distribution, metabolism, and elimination
• Regularly review and reconcile medications to minimize polypharmacy risks and ensure appropriate prescribing
• Monitor for adverse drug reactions and adjust dosages based on renal and hepatic function
• Educate patients and caregivers about proper medication management, adherence, and potential side effects

Fall Risk Assessment and Prevention

• Fall risk assessment identifies factors that increase the likelihood of falls in geriatric patients, such as muscle weakness, balance issues, visual impairment, and environmental hazards
  • Use standardized assessment tools (Morse Fall Scale, Hendrich II Fall Risk Model) to evaluate fall risk
  • Consider age-related changes in gait, balance, and sensory function that contribute to fall risk
• Implement fall prevention strategies based on identified risk factors
  • Recommend assistive devices (walkers, canes) and home modifications (handrails, improved lighting) to reduce fall hazards
  • Encourage regular exercise and physical therapy to improve strength, balance, and mobility
• Educate patients and caregivers about fall prevention techniques and the importance of reporting falls or near-falls to healthcare providers

Cognitive Impairment and Altered Mental Status

• Cognitive impairment refers to a decline in mental function, including memory, attention, language, and problem-solving abilities, which can affect a geriatric patient's ability to communicate and make decisions
  • Assess for signs of cognitive impairment using tools like the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA)
  • Consider underlying causes of cognitive impairment, such as dementia, delirium, or depression
• Altered mental status describes changes in a patient's level of consciousness, awareness, or responsiveness, which can be caused by various factors in geriatric patients
  • Evaluate for potential causes of altered mental status, including infections (UTI, pneumonia), metabolic disturbances (hypoglycemia, dehydration), or medication side effects
  • Monitor vital signs, oxygen saturation, and glucose levels to identify and treat underlying causes promptly
• Communicate clearly and patiently with cognitively impaired patients and involve caregivers in decision-making and care planning

Osteoporosis Considerations

• Osteoporosis is a common condition in geriatric patients characterized by decreased bone density and increased risk of fractures
  • Assess for osteoporosis risk factors, such as age, gender, family history, and medications (corticosteroids)
  • Consider the impact of osteoporosis on fracture risk during falls or trauma
• Implement measures to prevent and manage osteoporosis-related complications
  • Encourage regular weight-bearing exercise and adequate calcium and vitamin D intake to maintain bone health
  • Prescribe medications (bisphosphonates, denosumab) to improve bone density and reduce fracture risk when appropriate
• Educate patients and caregivers about osteoporosis prevention, fall risk reduction, and the importance of prompt medical attention for suspected fractures

Cardiovascular and Cerebrovascular Emergencies

Cardiovascular Emergencies in the Elderly

• Cardiovascular emergencies, such as acute coronary syndrome (ACS), heart failure, and arrhythmias, are common in geriatric patients due to age-related changes in the cardiovascular system and the presence of chronic conditions
  • Recognize atypical presentations of ACS in elderly patients, such as absence of chest pain or presence of non-specific symptoms (fatigue, shortness of breath)
  • Assess for signs and symptoms of heart failure, including dyspnea, edema, and jugular venous distension
  • Monitor for arrhythmias using ECG and treat according to advanced cardiovascular life support (ACLS) guidelines
• Consider the impact of comorbidities and polypharmacy on the management of cardiovascular emergencies in geriatric patients
• Adjust treatment plans based on individual patient factors, such as renal function, bleeding risk, and frailty

Stroke Symptoms and Management

• Stroke is a leading cause of disability and mortality in geriatric patients, and prompt recognition and treatment are crucial for improving outcomes
  • Use the FAST acronym (Face drooping, Arm weakness, Speech difficulty, Time to call emergency services) to identify stroke symptoms
  • Assess for additional stroke signs, such as sudden onset of numbness, confusion, vision changes, or severe headache
• Activate stroke protocols and coordinate with stroke centers for timely evaluation and intervention
  • Administer thrombolytic therapy (alteplase) within the appropriate time window for eligible patients with ischemic stroke
  • Consider endovascular thrombectomy for patients with large vessel occlusions who meet criteria
• Provide supportive care, monitor for complications (cerebral edema, hemorrhagic transformation), and initiate early rehabilitation to optimize functional recovery

Chronic Disease Management

• Effective management of chronic diseases, such as hypertension, diabetes, and chronic obstructive pulmonary disease (COPD), can reduce the risk of acute exacerbations and cardiovascular events in geriatric patients
  • Regularly assess and monitor blood pressure, glucose levels, and respiratory function to ensure optimal control of chronic conditions
  • Adjust medication regimens as needed based on patient response, adverse effects, and changes in health status
• Collaborate with primary care providers and specialists to develop comprehensive care plans that address multiple chronic conditions
• Educate patients and caregivers about chronic disease self-management strategies, including medication adherence, lifestyle modifications, and symptom monitoring

Environmental and Social Considerations

Hypothermia Risk and Prevention

• Geriatric patients are at increased risk for hypothermia due to age-related changes in thermoregulation, reduced subcutaneous fat, and decreased metabolic rate
  • Recognize signs and symptoms of hypothermia, such as shivering, confusion, slurred speech, and bradycardia
  • Assess for risk factors, including exposure to cold environments, inadequate clothing, and certain medications (antipsychotics, sedatives)
• Implement measures to prevent hypothermia in geriatric patients
  • Encourage proper clothing and layering in cold weather, including hats, gloves, and warm footwear
  • Ensure adequate indoor heating and insulation, especially for patients with limited mobility or financial resources
• Treat hypothermia promptly by removing wet clothing, providing warm blankets, and monitoring core body temperature until normothermia is achieved

Elder Abuse Recognition and Reporting

• Elder abuse encompasses physical, emotional, sexual, and financial abuse, as well as neglect and abandonment, and can have serious consequences for geriatric patients' health and well-being
  • Recognize signs of elder abuse, such as unexplained injuries, fearfulness, withdrawal, or sudden changes in financial status
  • Assess for risk factors, including cognitive impairment, social isolation, and caregiver stress or substance abuse
• Follow established protocols for reporting suspected elder abuse to appropriate authorities, such as adult protective services or law enforcement
• Provide support and resources to victims of elder abuse, including safe housing, counseling, and legal assistance
• Educate healthcare providers, caregivers, and the public about the signs and consequences of elder abuse and the importance of prevention and early intervention