Sunrise, Sunset…
As the song says, "Swiftly fly the days…" The average life expectancy in the United States in 2022 is 79.5 years, that's up almost five years since 1990, just a mere 32-years ago. We're all getting older.
While living longer is a goal for many, it also comes with its own problems. A simple bump for the average 30-year-old can be a lot more serious for a person who is eligible for Social Security. Like all fine machinery, the parts wear.
Many of the elderly have a list of medications that will go well off the average PCR. Gathering a history of existing medical conditions may seem like a monumental task. But this information is essential to properly treat the geriatric patient, and more importantly, it is vital to understand how medications and various conditions can affect a true assessment.
Some relatively common medications that are used often to treat our seniors may have otherwise unexpected effects on normal patient vitals. The use of anticoagulants can make what seems to be a simple fall into a life-threatening situation. The use of hypertension drugs may give us false security on what we may THINK is a normal BP. Cardiac drugs may mask true heart emergencies while other measures should be done. Even over-the-counter herbal medications may mask or alter vital signs. Getting a complete list of all prescribed and OTC medications as well as alcohol and tobacco use is an absolute must for the receiving doctors and nurses at the hospital end.
As a person ages, the possibility of Arthritis, in any form, is more prevalent, as is Osteoporosis and other pain inducing conditions. Care needs to be taken if using a backboard as it may cause unnecessary pain to an elderly person. Skin becomes thin and can tear easily. Gastric upset or the combination of antacids can mask unusual tenderness in the abdominal section. Overall pain perception can be deceptive. Asking an older person “if it hurts” may give them no reason to compare it to the norm and may cause you to miss vital clues. Even the traditional Glascow Coma Scale can be a poor indicator of the patient’s responsiveness and reflexes due to poor hearing, weak and painful movements, and visual defects. Since the lung tissue is not as elastic in the elderly as most younger people, signs of respiratory difficulty may advance much quicker than anticipated; use of a nasal cannula is often recommended for older patients.
Add in a lack of understanding that even a well-meaning younger health responder has about the elderly, many won’t look for in-depth abnormalities. Our brains shrink with age, some faster than others. Confusion that may be caused by a CVA, for example, may be dismissed as a normal effect of aging. A litany of ailments and complaints might be lost on a busy provider and important clues might be overlooked. And although the EMT of Paramedic may recognize the immediate need to stabilize fractures and stop bleeding after a fall, not everyone will dig into what MEDICAL condition may have preceded that fall.
Is it any wonder that the national mortality rate of the geriatric trauma patient is higher than younger patients? The state of Ohio has been working on creating a standardized GCS for use on geriatric patients, and other pockets of EMS trainers have emphasized the problems inherent with the elderly to improve emergency care. Many of us have been told to treat our older patients as if they were our own grandparents… we also need to have more understanding of how aging affects the body.
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