As populations age, unique and complex medical problems need to be considered. Elderly patients require a different set of assessment skills to meet their needs. Geriatric trauma patients are predisposed to a serious chain of events leading to infection, multiple organ failure and delayed wound healing. These patients are a specific population that require special care. Having knowledge of the changes that occur with aging will help plan the strategies needed to provide quality care in geriatric patients.
Considerations
There must be understanding of the normal changes associated with the aging process in order to provide quality care. The elderly have a number of risk factors that predispose them to injury. Poor visual acuity and poor visual attention could put a person at risk while driving. For an individual who may be crossing the street, slower gaits, impaired reaction times and limited neck rotation, may predispose them to being struck by a vehicle. Medication side effects and unanticipated medication interactions are risk factors due to pre-existing medical conditions and possibly having more than one physician providing medical care.
Neurological changes
Elders have a decrease in the cerebral blood flow to the head and a loss of functioning neurons that will compromise their neurological status. A minor blow to the head may result in a head injury, such as a concussion or a bleed.
Pulmonary differences
In elderly patients the lungs have less reserve and therefore less oxygen supply. They also have a reduced cough reflex. If the elder patient has a rib fracture, although a relatively minor injury, it is a major injury in this population due to the pulmonary reserve differences.
Cardiovascular changes
Geriatric patients have a higher incidence of atherosclerosis, plaque build-up on the arteries and high blood pressure. The heart does not pump as effectively as it did at younger ages and these patients require closer monitoring of their cardiac status.
Musculoskeletal and Renal Changes
As we age, our bones age and become brittle. Hip fractures are a greater risk. Arthritis also sets in and limits mobility and flexibility. The kidneys have less ability to concentrate urine and are less able to filter out and excrete toxins.
Skin and Nutrition
The aging process affects the skin also. The skin becomes thinner and provides less cushion against outside forces. The skin can easily tear and there is a loss of thermoregulatory ability. Inadequate nutrition can pose problems in the elderly. Without proper nutrition, wound healing is delayed. The total body water is decreased in the elderly which creates a greater risk for dehydration.
Psychosocial
Psychosocial issues need to be addressed for the elderly. End-of-life decisions such as specific directions for withholding or withdrawing treatments need to be discussed with them. Elders are a population that are at risk for maltreatment. Any unexplained bruises or burns, and head injuries should raise a red flag of concern. In addition, the lack of medical attention, malnutrition and fractures may be signs and symptoms of maltreatment.
References
- "Journal American Geriatric Society"; The Geriatric Emergency Department; Hwang & Morrison; Nov 2007
- "Journal of Gerontological Nursing"; Older Adult Care in the Emergency Department; Robinson & Mercer; July 2007
- "Emergency Nursing Core Curriculum"; Saunders / Elsevier 6th ed; 2006
