EMS Geriatric Emergencies - Common Ailments & Injuries

Geriatric patients represent a significant demographic in the field of prehospital emergency care. 

Due to the complexities that come with aging, older adults are more susceptible to certain medical and traumatic emergencies, often presenting with unique challenges that EMS providers must be prepared to address. 

These cases require a nuanced understanding of age-related physiological changes, atypical symptom presentation, and the impact of comorbidities. 

By recognizing the specific needs of geriatric patients, EMS providers can enhance the quality of care, improve patient outcomes, and better navigate the intricacies involved in emergency scenarios involving this vulnerable population.

Below are some of the most common ailments and injuries EMS providers can expect to encounter when responding to geriatric patients.

1. Cardiovascular Emergencies

- Myocardial Infarction (Heart Attack)

• Geriatric patients often present with atypical symptoms, such as weakness, shortness of breath, confusion, or syncope, rather than the classic chest pain.
• EMS providers should maintain a high index of suspicion for cardiac events, even in the absence of typical symptoms.

- Congestive Heart Failure (CHF)

• Common symptoms include dyspnea, orthopnea, peripheral edema, and pulmonary crackles.
• Many CHF patients take diuretics, which can lead to dehydration and electrolyte imbalances, further complicating their condition.

- Hypertension and Hypotension

• Uncontrolled hypertension increases the risk of strokes, heart attacks, and aneurysms.
• Conversely, geriatric patients are also prone to orthostatic hypotension, which can contribute to falls and syncopal episodes.

2. Respiratory Emergencies

- Chronic Obstructive Pulmonary Disease (COPD)

• COPD, including chronic bronchitis and emphysema, is common in older adults, particularly those with a history of smoking.
• EMS providers should assess for hypoxia, wheezing, or diminished breath sounds and be cautious with oxygen administration in long-term COPD patients.

- Pneumonia

• In geriatric patients, pneumonia may present with confusion, weakness, or decreased appetite rather than fever or cough.
• EMS should assess oxygenation and be prepared for respiratory support.

- Pulmonary Embolism (PE)

• A life-threatening condition that can present with sudden-onset shortness of breath, chest pain, or unexplained hypoxia.
• Risk factors include immobility, recent surgery, and a history of deep vein thrombosis (DVT).

3. Neurological Emergencies

- Stroke / Cerebrovascular Accident

• Stroke symptoms may include unilateral weakness, facial droop, slurred speech, confusion, or altered mental status.
• EMS should perform a rapid stroke assessment and transport patients to a stroke center as quickly as possible for potential thrombolytic treatment.

- Altered Mental Status (AMS)

• AMS can be caused by various conditions, including infection (e.g., sepsis or urinary tract infection), medication interactions, dehydration, or metabolic disorders.
• It is critical for EMS providers to investigate the underlying cause rather than dismissing confusion as normal aging.

- Dementia and Delirium

• Dementia is a progressive cognitive decline, while delirium is a sudden change in mental status, often due to infection, medication effects, or metabolic disturbances.
• EMS should gather history from caregivers and assess for contributing factors.

4. Traumatic Injuries

- Falls and Fractures

• Falls are one of the most common geriatric emergencies and are often caused by balance issues, vision impairment, hypotension, or medication side effects.
• Common fractures include hip, wrist, and vertebral fractures, which can lead to long-term immobility and complications.

- Head Injuries

• Older adults are at higher risk for subdural hematomas, particularly those on anticoagulants.
• Even minor head trauma can result in serious complications, necessitating careful assessment and monitoring.

- Spinal Injuries

• Osteoporosis and degenerative changes increase the likelihood of spinal injuries, even with low-impact trauma.
• Providers should be cautious when performing extrication and spinal immobilization in older patients.

5. Metabolic and Endocrine Emergencies

- Diabetic Emergencies (Hypoglycemia and Hyperglycemia)

• Older diabetics may present with vague symptoms, such as confusion or dizziness, rather than typical signs of hypo- or hyperglycemia.
• Polypharmacy and comorbidities can complicate glucose regulation, increasing the risk of emergency events.

Dehydration and Electrolyte Imbalances

• Older adults often have a diminished thirst response and may not drink adequate fluids, leading to dehydration and imbalances in sodium or potassium levels.
• Dehydration can contribute to confusion, hypotension, and an increased risk of falls.

6. Gastrointestinal Emergencies

Gastrointestinal Bleeding

• Geriatric patients taking anticoagulants or NSAIDs are at higher risk for GI bleeds.
• Signs include hematemesis, melena, or unexplained hypotension and anemia.

- Bowel Obstruction and Constipation

• Decreased motility and medication side effects can lead to severe constipation or bowel obstructions.
• Symptoms include abdominal pain, bloating, nausea, and vomiting.

7. Sepsis and Infection

• Older adults may present with atypical signs of infection, such as confusion, lethargy, or decreased appetite instead of fever or localized pain.
• Urinary tract infections (UTIs) are common and can lead to sepsis, especially in catheterized or immobile patients.
• EMS providers should assess vital signs and be aware that sepsis can progress rapidly in the elderly.

8. Behavioral and Psychiatric Emergencies

- Depression and Suicide Risk

• Depression is frequently underdiagnosed in older adults and may present as withdrawal, appetite changes, or worsening medical conditions.
• Geriatric suicide risk is significant, particularly in men over 65, necessitating thorough screening and intervention.

- Elder Abuse and Neglect

• EMS providers should be vigilant for signs of abuse or neglect, including malnutrition, pressure ulcers, unexplained injuries, or inconsistent histories from caregivers.
• Suspicious findings should be reported to the appropriate authorities for further investigation.

Conclusion:

When providing prehospital care for geriatric patients, it is essential for EMS professionals to remember that while aging brings unique challenges, it does not diminish the value, aspirations, or agency of an individual. 

Utilizing systems like the GEMS diamond can aid in ensuring thorough, empathetic assessments that respect the patient's holistic well-being. 

Approaching geriatric care with the awareness that older patients are driven by the same motivations as their younger peers helps in fostering trust and delivering high-quality, patient-centered care. 

Ultimately, treating older adults with respect and understanding is key to enhancing their experience in prehospital emergencies and supporting their independence and dignity.

Further Reading

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

NAEMT (2023) Geriatric Education for Emergency Medical Services (3rd Ed). Burlington, Massachusetts: Jones & Bartlett Learning

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell

Peterson, L. K., Fairbanks, R, J., Hettinger, A. Z., & Shah, M. N. (2009) Emergency Medical Service Attitudes Toward Geriatric Prehospital Care & Continuing Medical Education In Geriatrics. Journal of the American Geriatrics Society 57 (3): 530-5. Accessed November 8, 2024

Shah, M. N., Rajasekaran, K., & Sheahan, W. D., Wimbush T., & Karuza J. (2008) The Effect Of The Geriatrics Education For Emergency Medical Services Training Program In A Rural Community. Journal of the American Geriatrics Society 56 (6):1134-9. Accessed November 8, 2024