While some EMS Providers excel in managing the complex needs of geriatric patients, others may find it challenging due to the distinct and multifaceted nature of geriatric care.
To effectively address these challenges, tools such as the GEMS Diamond Assessment System offer an accessible framework for understanding and responding to the key needs of this demographic.
Recognizing that older patients share the same values — such as independence, freedom, and autonomy — as their younger counterparts is crucial.
One of the most significant missteps a provider can make is treating older adults in a manner that undermines their dignity or infantilizes them.
EMS providers should be aware that geriatric prehospital emergencies often present differently than those involving younger populations.
Here are some key considerations:
Atypical Presentations: Older adults may not show classic symptoms of certain medical conditions. For instance, heart attacks may present as general weakness, shortness of breath, or confusion rather than chest pain.
Similarly, infections like pneumonia or urinary tract infections might lead to altered mental status or fatigue without a fever.
Comorbidities and Polypharmacy: Geriatric patients frequently have multiple chronic conditions, such as hypertension, diabetes, or heart disease.
This, combined with the common use of multiple medications, can affect how symptoms manifest and complicate diagnosis.
EMS providers should be mindful of potential drug interactions and the effects of medications on vital signs or cognition.
Age-Related Physiological Changes: The aging body undergoes changes such as decreased cardiovascular reserve, reduced lung capacity, and impaired temperature regulation.
These changes can make older patients more vulnerable to shock, respiratory distress, or hypothermia and can affect their response to treatment.
Falls and Trauma: Falls are a leading cause of injury in older adults, often leading to fractures, head trauma, or spinal injuries. Due to bone density loss and the risk of osteoporosis, even minor trauma can result in significant injury.
Conclusion
In managing geriatric prehospital emergencies, EMS Providers must integrate knowledge of the distinctive aspects of aging with careful, compassionate care.
This includes staying vigilant for atypical presentations and being prepared to adapt assessment and treatment strategies to suit the complex health profiles of older adults.
Prioritizing a patient-centered approach while maintaining strong clinical judgment will ultimately help in delivering efficient, effective, and empathetic care.
By honing these skills, EMS professionals contribute not only to the immediate health and safety of their geriatric patients but also to the broader goal of fostering a healthcare system that meets the needs of its aging population.
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
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