The graying of America . . . We are undoubtedly getting older. A person doesn't wake up one morning and look into the mirror and say, "You look old!" Aging is a gradual process that affects everyone; some at a faster rate than others. Aging is something that no one can escape. And, as we age, we develop medical problems associated with growing old. EMT and paramedic programs have begun to recognize that the population of older adults is increasing and that training is needed to provide quality care for older individuals. Recognizing a weakness is the first step in correcting it.
This textbook is written to give the emergency care professional insight into the changes that occur as we age and the special problems experienced by older adults. It is written at the EMT-Intermediate level and above; however, all EMS professionals can glean important information from the material. Throughout the text we refer to the "prehospital care provider" (PHCP). This is a generic reference, and it applies to all levels of prehospital care personnel, including the first responder, EMT, EMT Intermediate, paramedic, and mobile intensive care nurse.
The chapters of this book are organized to give the prehospital care provider information in a systematic approachfrom the physical and emotional changes with growing old to medical emergencies. Additionally, a chapter is dedicated to the terminally ill patient.
Here is a summary of the chapters in this textbook.
CHAPTER 1: INTRODUCTION
This chapter discusses the graying of the U.S. population. Based on population measures from the U.S. Census Bureau, it is evident that, as a whole, the population of the United States is getting older. The chapter also addresses what impact this aging trend will have on the provision of emergency medical services to the community, especially in light of the federally mandated "Prudent Layperson Standard" covering emergencies.
CHAPTER 2: PHYSIOLOGICAL CHANGES WITH AGING
This chapter discusses the physical changes that occur as we age. Without question, the skin thins and becomes wrinkled, and the hair turns gray. But, there are many more other changes that occur. Each organ system is affected, and each system is discussed in a concise, easy-to-understand manner.
CHAPTER 3: PSYCHOSOCIAL CHANGES WITH AGING
Not only does the body change as it ages, but mental and emotional health can also be affected. Although mental prowess can be maintained until very late in life, there will be some slowing of mental processing. Depression is common in older adults, as is suicide ideation, especially in the older adult with chronic and debilitating conditions. Loneliness and isolation can also lead to alcohol or drug abuse. This chapter highlights the mental and emotional changes that may be evident in the older adult.
CHAPTER 4: PATIENT ASSESSMENT
The older patient can pose an assessment challenge to even the most seasoned EMS professional. This chapter presents information on patient assessment techniques that will help make the challenge less formidable. Information on communicating with the hearing or sight impaired is presented, along with tips on looking for more subtle information the older person may not admit or remember.
CHAPTER 5: ALZHEIMER'S DEMENTIA AND DELIRIUM
The media has frequently presented information on Alzheimer's dementia, paying particular attention to high-profile individuals who suffer from this devastating disease. But, Alzheimer's dementia is only one of many dementias. In addition, people may confuse delirium with dementiaan error based on misinformation. This chapter focuses on dementia and delirium, presenting information on each disorder. A mini mental status questionnaire is included to help in the assessment of impaired mental functioning.
CHAPTER 6: ELDER ABUSETHE SILENT CRY
A new societal epidemicelder abusehas been identified. With an increasing number of older adults and an associated increase in the demand for care, stress on family caregivers has been tremendous. A side effect of this stress has been elder abuse. In many states, EMS professionals are legally obligated to report elder abuse to law enforcement or the appropriate state agency or face fines, imprisonment, or both. Chapter 6 discusses the five types of elder abuse. In addition to recognizing the types of abuse, the chapter also describes characteristics of the victim and the abuser. Finally, the chapter addresses guidelines for intervention and documentation of the abuse.
CHAPTER 7: PHARMACOLOGY IN THE OLDER POPULATION
Oftentimes, having a quality of life means taking prescription medications. Because of the aging process, many older adults take one or more medications for any number of medical conditions. Sometimes these medications can adversely affect the body. This chapter focuses on the hazards of medication use in the elderly. Beginning with basic pharmacology, the chapter discusses how a normal dose of an important medication can harm the older patient. This chapter also presents information on medications that should be used with caution or avoided by the geriatric patient. Finally, a section of the chapter is devoted to herbal supplements.
CHAPTER 8: MEDICAL EMERGENCIES: COMMON PROBLEMS SEEN IN THE ELDERLY
The older adult is prone to many of the same medical problems seen in the younger adult; however, there are conditions that are more frequently experienced by the geriatric patient. These conditions include falls, syncope, stroke, and others. Chapter 8 discusses the myriad of complaints the EMS provider may see when responding to a call involving the senior citizen.
CHAPTER 9: ACCIDENTAL INJURIES
The senior citizen is at a significant risk for falls and injuries caused by falling. Additionally, people with osteoporosis can sustain fractures with no apparent causative trauma. This chapter focuses on falls and injuries, including fractures, head injuries, burns, and carbon monoxide poisoning.
CHAPTER 10: FALL AND INJURY PREVENTION
Chapter 10 is dedicated to preventing the falls and injuries that so often lead to the premature death of many older adults. As a public service, many EMS agencies conduct in-home safety surveys to point out risks that could increase the chance of a fall or other accident.
CHAPTER 11: END-STAGE RENAL DISEASE
This chapter discusses a major chronic condition faced by many elderly patientskidney failure and end-stage renal disease. The only treatment for this disease is dialysis or a kidney transplant. Although many patients have minimal complication's associated with the condition, there are times when EMS will be called to care for a patient who is gravely ill from end-stage renal disease. An overview of dialysis is presented along with information on emergency care of the dialysis patient.
CHAPTER 12: TERMINALLY III PATIENT
Death and dyingsomething that the EMS professional sees all too frequently. Although our primary function is to delay or prevent premature death, there are some situations when the patient expects and even wants death. This chapter addresses the dying patient, including advanced directives and do not resuscitate orders. It also discusses the physical processes seen at the end of life. The information presented here is different from that found in many EMS textbooks.
CHAPTER 13: PUTTING IT ALL TOGETHER
Chapter 13 combines the information given in the preceding chapters and puts it all together in a general approach to the patient. From protecting the patient from the cold to properly applying the gurney straps, the EMS professional is given information to enhance their ability to care for other adults.
The Appendix contains a listing of state agencies on aging and is current as of the date this book went to press. Additionally, sample forms for advanced directives, durable powers of attorney, and do not resuscitate orders are included for reference. The Appendix also contains a sample home safety checklist for use in injury prevention programs.
SPECIAL FEATURES Objectives
Each chapter begins with a list of objectives that indicates what the reader can expect to accomplish by reading the chapter. These objectives can also be used as a self-test.
Words to Know
In addition to the objectives, each chapter has a list of Words to Know accompanied by each word's definition. Rather than going to the back of the book to look up terms in the glossary, important terms are listed at the start of each chapter.
Throughout each chapter, key points are highlighted in boxes for easy reference. The reader can look for more detailed information on the topic within the text.
The text includes sample surveys that test for depression, mental acuity, and other clinical evaluations. This text also contains an in-home safety assessment that EMS providers can use to provide a valuable public serviceeducation to reduce the risk of falls and injuries in the home.
On the Job
Most chapters have an On the Job feature that presents a situation commonly found in the field. These scenes can be discussed in class or in small study groups to reinforce the information in the chapter.