AGING IN PLACE

1. Don’t Call Me Honey AGING IN PLACE EMS Training on Falls Prevention 1.0 Hour CME Credit for “Geriatrics” Part of Tompkins County’s “Step Up to Stop Falls” Program Beth Harrington, CIC #3385 August 2011

2. US Population Growth • Overall population increase from 1975 to 2025 is about 60% (216 million to 350 million) • % of age 65 and older increases from10.6 to 18.2 • The Baby Boom includes people born from mid-1946 to 1964 … the elderly segment is increasing almost twice as fast as the rest of the population

3. In 2010 there were 53,364 people age 100 years or older (80% of them being female)

4. Geriatric Use of EMS • Elderly patients are responsible for approximately 22- 39 % of EMS calls nationally • Emergency Medical Service utilization by the elder. Annals of Emergency Medicine. 1982;11:610-612 • Geriatric use of Emergency Medical Services. Annals of Emergency Medicine 1996;27:199-203 • Geriatric use of EMS is twice that of patients less than age 65 and three times greater over the age of 85 • Medical transport of the elder: A population-based study. American Journal of Emergency Medicine 1995;13:297-300

5. Geriatric Use of EMS • Geriatric patients are at increased risks of morbidity and mortality when experiencing trauma of all varieties, and although they account for just 12.5% of the population, they account for one-third of all traumatic deaths. • Elderly trauma inpatients in New York State: 1994-1998. Journal of Trauma. 2004 Jun;56(6):1297-304 • “Geriatric Trauma” in The Trauma Manual. Lippincott Williams and Wilkins: Philadelphia, 2002, pp. 469-476

6. What do you picture when you get the call for the“unknown medical 75 year old male?”

7. Aging … • Cognitive decline  Alzheimers • Physical realities • Loss of hearing and deterioration of vision • Weakening of musculoskeletal system • Loss of quality of skin integrity • Overall decrease in organ functioning • Existence of multiple chronic diseases • Better living conditions • Better primary health care • Better acute health care • Better pharmaceuticals

8. Falls in the Elderly • Falls are a major threat to the health and independence of older adults • 1/3 of people 65 years or older will fall each year • Leading reason for EMS calls in Tompkins County • 10% of all falls result in a serious injury (head or hip injury) • Average of over 1 year recovery time • May never return home • Leading cause of death in the elderly

9. Falls are Preventable … they are not an inevitable consequence of aging • Biological Risk Factors • Mobility problems (muscle weakness, balance issues) • Chronic health problems • Peripheral neuropathy • Behavioral Risk Factors • Inactivity (often associated with “a fear of falling”) • Medication side effects • Alcohol use • Environmental Risk Factors • Home and environmental factor • Incorrect size and/or use of assistive devices • Poorly designed public spaces

10. The “typical” fall victim in Tompkins County • Female in her 80’s • Lives with someone • Does need transport to hospital … after evaluation by EMS • Has some pain, bleeding, lacerations and/or abrasions associated with fall • Most common area of fall is in the home in the living room • Most common time of fall is around 1700 • Most common cause is trip/slip • Takes 4 or more medications

11. Polypharmia • Aging affects: • Absorption • Distribution • Metabolism • Elimination (toxic accumulation) • Increased sensitivity to potential side effects • “Bag of meds” or “Meds in the shoebox” syndrome • Multiple MDs • OTC medications • Medication side effects … blurred vision, hypotension, sedation, decreased alertness • Medication interactions Psychoactive medications Seizure medications Cardiovascular medications Analgesia

12. Geriatric Trauma • Most common: • Falls • Fractures • Open wounds • Superficial injuries • Strains and sprains • MVC – fewer, but more serious injuries and/or deaths related to older drivers • Burns

13. Geriatric Trauma • Be aware of underlying medical problems • Different splinting /immobilization techniques need to be utilized • Think outside of the box

14. Communication Issues

15. Failure to Communicate • Normal physiological changes may include: • An impaired or loss of vision • An impaired or loss of hearing • An altered sense of taste and/or smell • A lower sensitivity to touch • Any of these conditions can affect your ability to fully communicate with the patient

16. Communication “Do’s” • Talk directly to the patient • Formal, respectful approach • Face your patient when speaking • Try to stay in the middle of the field of vision • Protect the dignity of your patient – DO NOT use terms like “Sweetie”, “Hon”, “Dear”, “Pops” • Use Mr., Mrs. or Ms., or simply ask: • “My name is Ray. May I call you (insert first name here)?”

17. Communication “Do’s” • Don’t let well-meaning family members and/or care givers prevent you from hearing what the patient has to say if he or she can speak. • Watch out for “I don’t want to bother anyone” syndrome • More minor injuries/illness can become more serious over time • Probe for significant complaints/ symptoms • Chief complaint may be trivial/non-specific • Patient may not volunteer information

18. Communication “Do’s” • Speak slowly utilizing easy to understand terms (watch the acronyms and big medical words!) • Allow for autonomy – is it really that bad to let a patient lock their own door or take a few minutes to find a favorite hat ?

19. Assessment • Factors needed to form a complete patient impression • Living situation • Level of activity • Network of social support • Level of independence • Medication history

20. Assessment • Geriatric patients who are especially “at risk” : • Live alone • Have recently been hospitalized • Have recently been bereaved • Have an altered mental status • Are incontinent • Are immobile

21. What do seniors fear most? • Loss of memory • Robbery/assault • Stroke/loss of mobility • Loss of vision • Cancer • Finances/loss of health insurance • Health of children • Health of a spouse • Loss of ability to drive LOSS OF INDEPENDENCE and INABILITY TO REMAIN IN THEIR OWN HOME

22. Mental Status … • DO NOT assume: • Confusion is normal for any elderly patient • Aging means impaired thinking ability • DO assume: • An altered mental status is the result of trauma or a medical condition until proven otherwise • That there is a need to confirm what “normal mental status” is for this patient

23. Not Always the “Golden Years” • Abuse is the: • “Willful infliction of injury, unreasonable confinement, intimidation or cruel punishment, resulting in physical harm, pain, or mental anguish; • Willful deprivation of goods or services that are necessary to avoid physical harm, mental anguish, or mental illness”

24. Elder Abuse • Physical • Emotional • Sexual • Financial exploitation • Neglect (includes self-neglect) • Occurrence ranges from 2 to 10% … but it is thought that for every 1 reported case, there are 5 victims not reported • Abuse may exacerbate pre-existing conditions

25. Assessment and History • Note explanations that just sound “wrong”: • Conflicting histories from patient and caregiver • History inappropriate to the type or degree of injury • Bizarre or unrealistic explanation • Long delay in treatment from time of injury. • History of being “accident prone” • Denial in view of obvious injury • Injuries inconsistent with story - bruises, black eyes, welts, lacerations, rope marks, fractures. • Open wounds, untreated injures in different stages of healing.

26. Reporting • Office of Children & Family Services • Protective Services for Adults • Tompkins County Social Services Adult Protective Services at 274-5285 • NYS Hotline 1-800-342-3009 (Press Option 6) • Document what you see, hear and do

27. Falls Prevention Program • For any patient who has fallen but does not need and/or refuses transport to the hospital • Provide informational brochure • Complete brief data form

28. Questions – Thank You