Falls and Traumatic Injuries
Falls are a pervasive issue, accounting for a significant portion of EMS calls for older adults, and are the leading cause of injury-related deaths in this demographic. These incidents often happen at home and can lead to severe injuries, such as hip fractures, subdural hematomas, or spinal injuries, even if the fall appears minor. EMS providers must perform a careful assessment, considering potential underlying medical issues that may have caused the fall, like a cardiac event or syncope.
Altered Mental Status
Altered mental status (AMS) in seniors is a broad complaint that can signify a range of issues, from mild confusion to coma. It's a common reason for EMS calls and requires thorough evaluation, as the cause can be life-threatening. Unlike younger adults, who may have clear symptoms, AMS in older patients can be caused by less obvious factors such as dehydration, urinary tract infections (UTIs), hypoglycemia, or medication interactions. EMS must differentiate between acute delirium and chronic dementia, though it's important to remember a patient with dementia can also experience an acute change in mental status.
Common causes of altered mental status in seniors
- Infections: UTIs and pneumonia are frequent culprits.
- Dehydration: A common and treatable cause of confusion in the elderly.
- Medication side effects: Interactions or improper dosing from polypharmacy can cause cognitive changes.
- Metabolic issues: Hypoglycemia or hyperglycemia in diabetic patients can affect mental clarity.
Cardiovascular Emergencies
Cardiovascular issues, including heart attacks, heart failure, and arrhythmias, are major drivers of geriatric EMS calls. It's critical for EMS to recognize that older patients may not present with the classic chest pain symptoms of a heart attack.
- Atypical symptoms: Seniors might experience nausea, weakness, fatigue, or confusion instead of chest pain, making diagnosis more challenging.
- Congestive heart failure (CHF): Exacerbations of CHF often lead to respiratory distress and require urgent EMS care.
Respiratory Distress
Conditions causing shortness of breath (dyspnea) are the third most common emergency for EMS providers. For seniors, this is frequently linked to chronic conditions.
- Chronic Obstructive Pulmonary Disease (COPD): Exacerbations are a frequent cause of breathing difficulty.
- Pneumonia: Pulmonary infections are prevalent among geriatric patients and can lead to respiratory distress.
- Congestive Heart Failure: Fluid buildup in the lungs from CHF can cause severe shortness of breath.
Medication-Related Incidents (Polypharmacy)
Older adults, who often take multiple medications, are at a higher risk of adverse drug events (ADEs), which can lead to emergency hospitalization. EMS is frequently called for complications related to polypharmacy.
- Common culprits: Medications like warfarin, insulins, and oral antiplatelet or hypoglycemic agents are most often implicated in ADEs requiring emergency care.
- High-risk meds: Although implicated less frequently, specific high-risk medications can also cause serious issues.
Sepsis and Infections
Seniors are more susceptible to severe infections that can quickly become life-threatening if not addressed promptly. The signs of sepsis, a life-threatening complication of an infection, can be subtle and easily missed in older adults.
Comparison of Common Geriatric vs. Younger Adult EMS Calls
| Feature | Geriatric EMS Calls | Younger Adult EMS Calls |
|---|---|---|
| Common Chief Complaints | Falls, altered mental status (confusion), atypical cardiac symptoms, respiratory distress from chronic conditions | Trauma (motor vehicle accidents, sports injuries), typical cardiac symptoms (chest pain), respiratory distress (asthma attacks), substance abuse |
| Symptom Presentation | Atypical and non-specific (e.g., confusion instead of chest pain) | Often more classic and predictable symptoms |
| Underlying Issues | Often linked to multiple chronic conditions (hypertension, diabetes), polypharmacy, and age-related changes | Typically more related to a single acute event, trauma, or substance use |
| Risk Factors | Falls, multiple comorbidities, cognitive impairment (dementia), and medication interactions are significant risk factors | Lifestyle choices, occupation, and recreational activities often contribute to risk |
Conclusion
Geriatric EMS calls present a complex and challenging scenario for emergency medical providers, often involving multiple comorbidities, polypharmacy, and atypical symptom presentations. The most common issues, including falls, altered mental status, cardiovascular events, and respiratory distress, require a nuanced approach to assessment and treatment. Given the rapidly aging population, a deep understanding of these specific challenges is crucial for delivering effective care and improving outcomes for older adults in emergency situations. For further information on geriatric emergency care protocols, refer to resources like the American Academy of Family Physicians, which offers comprehensive geriatric assessment guidelines.
