The Growing Proportion of Elder Patients in EMS
National data consistently shows that older adults utilize Emergency Medical Services (EMS) at a significantly higher rate than younger populations. As the U.S. population ages, this trend is only expected to accelerate, placing increased demand on emergency response systems.
The Numbers Behind the Calls
Recent and past studies provide a clear picture of the disproportionate use of EMS by the elderly:
- NEMSIS Data: A 2014 study using NEMSIS data revealed that older adults accounted for 32.5% of all emergency 911 responses nationwide. For all adult responses, older adults comprised an even larger share at 40.76%.
- Regional Projections: Analysis of a statewide database in North Carolina projected that older patients could account for as much as 49% of all EMS transports by 2030, underscoring the rapid shift in patient demographics.
- Higher Transport Rates: Research has shown that EMS use for transport to the emergency department increases with age, with individuals aged 85 and older arriving via EMS more often than any other age group.
- Local Variations: A study from a suburban community showed that fall-related calls among those 60+ increased dramatically over a decade, representing 11.5% of all responses for that age group.
Common Reasons for Elderly EMS Calls
The reasons for elderly individuals requiring EMS are often complex, stemming from age-related physiological changes, chronic conditions, and frailty. These can be categorized into several common emergencies:
- Falls and Traumatic Injuries: Falls are the leading cause of non-fatal injuries and death among older adults. They are a primary driver of EMS calls, sometimes requiring a “lift assist” even without transport. Fragility from conditions like osteoporosis means minor falls can have severe consequences, including hip and spinal fractures.
- Cardiac Emergencies: Older adults frequently experience cardiovascular events like heart attacks, heart failure, and arrhythmias. Symptoms can be atypical, presenting as confusion, fatigue, or general weakness rather than classic chest pain.
- Respiratory Distress: Conditions such as Chronic Obstructive Pulmonary Disease (COPD) and pneumonia are common in the elderly, leading to calls for breathing difficulties. As with cardiac events, pneumonia may present atypically with altered mental status instead of fever.
- Altered Mental Status: Confusion or a sudden change in mental state is a frequent reason for an EMS call. This can be caused by various factors, including infections (e.g., Urinary Tract Infection), medication interactions, or dehydration, and should not be dismissed as normal aging.
- Diabetic and Metabolic Issues: Hypoglycemia or hyperglycemia in elderly diabetic patients can lead to confusion and fainting. A diminished thirst response also puts them at risk for dehydration and dangerous electrolyte imbalances.
Challenges for EMS with Geriatric Patients
Responding to calls for older adults presents unique challenges for Emergency Medical Services personnel. The aging process affects all bodily systems, complicating assessment and treatment. These include:
- Atypical Presentations: Classic signs of serious conditions may be absent or masked. A heart attack might present as shortness of breath, and a serious infection might cause confusion without fever. This requires a higher index of suspicion and advanced training from paramedics.
- Polypharmacy: Many older adults take multiple prescription medications. These drugs can interact with each other, alter symptom presentation, and complicate treatment. For example, blood thinners increase the risk of hemorrhage from minor trauma.
- Communication Barriers: Sensory deficits like hearing loss or cognitive impairments such as dementia can impede effective communication, making it difficult for responders to gather a complete medical history or assess a patient's baseline mental status.
- Increased Scene Time: The complexity of geriatric cases and the need for thorough assessment often lead to longer on-scene times for paramedics, potentially delaying definitive care for the patient and diverting resources from other emergencies.
- Risk of Under-triage: Due to a lack of geriatric-specific training, low-impact incidents like falls can be under-triaged. This is especially dangerous since older adults have a higher risk of serious, hidden injuries, such as subdural hematomas, even from seemingly minor events.
Older Adult vs. Younger Adult EMS Calls
| Characteristic | Older Adults (65+) | Younger Adults (<65) |
|---|---|---|
| Symptom Presentation | Often atypical or vague (e.g., confusion, weakness for cardiac events). | More likely to present with classic symptoms (e.g., chest pain for heart attack). |
| Call Frequency | Disproportionately higher rate of use per capita. | Lower rate of use compared to the elderly, though still a large volume. |
| Underlying Conditions | More likely to have multiple comorbidities (e.g., heart disease, COPD, diabetes). | Generally fewer complex, chronic conditions. |
| Most Common Call Reasons | Falls, syncope, cardiac events, strokes, altered mental status. | Trauma (frequent users), substance abuse, respiratory issues in younger age groups. |
| Impact of Injuries | Minor trauma can have devastating consequences due to frailty and osteoporosis. | Better ability to withstand and recover from traumatic injuries. |
Proactive Solutions and the Future of Geriatric Care
The growing demand for geriatric emergency services highlights the need for proactive and preventive strategies. Community-based interventions are key to reducing the burden on EMS and improving the quality of life for older adults.
- Fall Prevention Programs: Many EMS calls are related to falls that can be prevented. Referrals to community programs that address balance, strength, and home safety are essential. EMS providers are uniquely positioned to identify risks during an in-home response. Learn more about fall prevention strategies from the CDC: Preventing Falls in Older Adults.
- Medication Management: Caregivers and healthcare providers should help older adults manage their medications effectively to prevent adverse drug reactions and complex interactions.
- Community Paramedicine: Some EMS systems are developing community paramedicine programs, where paramedics perform home visits for non-emergency issues, reducing the need for 911 calls. This can include chronic disease management and fall risk assessment.
Conclusion
Older adults represent a significant and growing portion of EMS call volume, driven by complex health issues, comorbidities, and higher rates of falls. This demographic shift necessitates a proactive response from emergency services, healthcare providers, and the community. By increasing geriatric-specific training for paramedics and implementing targeted prevention strategies, particularly for falls, we can improve outcomes for seniors and ensure that EMS resources are used most effectively for the benefit of all.
