Geriatric Emergencies

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Who is considered a “geriatric patient” and why does that matter?

Geriatric patients are classified as persons over the age of 65 years. This is the fastest-growing segment of the population in the United States. The US Census Bureau estimates that by the year 2040, there will be 80 million older adults, making up 21% of the population.

The chronological age is the actual number of years that an individual has lived, whereas the physiologic age describes the actual functional capacity of the patient’s organ systems in a physiologic sense ( Fig. 64.1 ). Disease states such as diabetes mellitus, coronary artery disease, renal disease, arthritis, and pulmonary disease can decrease the physiological reserve. This makes it more difficult for elderly patients to recover from a traumatic injury or illness. There are significant physical and physiologic changes that occur with aging ( Table 64.1 ).

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What are the top mechanisms of injury for geriatric patients?

Falls and motor vehicle collisions (MVCs) are the leading mechanisms of injury that bring elderly patients to a trauma center in the United States.

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What are the neurological findings you may see when you assess a geriatric trauma patient?

As the brain ages, the overall mass decreases, and as a result, there is greater stretching of the bridging vessels that pass from the brain to the dural sinuses. This puts the geriatric population at a higher risk for sheer injury with a low mechanism of action (resulting in a higher incidence of subdural hematomas). Altered mental status is common, and it can be difficult to determine acute versus chronic changes. When possible, talk with caregivers and family to determine baseline and obtain an initial Glasgow Coma Scale (GCS) score at the time of transport.

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What are the respiratory findings you may see when you assess a geriatric patient?

Elderly patients have a reduction in pulmonary compliance, total lung surface area, and decreased ability to cough. These changes result in greater risk for elderly patients to develop infectious processes and greater injury from pulmonary and thoracic traumas. Calcium deposits begin to form where the ribs meet the sternum, making the rib cage less flexible and placing the patient at an increased risk for injury. The lungs lose elasticity, the muscles used in breathing lose strength and coordination, and gas exchange becomes impaired, resulting in low oxygen (hypoxia) and elevated carbon dioxide (hypercapnia) levels.

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