GERIATRIC PATIENTS (MEDICAL)
GENERAL CONSIDERATIONS
There is no scientific definition of the age at which a patient should be considered “geriatric”. For years it has been 65. Recent data has made some training programs drop the age to 55 where the anatomic and physiologic changes of age become clinically important. Geriatric patients pose new issues and need to be handled differently. Their vital signs, mental status, use of anti-coagulants, and more complicated medical history are just a few considerations.
MEDICAL PATIENTS
1. A thorough history of past and present medical conditions needs to be obtained.
2. Current medications should be reviewed.
3. Vital signs may be abnormal while appearing within normal limits.
a. Geriatric patients have limited capacity to raise their heart rates when stressed. Tachycardia may be occurring at rates of 90.
b. Geriatric patients very commonly have uncontrolled high blood pressure. Systolic blood pressures below 120 mmHg may indicate hypotension and commonly accepted levels of 90 mmHg may represent severe hypoperfusion.
4. Airways can be compromised by dentures, the displacement of dentures, neck immobility and obesity.
5. A detailed physical examination becomes more important to find clues to additional medical issues and hidden injuries not revealed in the history.
6. Confusion, disorientation, or frank delirium may occur in a geriatric patient in distress.
a. Severe agitation can occur. Sedation should follow the SEDATION protocol guidelines. Use the lowest effective dose of medications when indicated and repeat as needed. Medication clearance is delayed in the geriatric population.
7. Multiple medications, inconsistent use of prescribed medications, or overdose and adverse reactions or drug interactions need to be considered.
8. Consider MIH referral for home safety and follow-up as indicated.
GENERAL CONSIDERATIONS
There is no scientific definition of the age at which a patient should be considered “geriatric”. For years it has been 65. Recent data has made some training programs drop the age to 55 where the anatomic and physiologic changes of age become clinically important. Geriatric patients pose new issues and need to be handled differently. Their vital signs, mental status, use of anti-coagulants, and more complicated medical history are just a few considerations.
MEDICAL PATIENTS
1. A thorough history of past and present medical conditions needs to be obtained.
2. Current medications should be reviewed.
3. Vital signs may be abnormal while appearing within normal limits.
a. Geriatric patients have limited capacity to raise their heart rates when stressed. Tachycardia may be occurring at rates of 90.
b. Geriatric patients very commonly have uncontrolled high blood pressure. Systolic blood pressures below 120 mmHg may indicate hypotension and commonly accepted levels of 90 mmHg may represent severe hypoperfusion.
4. Airways can be compromised by dentures, the displacement of dentures, neck immobility and obesity.
5. A detailed physical examination becomes more important to find clues to additional medical issues and hidden injuries not revealed in the history.
6. Confusion, disorientation, or frank delirium may occur in a geriatric patient in distress.
a. Severe agitation can occur. Sedation should follow the SEDATION protocol guidelines. Use the lowest effective dose of medications when indicated and repeat as needed. Medication clearance is delayed in the geriatric population.
7. Multiple medications, inconsistent use of prescribed medications, or overdose and adverse reactions or drug interactions need to be considered.
8. Consider MIH referral for home safety and follow-up as indicated.