Why Geriatric Patients Require a Different Approach
Adults over 65 represent the fastest-growing segment of EMS patients. By 2030, one in five Americans will be over 65. Aging brings physiological changes that alter how diseases present, how injuries affect the body, and how patients respond to treatment. An EMT who applies the same assessment approach to a 75-year-old as to a 35-year-old will miss critical findings and may provide inappropriate care.
The concept of "physiological reserve" is central to understanding geriatric patients. Younger patients have excess organ capacity that allows them to compensate for illness and injury. Aging diminishes this reserve, meaning geriatric patients decompensate faster and with less warning. A blood pressure of 110/70 might be normal for a young adult but could represent significant hypotension in an elderly patient who normally runs 160/90.
Age-Related Physiological Changes
The cardiovascular system undergoes significant changes with aging. The heart muscle stiffens, reducing cardiac output. Blood vessels become less elastic, leading to baseline hypertension. The baroreceptor reflex weakens, making orthostatic hypotension common. These changes mean that tachycardia may not develop in response to hypovolemia because the aging heart cannot increase its rate as readily. Beta-blocker and calcium channel blocker medications further blunt this response.
Respiratory changes include decreased chest wall compliance, reduced lung elasticity, and diminished cough reflex. The result is lower baseline oxygen saturation and increased susceptibility to pneumonia. A "normal" respiratory rate of 20 in an elderly patient may actually represent respiratory distress that would manifest as a rate of 30 or higher in a younger patient.
Neurological changes include slower processing, decreased pain perception, and potential baseline cognitive impairment. Elderly patients may not report pain from serious injuries like hip fractures or myocardial infarction. Confusion may represent their baseline (ask family members) or could indicate an acute process like stroke, infection, or hypoglycemia.
Medication Considerations
The average geriatric patient takes five or more medications daily, a phenomenon called polypharmacy. These medications can mask symptoms (beta-blockers prevent tachycardia), cause symptoms (diuretics cause dehydration and electrolyte imbalances), and interact with each other in unpredictable ways. Always gather a complete medication list, including over-the-counter supplements. Bring all medication bottles to the hospital.
Communication Strategies
Effective communication with geriatric patients requires patience and adaptation. Speak clearly and at a normal volume (shouting distorts sound for hearing-impaired patients). Face the patient so they can read your lips. Use simple, direct language. Allow extra time for responses. Do not assume confusion means dementia; it could indicate a reversible condition. Include family members or caregivers in the conversation when appropriate, but always address the patient directly and respect their autonomy.