Unit
- Age-related physiological changes: Older adults experience reduced cardiac output, decreased renal function, and diminished immune response, which mask typical disease presentations. For example, a senior with sepsis may present with confusion rather than fever, leading to delayed diagnosis if staff rely on standard indicators.
- Atypical symptom presentation: Many conditions manifest differently in seniors. Myocardial infarction often presents as shortness of breath or fatigue instead of chest pain. Emergency protocols must adjust for these variations to avoid missed or delayed diagnoses.
- Polypharmacy interactions: The average older adult takes multiple medications, increasing risks of adverse drug reactions and drug-disease interactions. Emergency clinicians must consider how chronic medications affect acute illness presentation and treatment options.
- Cognitive and sensory impairments: Dementia, hearing loss, and vision problems are common in older patients. These impairments hinder history-taking and compliance with instructions. Staff must use adaptive communication techniques and involve caregivers appropriately.
- Frailty and functional decline: Frail seniors have limited physiologic reserve and are vulnerable to stressors like infection or injury. Emergency care must aim to preserve function and avoid interventions that accelerate decline, such as unnecessary hospitalizations.
- Skin integrity and mobility: Aging skin is fragile and prone to breakdown. Prolonged ED bed rest can lead to pressure ulcers. Protocols should include pressure redistribution and early mobilization to maintain skin health.
- Thermoregulation changes: Older adults have impaired thermoregulation, making them susceptible to hypothermia or hyperthermia. Environmental controls in the ED and careful monitoring of temperature are essential.
- Implications for emergency management: Understanding these physiological changes enables administrators to design caregiver workflows, equipment selection, and training programs that address the distinct needs of geriatric patients.
- Fall risk assessment: Older adults have high fall risk due to gait instability, muscle weakness, and environmental hazards. Emergency departments should implement validated fall risk screening tools upon arrival and initiate fall prevention measures, including non-slip socks, bed alarms, and careful transfer assistance, to reduce injury and recurrence.
- Advance care planning: Many seniors have advance directives or goals of care preferences that should be respected during emergencies. ED staff must be trained to identify and document advance directives, initiate goals-of-care conversations when appropriate, and coordinate with palliative care to align treatment with patient values.
- Delirium recognition and management: Delirium is a common, underrecognized emergency in older adults, often indicating underlying illness. Standardized screening using tools like the Confusion Assessment Method should be routine. Non-pharmacologic interventions, such as reorientation and family presence, should be prioritized over sedation to improve outcomes.
Scope of Practice
Role: Emergency Department Manager
Within scope:
- Developing and updating protocols for geriatric patient assessment
- Training staff on atypical symptom recognition
- Ensuring availability of age-appropriate equipment (e.g., geriatric beds, hearing aid compatible phones)
- Implementing screening tools for delirium and fall risk
- Coordinating with pharmacy to review medication lists
Outside scope:
- Diagnosing specific medical conditions
- Prescribing medications or adjusting dosages
- Performing direct patient care procedures
- Interpreting complex physiological data for individual patients
- Replacing the role of clinical specialists in geriatrics
Quick Revision
- Geriatric physiology blunts typical disease signs; abnormal presentation is the norm.
- Atypical symptoms like confusion or weakness require high suspicion and adapted triage.
- Polypharmacy is a critical factor that influences clinical decisions and patient safety.
- Cognitive and sensory deficits demand communication adjustments and caregiver involvement.
- Emergency managers must design systems that account for frailty, skin integrity, and thermoregulation.