Elderly Medicine
Aims For The Week
Describe the investigation and management of delirium
Discuss the physiological changes associated with aging and their management implications
Explain the investigation of Transient Loss of Consciousness (TLOC)
Describe the investigation of frequent falls in the elderly
Discuss the symptomatic management of the dying patient
Describe common injuries in the elderly
List the features and specify the management of oncological emergencies
Describe the management of acute urinary retention
Summarise the difficulties in managing a patient with dementia
Identify the risk factors and signs of elder abuse
Physiology
‘Children aren’t just little adults’
This is possibly one of the most repeated clichés in medicine, for a good reason- it’s true! However, maybe this week we should try starting a new phrase…
‘Old people aren’t just wrinkly young people’
The elderly have different physiology & pathophysiology when compared to the general adult population, just as children do.
Collapse ?cause
Have you ever picked up a card, realised it’s a ‘collapse query cause’… in an elderly person and thought, ‘Yes! This will be a straightforward diagnosis and management decision!’ No? Well, you probably still won’t after reading these resources on the investigation & management of falls & transient loss of consciousness in the elderly… but they will prove helpful. As will this resource on two frequent and easily missed injuries, which result from these falls.
Delirium & Dementia
We’re pretty good at recognising someone at risk of, or in, many different kinds of organ failure and we do a good job of managing it in the emergent setting (it is our bread and butter after all)- respiratory failure, heart failure, renal failure… well, what about ‘brain failure?’ Because that’s essentially what delirium is.
It is important to be comfortable diagnosing and managing delirium, as this is one of the most common presentations in the elderly and is often unrecognised. This is a major problem because delirium increases length of stay and adversely affects patient outcomes.
Acute urinary retention is one cause of delirium, which is more common in the elderly, look at the linked resource for how we manage this in hospital.
Patients with dementia are of course at a much higher risk of delirium. Dementia is a chronic condition and we only see these patients for a brief period of their lives, but it’s important that we recognise the different types, and how we can adjust our communication to make things easier for them to.
If a patient requires treatment, but is unable to make decisions about their healthcare, remember that you must complete an Adults With Incapacity form.
We’re always told to listen to our elders and some clever people from EMDocs (who are probably older than me) have written these articles on the pearls and pitfalls of managing elderly patients and trauma in elderly patients. Have a read so that you can learn from other’s mistakes (and hopefully not make them yourselves).
Unfortunately not all injuries in the elderly are accidental, this resource should highlight when to suspect elder abuse.
If you suspect the patient has suffered, or is at risk of of harm under the Adult Support And Protection Act 2007 you are legally obliged to inform social work.
Oncological Emergencies
In the ED it’s not often that we would be involved in the ongoing management of patients’ cancer diagnoses, however occasionally patients may present due to oncological emergencies, here is a guide to some of these conditions and their management.
End of Life Care
Ultimately though, no matter how hard we try, no matter how good our ‘resuscitationist’ skills are, sometimes we need to recognise that our patient is at the end of their life.
At this point we need to realise that our goals have to change and that our aim becomes giving them a dignified and comfortable death.
This is one of the most important skills to learn in the ED and is further discussed in this post from #EM3.
