Over at this week’s MedicCast podcast for EMS providers, we take a look as some of the special considerations in the treatment of geriatric patients. First, a look at geriatric trauma considerations and why special care is needed to ensure that the elderly trauma patient is taken to the most appropriate facility just like younger patients. A recent study by the State of Maryland found that geriatric trauma patients were not being taken to trauma centers as much as younger patients with similar injuries.
The show also includes a look at polypharmacy and how it affects the geriatric population. Polypharmacy is the presence of at least 5 to 7 prescribed medications for a patient. Each additional med increases the risk for adverse drug interactions, compounded side effects and endangers the patient. Encourage patients to review their medications at least annually with their physicians.
Any person may experience problems with polypharmacy, but an elderly person will have more issues due to decreased metabolism, reduced renal and hepatic function, and slowed GI clearance and absorption.
Listener Eric sent this tidbit in from a California newspaper. It examines the trends in geriatric health care. It discusses some alarming statistics brought up in a report from a professor at the University of California San Francisco. In this report, Retooling for an Aging America: Building the Health Care Workforce, the following points are made:
One Geriatric Doctor per 2500 elderly patients
Fewer than 1% of nurses are trained in geriatric care
Nursing aide job turnover at 71%
90% of home health aides leave within two years
National average pay for home health aides is $8.50 per hour
The gist of the article is that major change needs to occur in the training and pay for healthcare workers involved in care for the elderly or the system will continue to collapse under the increasing weight of the aging population. Registered nurse specialists in geriatric care need to be trained. Additional training and financial resources need to be arranged for the aides that assist nurses in the facilities and home environments.
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Two healthy 14 year old boys each playing a sport they loved, collapsed while playing sports. They were in cardiac arrest. Both boys died before a defibrillator arrived on an ambulance.
Now, their parents are pushing Congress for more funding for schools to equip their gymnasiums and athletic facilities with AEDs to help prevent such tragedies from happening again. They have joined a cardiologist to testify before a Senate committee about the startling number of such incidents that happen each year.
Some states have passed laws requiring public schools to have AEDs in place to treat sudden cardiac arrest in otherwise healthy young athletes. However, these parents want more. They wish to have mandatory funding for all secondary and elementary schools nationwide to be equipped with these lifesaving devices.
With AED prices getting lower each year (some now below $800), there seems to be no reason to not have an AED placed in a public building. I would like to see AEDs become part of the building code for a public building. Just like sprinkler systems, a conveniently placed AED would go a long way to providing rapid response and defibrillation to any sudden cardiac arrest. Many shopping malls and airports already have them in place and have been used successfully by bystanders to revive victims.
What about churches, supermarkets, large restaurant chains, travel centers? Each of these locations see people in sufficient numbers that they would surely benefit from an AED placed there. They could advertise it right alongside their sign for “Air Conditioned: Come on in, it’s cool!”
“Bring grandpa and his heart condition. We’ve got an AED!”
Somebody get me the can of worms so I can open it. I found this article based on research that points at cardiac medication non-compliance following myocardial infarctions and patient mortality. The authors of the study conclude that one way to increase compliance is to provide the 4 most commonly prescribed cardiac meds to patients for free following their cardiac event.
These meds include: Aspirin, ACE inhibitors, Beta Blockers, and Statins. While the cost of these medications is not the only reason for patient non-compliance, it is certainly a factor here in the U.S. The removal of the Medicare copay would improve patient outcome and quality of life for some of these patients if it encouraged them to buy their prescribed medications.
The study out of Harvard University, looks at a theoretical basis for its findings and the authors point out that while their findings appear significant and make medical sense, there should be actual trials set up where some patients randomly get their meds for free and others remain under the current system. Who would be more compliant with their meds?
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I found this article recently that looked at the effects of medication review by geriatric specialists on the overall health of elderly patients. While this seems to be a no-brainer, elderly patients are more at risk for suffering combined effects of multiple medications as well as changes in the way they metabolize drugs out of their systems.
With an increased focus on patient safety on all of our minds, monitoring elderly patients to ensure they are not receiving too much of one medication or a dangerous combination of multiple meds falls to the entire care team. I’ve reported in the past about studies on nursing home falls and how reducing some medications had a positive effect.
The study in the article above concluded that 26% of patients were either given inappropriate prescriptions or too high a dose of a necessary med. It reviewed the care of 850,000 U.S. veterans cared for in VA facilities in 1999 and 2000. Interestingly, the 3% of the studied patients who were cared for by a geriatric specialist had a greatly decreased risk of similar medication errors.
It makes sense that the elderly need specialized care in a similar way that children need pediatric specialists. With decreased organ function across their body system, the elderly react differently to disease, medication, and injury. We know this and yet we don’t necessarily change our oversight to account for those differences. They are often treated under the same guidelines used for a healthy 40 year-old.
Over at this week’s MedicCast podcast for EMS providers, we take a look as some of the special considerations in the treatment of geriatric patients. First, a look at geriatric trauma considerations and why special care is needed to ensure that the elderly trauma patient is taken to the most appropriate facility just like younger patients. A recent study by the State of Maryland found that geriatric trauma patients were not being taken to trauma centers as much as younger patients with similar injuries.
