General Approach to EM Geriatrics

Background

Generalized Approach to the Geriatric patient.

4 Basic Assessments.

• Medical
• Cognitive
• Functional
• Social

Medical

• Common acute illness presents atypically - generalize weakness = MI or Hyponatremia
• Vital signs often normal in illness
  • beta blocked, lack temperature
• Labratory studies often nornmal
  • no leukocytosis
• Often consider polypharmacy

Cognitive

• assess memory and orientation; compare to baseline
  • evaluate for deliruim
• important for assessing reliability of history and remembering dispo instructions

Functional

• Up to 3/4 of older patients present with chief complaint of functional decline
  • ask about shortness of breath during episodes
• Basic ADLs
  • walking, transferring, dressing, toileting
  • get up and go test:ability to rise, ambulate 10 ft, turn around, and sit back down
• Instumental ADLs
  • finances, taking medications, meal prep, driving
• Patients must be able to transfer and ambulate at a minimum to consider discharge by self

Social

• Supports
  • who live with, family in town, anyone helps out?
• Living environment
  • steps, hallways wide enough for walker, how far bathroom/kitchen from bedroom

See Also

Geriatrics (Main Page)

References

ACEP Geriatric Video Series

Authors

Allen Bookatz, Ross Donaldson, Neil Young, Daniel Ostermayer