Prehospital management of older patients

Abstract

The number of older inpatients has been steadily increasing worldwide. Recognition of acute disorders like cognitive impairment, depression and malnutrition is not easy for prehospital personnel. By the year 2020, people over 65 will make up the majority of patients treated by prehospital providers. It is critical for every prehospital provider to have the specialised knowledge of older persons to optimise care for this group of patients. Despite caring for large numbers of older adults at home or in nursing homes, prehospital emergency medical services (EMS) providers receive minimal geriatric-specific training for the early recognition of complex complaints. The physiology and anatomy of older patients differ significantly with concurrent illness, polypharmacy and social problems having effects on trauma, responses to prehospital intervention and outcomes in emergency departments (EDs). There has been a paucity of literature illustrating the critical role of EDs and the prehospital management of the older patients. However, more recent medical literature gives some successful experiences of acute geriatric unit care in the ED for the management of geriatric emergencies, as well as admission prevention through integrated community services, hospital at home schemes, better out of hours care and improved training and skills for prehospital professionals.