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Aortic Dissection is a degeneration of the wall of the aorta, either in the thoracic or abdominal cavity. It can result in an Aneurysm or in a rupture of the vessel.

Aortic dissection is more common in the thoracic aorta.
Aneurysm is more common in the abdominal aorta.

A.D = Patients will often present with chest pain radiating through the back or, if rupture occurs, cardiac arrest.

Aneurysm = May present with tearing abdominal pain or unexplained low back pain. Pulses in the legs are diminished or absent and the lower extremities feel cold to the touch.

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Intellectual decline and/or regressive behavior are not normal age-related changes.
Emotionally stressful situations facing many elderly people: isolation, loneliness, loss of self-dependence, loss of strength, fear of the future, etc.
Depression secondary for medications such as Haldol and Thorazine.
Common classification of psychological disorders related to age include:
-Affective disorders (depression)
-Dissociative disorders (paranoid schizophrenia)
-Organic brain syndrome
-Personality disorders (dependent personality)

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Common signs and symptoms of a physiological disorder include:
-lapses in memory
-cognitive difficulty
-changes in sleep patterns
-fear of death
-changes in sexual interest
-thoughts of suicide
-withdrawal form society

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15% experience depression.
General signs and symptoms noted previously
-lapses in memory
-cognitive difficulty
-changes in sleep patterns
-fear of death
-changes in sexual interest
-thoughts of suicide
-withdrawal form society
MAY indicate depression.

Stressful events: death of a loved one.
Sensory changes: deafness and blindness, may make the patient vulnerable to depression

Hypochondriasis side effect of depression, patient will still show some degree of emotional pain and/or dysphoria.

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Highest suicide rates in the U.S. are amoing 65+ especially men.
20% of all suicides
Someone over the age of 65 commits suicide every 90 minutes.
Depression is the leading cause.

-NO likely to seek help, express their anger or sorrow.

Stressor that put the elderly at risk of suicide include:
-Bereavement
-Chronic illness
-Family history of suicide
-Family issues
-Financial problems
-Isolation and loneliness
-Living in a youth-oriented people
-Low serotonin levels (decline with age)
-Physical impairment
-Substance abuse
-Unrelieved pain

Suicidal behavior is related to stress.

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-Loss of interest in activities that were one enjoyable
-Curtailing social interaction, grooming, and self-care
-Grieving a personal loss (I don't want to live without him/her)
-Feeling useless ("nobody would miss me)
-Putting affairs in order, giving away things, finalizing a will
-Stockpiling medications or other lethal means of self-destruction, including firearms

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👉An estimated 2-5% of people over 65 may experience hypothyroidism due to changes in hormone production.
👉Although aging is one of the major factors that cause hypothyroidism typical signs and symptoms include:
-Mental confusion
-Anorexia
-Falls
-Incontinence
-Decreased mobility
-Increased muscle and joint pain
👉Hyperthyroidism is less common in elders but can be caused due to medication errors especially because of thyroid hormone replacement overdose.
👉Common signs and symptoms of hyperthyroidism are:
-Heat intolerance
-A-Fib
-Weight loss
-Abdominal distress
-Diarrhea
-Exhaustion
-Depression

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👉Age related changes affect hormone levels often causing the elderly to have issues with their glucose levels or thyroid gland. These disorders are usually caused by:
-Poor diet
-Decreased physical activity
-Loss of lean body mass
-Impaired insulin production
-Resistance by body cells to the actions of insulin
👉Diabetes Type 2 can be diagnosed with routine blood/urine tests. Early signs and symptoms of Diabetes are fatigue/ weakness which can progress into neuropathy and visual impairment if not treated/diagnosed accurately.
👉Complications of not treating diabetes appropriately are:
-Hypoglycemia from injecting too much insulin
-Lack of nutrition due to being unable to purchase food or chew food.
-Hypoglycemia can also be a cause of alcoholism
-Atherosclerosis
-Delayed healing
-Retinopathy/blindness
-Altered renal function
-Severe PVD
-Foot ulcers
-Amputations

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Develop with age, A-fib is the most common arrhythmia encountered and can be a predictor of long-term mortality in elderly patients.

Occurs primarily as a result of degeneration of the patient's conductive system.

Anything that decreases myocardial blood flow can produce an arrhythmia

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Ankylosing spondylitis is when the spine becomes stiff and inflexible due to the bone on the edge of the vertebrae fusing together over time. The fused spine can be extremely fragile and can fracture along with spinal cord injury. There are no known causes, but genetics are believed to be the main part of it.
Signs and Symptoms
-Pain and stiffness in lower back and hips in morning or after periods of inactivity
-Fixed hunched over position (Hyperkyphosis)

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Heart Failure takes place when cardiac output cannot meet the body's metabolic demands.

Falls into one of four categories:
Impairment to flow
Inadequate cardiac filling
Volume overload
M.I.

Prolonged M.I. contractions make elderly vulnerable to heart failure.
Other factors:
Anemia
Arrhythmias
Hypoxia
Ischemia
Noncompliance w/ drug therapy
Use of NSID

S&S vary in elderly, but regardless of age, some form of edema exists.
Fatigue
Dyspnea
Paroxysmal nocturnal dyspnea
Dry, hacking cough
Nocturia
Anorexia

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What changes in physiology can contribute?

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What changes in physiology can contribute?

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Decreased aldosterone - impaired sodium regulation

Decline in glomerular function - more difficulty regulating body water

Decreased skin vascularity/sweat glands - less able to adapt to temp changes/less sweat production

Loss of skin elasticity - thinning of skin, less insulation

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What can cause hypothermia in geriatric patients?
-cold indoor surroundings
-socioeconomic factors
fixed income prohibits paying for adequate heating
poor nutrition leads to decreased fat stores
-pathophysiologic conditions (to name a few)
arthritis
infection
stroke
thyroid disease

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Less able to compensate for heat loss

Less able to sense change in temp

Less total body water to store heat

Less likely to increase cardiac output (tachycardia) to respond to cold stress

Decreased ability to shiver

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Signs can be subtle! Be observant
-Altered Mental Status/Slurred Speech
-Ataxia (Clumsy voluntary movements)
-Coma

ECG Hallmark: Osborne Waves

Hypothermia in Geriatric Patients equals HIGH MORTALITY

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What can cause hyperthermia in Geriatrics? Same key points!
-Environment, Socioeconomic Factors, Illness

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-Unable to control body temperature adequately

-Medications MAY increase risk of hyperthermia

-Reduced ability to shift fluids: dehydration more likely

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Heat Cramps - cramping! (common in leg/abdominal muscles)

Heat Exhaustion - cramps, dizziness, nausea, headache, Core Body Temp (CBT) elevation (up to 103)

Heat Stroke - Clinical Manifestations:

Temp Regulation: Increased RR,Tachycardia, increased sweating

CNS: Confusion, irrational behavior, combative, altered mental status, convulsions

Cardiovascular: persistent sweating (increased catecholamines), or no sweating (dehydration/drug use), tachycardia, hypotension, electrolyte abnormalities (ECG)

ECG Changes: Sinus Tach, Non-specific ST segment changes, prolonged QT interval

Hyperthermia carries SIGNIFICANT MORTALITY

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They are not uncommon in elderly. In most cases, the cause of seizures are related to  CNS injuries such as:
-Stroke
-Trauma
-Tumor
-Degenerative brain disease

Selection of meds are due to the type of seizures the patient is having.

Most common side effect of antiseizure med is sedation.

Other common side effects include:
-Gi distress
-Headache
-Dizziness
-Lack of coordination
-Dermatologic reactions (rashes)

Tx: airway management and supportive therapy

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👉Early diagnosis of disorders may help prevent disabilities through methods such as hormonal therapy and lifestyle changes. 👉Diabetes and hyperthyroidism are common disorders among the elderly but can be prevented or rather controlled by the following:
-Controlling glucose levels
-Balanced diet
-Exercise
-Drug therapy to reduce risks of vascular and neurologic complications which may lead to metabolic disorders.
👉Some disorders such as hyperthyroidism cannot be easily determined in the field but several factors contribute to such disorder including those of: Aging, cardiovascular (aortic aneurysm), GI, or neuromuscular disorder such as Marfan Syndrome which results in abnormal growth of distal tissues and dilation of the root of the aorta.

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With age the lungs experience loss of strength and coordination in the respiratory muscles cough and gag reflux reduced.
Increased likelihood of respiratory failure.

Age Related Complications
-Decreased chest compliance
-Loss of lung elasticity
-Increased air trapping due to collapse of smaller airways.
-Reduced strength and endurance of respiratory muscles.

Previous medical history has a huge role in the longevity and health of a person's respiratory efficiency.
- Smoking
-Obesity
-Work place
-Congenital disorder's
-Asthma

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A condition in which the kidneys lose the ability to remove waste and balance fluids.

Both acute and chronic.

5 stages of kidney failure:

Stage 1 with normal or high GFR (GFR > 90 mL/min)

Stage 2 Mild CKD (GFR = 60-89 mL/min)

Stage 3A Moderate CKD (GFR = 45-59 mL/min)

Stage 3B Moderate CKD (GFR = 30-44 mL/min)

Stage 4 Severe CKD (GFR = 15-29 mL/min)

Stage 5 End Stage CKD (GFR <15 mL/min)

Causes:
1. Diabetes
2. Hypertension

Signs and symptoms:

Decreased urine output, although occasionally urine output remains normal.

Fluid retention, causing swelling in your legs, ankles or feet.

Shortness of breath.

Fatigue.

Confusion.

Nausea.

Weakness.

Irregular heartbeat.

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Leading cause of disability among people age 65 and older. Factors that contribute
-Age related loss of muscle mass
-Obesity
-Disorders of the joint
-Trauma
-Congenital abnormalities, like hip dysplasia
Prevention strategies include
-Stretching
-Activities that strengthen stress absorbing ligaments.
Signs and symptoms
-Tenderness
-Swelling
-Loss of flexibility

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Inflammation of the glomeruli in the kidneys. (filters)

Signs and symptoms:

Pink or cola-colored urine from red blood cells in your urine (hematuria)

Foamy or bubbly urine due to excess protein in the urine (proteinuria)

High blood pressure (hypertension)

Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen

Urinating less than usual

Nausea and vomiting

Muscle cramps

Fatigue

Causes:
1. infections
2. autoimmune diseases
3. Vasculitis

Complications:
1. AKI
2. Kidney failure
3. Hypertension

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powerful anti-inflammatory agents
Used to treat rheumatoid arthritis

Common meds:
Cortisone, Hydrocortisone, Prednisone

Side effects:
-HTN
-Peptic Ulcer
-Aggrevation of diabetes mellitus
-Inc. infection risk
-may suppress normally produced corticosteroids

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Narcotics and Corticosteroids treat pain and inflammation for rheumatoid arthritis and osteoarthritis
Common narocotic analgesics:
Codeine, Demerol, Morphine, Vicdodin, Oxycodone, and Dilaudid
Side effects
sedatioin, mood changes, N&V,  constipation, orthostatic hypotension, and respoiratory depression

NSAIDS and acetaminophen are used for mild to moderate pain
Common side effect is gasatric irritation
High dosages can cause renal and hepatic toxicity

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Specific antiseizure medication medication depends on the type of seizure present in the patient

Common side effects
GI distress, Headache, dizziness, lack of coordination, and rashes

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Depression is the most common mental disorder in the elderly due to death of a spouse, divorce, declining health, and/or loss of independence

Common prescribed antidepressants:
Serotonin reuptake inhibitors - Prozac, Wellbutrin
Tricyclic antidepressants - Elavil and Trofanil
Monoamine oxidase inhibitors - Marplan and Nardil
The use of antidepressants can cause side effects:
-sedation, lethargy, and muscle weakness
-Produces anticholinergic effects (dry mouth, constipation, urinary retention, and confusion)
-Orthostatic hypotension,cognitive abilities

Elderly patient with bipolar disorder may be treated with lithium carbonate. The drug helps control s the modd swings.

Common antipsychotic meds:
- Thorazine, Mellaril, Taraactan, Navane, Haldol
They can cause sedation and anticholinergic effects, restelessness, and involuntary muscle moevements

Benzodiazepine are the most commonly prescribe sedative-hypnotic and anciolytic drugs. They are used to reduce anticty, promote sleep, and relax the patient.
Common Benzos
-Flurazepam, temazepam, triazolam, , diazepam, lorazepam, and librium
Side effects can cause drowsiness, sluggishness, and addictioin

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Biggest risk factor in elderly individuals prescribed anticoagulants is the increased risk of hemorrhage following falls.

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Angina pectoris literally means "pain in the chest." Angina develops when narrowing of the coronary vessels as a result of plaque or vasospasm leads to an inability to meet the oxygen demands of the heart muscle.

The heart muscle usually responds by sending out pain signals, which represent a buildup of lactic acid.

In an elderly patient, exercise intolerance is a key symptom of angina.
Obtain history of any changes in routine, ask about any increase in stress.

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Used to treat hypertension and CHF. They are the ones that end in "pril".

-Can cause chronic hypotension in patients that are also taking a high-dose loop diuretic.
-Hemodialysis patients may experience anaphylactic reactions with ACE inhibitors. This is due to kinase II being blocked by ACE inhibitors. Plasma levels increase 10-fold causing a reaction.
-Can cause plasma volume reduction and hypotension with prolonged vomiting and diarrhea, especially in elderly.

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Diuretics act on kidney to inc urine flow and the excretion of water and sodium.
Treats HTN and CHF
Common Meds:
Hydrochlorothiazide, Furosemide, Bumetanide, & Torsemide

For Furosemide:
often prescribed a smaller dose due elderly being sensitive to adult dosages
Side effect may cause excessive urination
-may put elderly at risk for postural hypotension, circulatory collapse, potassium depletion, and renal function impairment

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Urinary Tract Infections (UTI) affect about 10%  of the elderly population every year. Younger women suffer more from utis than men do. This infection is usually caused by bacteria and can then lead to urosepsis due to low immune system in elderlies.

Factors than can contribute in UTI's are:
-Atrophic vaginitis (in women)
-Bladder outlet obustrictio from benign prostate hyperplasia (in men)
-Dementia, w/ resulting in poor hygiene
-Diabetes
-Immobolization
-Stroke
-Upper urinary tract stone
-Use of bladder catheters

S&S
-Cloudy, foul smelling urine
-bladder pain
-frequent urination

Urosepsis S&S
-acute process
-fever
-chills
-abd discomfort

Usually begins within 24-72 hrs after catheterization or cystoscopy.

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Widely used to treat HTN, angina, and cardiac arrhythmia
-olol
Common B-Blocker Meds:
Propranolol, Atenolol, Sotalol, Esmolol, Metoprolol, Labetalol

Side effects: (elderly are more susceptible)
Depression, lethargy, and sleep disorders

Since most geriatric patients have preexisting Cardio problems, administering B-blockers will limit the body's ability to compensate.
-can cause orthostatic hypotension
-limits heart's ability to increase contractile force
-limits heart's ability to increase cardiac output

Treatment for B-Blocker OD:
-general supportive measures
-removal of gastric contents
-fluids
-administration of non-adrenergic inotropic agents, such as glucagon, for hypotension
-Atropine

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Most common renal diseases in geriatrics include renal failure, glomerulonephritis, and renal clots.

Two age-related factors: 1. loss in kidney size, 2. changes in the walls of the renal arteries and in the arterioles serving the glomeruli.

More likely to accumulate toxins and medications within the bloodstream.

Signs and symptoms that precipitate acute renal failure include: hypotension, heart failure, major surgery, sepsis, angiographic procedures (dye is nephrotoxic), and use of nephrotoxic antibiotics. Chronic hypertension.

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its a degenerative disorder that is characterized by changes in muscle response that include tremors, loss of facial expression, and gait disturbance. It appears in people who are 50 but peaks at 70.
- the cause of Parkinson's disease is unknown, but it does affect the basal ganglia in the brain. some most common causes...
- viral encephalitis
- atherosclerosis of cerebral vessel
- metabolic disorders
- tumors
- head trauma
- degenerative disorder

This disease is progressive and soon becomes rigid and more slow and jerky. A kyphotic deformity is a hallmark sign, and they seem to say they feel frozen by the feet.
- they communicate slowly and are devoid of all face expressions, this leads to depression and anxiety.
- there is no known cure for Parkinson's, but for prehospital its mainly transport and treating more manageable conditions

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Largely responsible for fractures of the hip, wrist, and vertebral bones following a fall or other injury. Risk factors would include
-Age: Decreased density should be considered at about age 50
-Gender: The decline of estrogen production places women at higher risk of developing osteoporosis than men.
-Race: White and Asian more likely to develop it than African Americans and Latinos
-Body weight: low body weight at greater risk to develop it.
-Family history: Genetic factors such as peak bone mass attainment.
-Miscellaneous: Late menarche, nulliparity, and use of caffeine, alcohol, and cigarettes are all thought to be determinants of bone mass.

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Substance abuse in the elderly is generally related to end-of-life circumstances including:
-Loneliness
-Unemployment
-Loss of partner/friends
-Malnutrition
-Polypharmacy
-Relocation

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can be confused easily in elderly, but the first seizure can occur as a result of damage from previous strokes. Some seizures can be subtle and are not necessarily the major type. many causes of seizures in elderly are...
- Alcohol withdrawal
- hypoglycemia
- Mass lesion
- Epilepsy
- stroke
- syncope

Antiseizure medications are...
- Carbamazepine (tegretol)
- Ethosuximide (Zarontin)
- Gabapentin (Neurontin)
- Lacosamide (Vimpat)
- Lamotrigine (Lamictal)
- Levetiracetam (Keppra)
- Phenobarbital (Luminal)
- Phenytoin (Dilantin)
- Valproic acid (Depakote)

Because you cant really determine the cause of seizures always treat life-threatening emergencies and rapid transport to eliminate possible stroke. If the pt were to fall during a seizure, check for evidence of trauma and treat if so.

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(Stroke/TIAs)
Stroke
- is the fourth leading cause of death in the united states
- the likelihood of elderly people dying from strokes increase with age, and occlusive strokes are more common in elderly than in younger adults, and Transient Ischemic attacks are also common in older patients.
- Older pts are at high risk because of because of atherosclerosis, hypertension, immobility, limb paralysis, CHF, and atrial fibrillation.
- More than one-third of elderly patients will who suffer from TIAs will develop permanent stroke and this condition is usually caused by syncope in elderly.

Strokes two categories
Brain Ischemia
- injury to the tissue in the brain that is caused by inadequate supply of oxygen and nutrients. This usually accounts for 80% of all strokes
Subarachnoid Hemorrhage/ intracerebral hemorrhage
- they have different presentations, and treatments, but they account for a high percent of strokes that lead to death.

Symptoms
- altered mental (highly suspected), coma, slurred speech, paralysis, mood change, and seizures

Treatment/ prevention
- Prehospital stroke scale
- rapid transport, or fibrinolytic agents can help patients suffering from occlusive (ischemic) strokes that can decrease the damage.
- cessation of smoking, recreational drugs
- control of hypertension
- treatment of blood disorders, like anemia and polycythemia ( excessive RBC's)
- treatment  of Cardiac disorders like arrhythmias and Coronary artery disease

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Increased drug sensitivity and polypharmacy contribute to occurrence of substance abuse in the elderly.
The elderly population is more likely to hide their dependence on certain medications.

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While many elderly individuals completely abstain from alcohol, approximately 27% admit to excessive drinking regularly. Elderly people are more likely to have complications from toxicity and drug interactions. Providers should keep in mind that signs of alcoholism may mimic those of other age-related conditions, such as dementia.

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are common and most frequent emergency among the elderly.
Common GI complaints:
nausea, poor appetite, diarrhea, and constipation

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Causes:
-tumors
-prior abdominal surgery
-presence of vertebral compression fraction

S&S:
-diffuse abdominal pain
-bloating
-N&V
-Abdomen may feel distended when palpated
-Hypoactive/absent bowel sounds
If Bowel Obstruction is present for a good while then pt may present with
-fever
-weakness
-shock
-various electrolyte distrubances

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Upper GI Bleed:
Peptic Ulcer disease - injury to mucous lining of GI tract due to stomach acids, digestive enzymes, or other agents
Gastritis - inflammation of the lining of the stomach
Esophageal Varices - abnormal dilation of veins in the esophagus
Mallory-Weiss tear - tear in the lower esophagus usually due to severe & prolonged vomiting

Lower GI Bleed:
Diverticulitis - presence of small pouches on the colon
*causes 70% of life threatening lower GI bleeds*
Tumors - can cause bleeding when it erodes into the blood vessels within
Ischemic Colitis - inflammation of the colon due to impaired or decrease blood supply
Arteriovenous malformations - abnormal link between an artery and vein

Hallmark S&S:
-Melena
-Hematochezia
-orthostatic hypotension
-pulse >100 bpm
-confusion

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Occurs when a portion of the bowel doesn't receive enough blood to survive

Causes:
-Changes in the heart (A-fib)
-Atherosclerosis
-Significant bowel swelling to cut off blood flow

S&S:
-Pain out of proportion *Immense Pain*
-Bloody diarrhea
-Tachycardia
-Abdominal Distention

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An M.I. involves actual death of muscle tissue owing to a partial or complete occlusion of one or more of the coronary arteries.
Common age patients hospitalized: 65+

The elderly patient with M.I. is less likely to present with symptoms, such as chest pain

Atypical S&S:
Absence of pain
Confussion / Dizzines
Dyspnea
Exercise intolerance
Fatigue
Neck, dental, and or epigastric pain
Syncope

Unlike younger patients, the elderly are more likely to suffer a silent MI.

Most commonly triggered by some form of physical exertion or preexisting heart disease.