Just as “children are not little adults,” the physiologic and behavioral differences of the elderly demand that emergency clinicians manage illness in the elderly differently than we do in younger adults. In fact, two central medical principles used for children can be applied to the elderly: Patients are more vulnerable, and symptoms are much less specific.
There are unique issues involved in assessment and treatment of the elderly. Sir William Osler said, “In the old and debilitated, a knowledge that the onset of pneumonia is insidious and that the symptoms are ill-defined and latent should place the practitioner on his guard and make him very careful.” Osler’s statement holds true not only for pneumonia but also for nearly all diseases in the elderly.
“Textbook” symptoms are the exception rather than the rule in many cases with elderly patients. A behavioral change may be the only hint of an underlying infection. At least 75% of all episodes of functional decline in nursing home patients are due to infection. It is a common mistake to assume that a confused 80-year-old is “just suffering from dementia,” when in fact he or she may be a normally intact and independent person with acute delirium secondary to a UTI. Ask family members or caretakers about recent falls, anorexia, decreased activity, new incontinence, or confusion. (See table below.) These may be the only clues to a serious illness.
This information can help define the patient’s baseline functional and mental status. Five minutes on the telephone with the primary care provider or the patient’s daughter may prompt life-saving antibiotics instead of an inappropriate prescription for Haldol.
Enhance your assessment skills and management practices in elderly patients with the geriatric sessions at the 18th Annual Clinical Decision Making in Emergency Medicine conference in Ponte Vedra, FL ? June 26-29, 2019. http://www.clinicaldecisionmaking.com
Last Updated on November 1, 2021