Norfolk and Norwich University Hospital has announced recently that they will be opening a dedicated A&E unit specifically for elderly patients over the age of 80. These patients make up one in seven of the hospital’s 350 A&E admissions every day.
The unit will be staffed by doctors, geriatricians and nurses who specialise in care for the elderly and who are trained in the unique needs of this age group. They will be able to deliver prompt and appropriate care straight away, without the patient waiting for a referral from the standard A&E department.
The Aging Population
The Office for National Statistics tells us that the UK population is aging rapidly. 18% of are now aged over 65 and 2.4% are aged over 85. According to the latest statistics released, there are now 265 people of the age of 65 or over for every 1000 people of working age.
With the population aging across the country, we all need to be aware of the special needs of the elderly in our community. With a one in five chance that your first aid patient will be aged 65 or over, it has never been more important to understand the challenges and skills of first aid for the elderly.
Treating Older People
Much is written and taught about first aid for children, with specialist paediatric first aid courses available to train first aiders in the unique needs of the under 8s. Yet many elderly people, especially those in their 80s and 90s, require first aid care that is just as specialised.
Elderly people have different emotional and physiological needs to the general population, and they are often at greater risk, both from infection and from their treatment actually causing further damage. So how should we approach first aid for the elderly, and what do we need to do differently to ensure we are giving them the best possible care?
Two of the biggest risks for elderly patients are heart attacks and strokes, and it is important that you learn to recognise the symptoms of each, as in both cases, literally every minute counts. The faster your response, the better the outcome.
Stroke symptoms include:
- Sudden numbness in the face, arm or leg on one side
- Sudden confusion or disorientation
- Problems with speech or understanding what is being said
- Sudden loss of balance or co-ordination
- Drooping of one side of the face
Heart attack symptoms include:
- Chest pain (which may not be severe)
- Pain in the left arm, shoulders or back
- Shortage of breath or light headedness
- Sweating and sudden onset fatigue
As a first aider, there may not be much you can do to directly help a patient suffering from a stroke or a heart attack, but recognising the symptoms and calling an ambulance fast can literally make the difference between life and death.
If the patient’s heart stops during a heart attack, it is important to remember that older people have weaker bones, and so CPR should be performed with care to avoid breaking ribs.
Elderly people tend to have thinner, more fragile skin, which can tear easily and this means that they are more prone to cuts, scratches and abrasions. Since their immune system is not as strong as that of a younger person, they are more at risk of infections from broken skin, and so it is important that all such wounds are cleaned thoroughly and treated with an appropriate antibiotic cream.
Care must be taken when dressing wounds for elderly patients, as plasters or sticky tape can damage the skin and cause tearing when they are removed. Wherever possible, arm or leg wounds on elderly patients should be dressed in such a way that the dressing goes all the way around the limb, and the tape only sticks to the dressing.
Elderly people will tend to have weaker bones than younger patients, as a result of osteoporosis and general wear and tear. This makes them much more prone to breakages if they fall over.
It is important to remember how brittle elderly people’s bones can be when moving a fall victim, as you could end up doing more harm than good. It is usually better to simply make them as comfortable as possible where they are, and leave any moving to the trained paramedics when they arrive.
While you are waiting for the ambulance, you should check for, and treat, any bleeding, and also check that the broken bone has not compromised the circulation to the fingers or toes, causing them to turn blue. Apply ice, wrapped in a towel, around the area of the break to reduce swelling and improve blood flow.
Problems with Dementia
As people age, many of them start to suffer with dementia, and this can be problematic when it comes to administering first aid. Elderly patients can be a lot like small children in an emergency situation, and will need to be kept calm and reassured at all times. Try to communicate calmly, slowly and clearly with the patient to find out what has happened and where they might be hurt. If they are confused and frightened, this will only slow the process down, costing vital minutes of care.
Another problem with dementia is the risk of choking, as dementia patients often do not chew their food enough before swallowing. If you are caring for an elderly person, make sure you are familiar with the Heimlich manoeuvre just in case.
If a dementia patient has taken an accidental overdose, as a result of forgetting they had taken their medication, or forgetting the correct dose, it is important to gather as much information as possible about the drugs ready for the ambulance crew when they arrive.
Hypothermia and Heatstroke
Elderly people often have a reduced ability to regulate their body temperature, which can leave them at risk of becoming too cold, or even over heating, without being aware of it, causing hypothermia or heatstroke (hyperthermia).
In both cases, it is important to call an ambulance as quickly as possible, and to try to normalise the patient’s temperature while you wait. In the case of hypothermia, remove any wet clothing and wrap them in warm dry blankets. However, you should avoid placing them too near to a fire or radiator, as they need to warm up gradually, from the torso out. In the case of heatstroke, you should try to cool the patient down with a cold shower, or by sponging them with cold water, as well as giving them iced water to drink.
Taking Time to Care
Above all, it is important to take the time to care when delivering first aid to the elderly. Talking slowly and clearly to the hard of hearing, having a reassuring manner around the fragile and the frightened, and understanding the unique needs of this age group, emotionally as well as physically, can make a real difference to both their experience and the outcome.