Assessments for adult patients typically centre around their complaints, guiding examinations, and treatment plans. However, for geriatric patients, the approach drastically changes, demanding a specialized understanding in both outpatient and emergency settings. Dr Ravi Sharma, specializing in geriatrics with a vaccination focus, delves into the distinct nuances. Definitions of geriatric patients vary globally; with India at 60 years, complexities arise with age-associated comorbidities like diabetes, hypertension, and heart issues. Comprehensive assessments are necessary, especially in functional abilities, given the diversity of prescriptions and medical reports that elderly patients bring along. 

Early identification of issues, effective communication about medications, and tailored care plans are essential.

Introduction

In the context of adult patients, assessments typically revolve around their complaints, guiding examination and management based on these concerns. However, when it comes to geriatric patients, the approach differs significantly, warranting a distinct understanding of their assessment in outpatient departments (OPDs) or emergency settings. Dr. Ravi Sharma here—my focus on geriatrics and a keen interest in vaccination drive my continuous learning in this field. Defining a geriatric patient varies, with India pegging it at 60 years, while global standards often differ due to diverse considerations, such as medical, societal, and financial purposes.

With aging, comorbidities rise, complicating diagnoses in geriatric patients—diabetes, hypertension, heart conditions, and respiratory issues become more prevalent. Functional assessment, often termed Comprehensive Assessment, becomes pivotal in understanding an elderly patient’s overall functionality. Additionally, these patients usually arrive at OPDs with files full of reports, reflecting a blend of consultations, economic factors, and sometimes non-essential tests, often influenced by internet research and various prescriptions obtained from multiple specialists. Understanding their medications, including herbal or non-prescribed remedies, becomes crucial, as anything affecting the body qualifies as medication.

Comprehensive Considerations in Assessing Elderly Patients in Clinical Settings

Each medication holds significance, whether allopathic, Ayurvedic, or homeopathic. When a patient arrives at the OPD with a specific complaint, it might stem from a fall, surgery, bleeding, fever, vomiting, loose motions, loss of appetite, swelling, breathlessness, altered sensorium, or altered memory. The distinction between recalling old memories and experiencing recent memory loss is crucial. Despite the presenting complaint, we tailor the examination to that system and explore further based on their concerns.

Unearthing comorbidities becomes crucial, revealing details such as a patient managing diabetes or heart issues. Even when seeking care for a specific ailment, like vomiting, it’s vital to acknowledge any concurrent conditions. For instance, if an individual has diabetes and presents with vomiting, it might signify diabetic ketoacidosis, altering our approach.

In evaluating an elderly individual, an assessment of their daily activities is imperative. Ensuring they can self-administer medications, follow dietary instructions, and manage personal care is crucial. A functional assessment might seem extensive, but it proves relatively simple and not excessively time-consuming.

Before prescribing medications, examining renal function and liver function and investigating reports uncovers surprising revelations, like vitamin deficiencies or lipid irregularities. Considering the patient’s other prescriptions, whether from a general physician, family doctor, or self-medication, becomes vital. Engaging with a patient’s history and previous medications helps avoid potential drug interactions or adverse effects.

Their arrival might be prompted by specific complaints or precipitating factors. While addressing their primary complaint, a comprehensive evaluation involving vital checks, exploration of comorbidities, and scrutiny of their medication regimen is essential for holistic care.

Streamlining Approach and Insights for Optimizing Emergency Care for Elderly Patients

In this country, many individuals access free medications from various sources, which leads to confusion about the medicines taken. This occurs because people obtain medications from multiple places, place them in envelopes, and then lose track of what each envelope contains. These envelopes tend to pile up, leading to disarray and mix-ups. When people visit the hospital, these discrepancies cause chaos and delays in their treatment. Emergency rooms place importance on investigation reports. My late father used to emphasize that emergencies allow enough time for careful consideration rather than relying on knee-jerk reactions. The functional status of the patient is also a crucial factor in final decisions. Specific complaints, such as falls, injuries, high fever, breathlessness, and GI discomfort, bring most elderly patients to the emergency room. This book was inspired by Prosser’s work during the COVID period, focusing on identifying the symptoms elderly patients present with and offering suitable management strategies. 

These common symptoms are utilized to guide medical investigations and appropriate treatment. Ensuring vital checks, such as blood pressure, temperature, and pulse oximetry, helps to uncover key information swiftly. 

Examining and documenting various bodily systems is essential to an emergency room evaluation, covering both the specific complaint and general health observations. Quick tests for diabetes and pulse oximetry are useful for diagnostic clues in elderly patients. Medical histories can be hazy in emergencies, so it’s important to seek clues from investigations and a patient’s immediate condition to determine the course of action.It’s crucial to consider the possibilities of physical injuries, comorbidities, and the often-overlooked aspect of elder abuse. Dehydration, hypertension, electrolyte imbalances, fractures, elder abuse signs, and sepsis are among the common issues observed in elderly emergency cases. Referral to specialists is advised after initial investigations; seeking a comprehensive view from various specialists aids in rationalizing treatment plans. Ultimately, geriatricians help streamline prescriptions and investigations for better elderly patient care. The aim is to ensure a holistic and rationalized approach to emergency care for the elderly.

Conclusion

Care for geriatric patients diverges significantly from standard assessments due to increased comorbidities and functional changes. Geriatric care must account for the complexities—balancing age-related complications and diverse medical records. Timely intervention, understanding medications, and efficient investigation reports are pivotal in treating elderly patients in emergency settings. This streamlining of approach and the quest for a rationalized response to an elder’s needs are key to optimized care. The aim is to foster a specialized approach, providing holistic and comprehensive care to geriatric patients in emergencies.