Most everyone is familiar with the huge animal herds that perform a monumental annual migration in Africa. However, you may not be aware of a similar migration that is about to occur in the U.S. A significantly large number of us “baby boomers” will migrate into the geriatric scene in the near future (Canada calls us “Boomies” and Britain simply “The Bulge”). We will bring with us an increased incidence of disease and injury that will raise demands on the nation’s health care system — this includes EMS.
The Institute of Medicine’s report on EMS (Emergency Medical Services at the Crossroads, 2006) sorted 2003 U.S. data for ambulance transports to emergency departments by patient age. Ages 65 to 74 accounted for 27.5 percent of transports; ages 75 and older took an additional 40 percent. You do the math. And expect an increase in the near future.
Some elder facts:
- In 2011, most baby boomers will begin to turn 65.
- By 2026, the population of Americans ages 65 and older will double to 71.5 million.
- The fastest growing segment of the population is individuals over age 80; between 2007 and 2015, the number of Americans ages 85 and older is expected to increase by 40 percent.
- If you make it to age 65, the average life expectancy is an additional 18 years, to age 83.
- The oldest confirmed (via birth certificate) human age to date was 122 years, ending in 1997. Since that time, the current “oldest person alive” is generally in the hundred teens range.
Many older Americans are working longer, and the Boomers are expected to increase that trend. Seniors are healthier than in previous decades, even with an increasing incidence of certain health issues such as obesity and substance abuse.
Our journey into old age will play out rather predictably. Early on, healthcare should ideally focus on maintaining good health to enable work productivity and leisure enjoyment. But at some point, we begin to run out of time; survival will fail to be an option. For those of us fortunate enough to reach old age, the months or years immediately preceding our elderly death is when many of us will spend an increasing amount of time and money on healthcare.
Life quality may become increasingly more important than quantity. And it is important for us to give this some thought. How do you define quality of life for yourself? What makes life worth living? What do you value? Independence, work, health, wealth, family, friends? Whatever is on your list, the older you get, the more likely you are to suffer a reduction or loss of these quality indicators.
Add these conditions to an understanding of the physical and mental changes that generally occur with aging and you will have a foundation on which to build your skills in geriatric care. The following suggestions may be helpful:
- Be respectful; use “Ms.,” “Mr.” or “Mrs.,” and not “honey” or “dear” (unless the elder parent, grandparent or significant other belongs to you).
- Respect the patient’s independence (or what’s left of it). Keep the patient informed, explain any treatment and ask for permission to proceed with treatment.
- Face the patient when you speak to them and don’t raise your volume.
- Slow down the pace if you can; take the time to assure comfort.
- Don’t assume your patient’s complaint is due to old age. Just remember this little story: an elderly man reported to his doctor that his right knee had started to hurt. The doctor replied “It’s just old age, you’ll get used to it”. To which the patient responded, “But my left knee is just as old and it doesn’t hurt!”
- Disease may present atypically: dyspnea instead of chest pain for MI; increased respiratory rate instead of cough for pneumonia; infection without fever.
- Body system reserves decrease with increasing age, thus making a simple illness or injury a potential threat to health and independence.
- Check your geriatric general knowledge at http://www.webster.edu/~woolflm/myth.html.
- Take a geriatric course for EMS providers (http://www.gemssite.com; this site also has an extensive list of geriatric web links).
It‘s time to amplify our efforts to address the increasing out-of-hospital healthcare needs of our elders. Perhaps we can learn from the highly successful EMS program for children, EMS-C, and begin working towards EMS-E.
References
- Institute of Medicine of the National Academies, Future of Emergency Care Series. (2006). Emergency Medical Services: At the Crossroads. Washington, DC: The National Academies Press.
- National Institute on Aging. Growing Older in America: The Health and Retirement Study, 2007.
- American Association of Homes and Services for the Aging. Aging Services: The Facts. Retrieved January 16, 2007 from http://www2.aahsa.org/aging_services/default.asp
- Congressional Budget Office. The Long-Term Outlook for Healthcare Spending. November, 2007.
