It’s projected that by 2030, 1 in 5 Americans will be 65 or older, and the number of geriatric patients will only increase as medicine and science continue to advance and improve life expectancy.
As patients age, their bodies undergo many changes, meaning a more targeted approach to medical procedures, including airway management techniques, is required. Understanding these circumstances can make a vast difference in outcomes during emergencies.
Health Changes in Geriatric Patients
Regardless of outward appearance, geriatric patients undergo many physiological changes that may make airway management more difficult. These include:
- Decreased lung elasticity.
- Decreased chest wall compliance and respiratory muscle strength.
- Reduced cough and mucociliary clearance.
- Reduced responsiveness of brain respiratory centers to hypoxemia and hypocarbia.
- Limited mouth-opening.
- Reductions in vital capacity.
- Lost integrity in teeth and gums.
Airway Management in a Healthy Geriatric Patient
As with all patients, it’s important to gauge basic vitals and level of consciousness while preparing for treatment. However, there should be extra precautions taken with all geriatric patients, even if they appear to be in good overall health. Keep in mind that:
- Dentures can make intubation more difficult, but removing dentures can worsen face mask seals.
- Broken teeth are more likely to become obstructions in elderly patients.
- Elderly patients face an increased risk of aspiration.
- Chest wall stiffness may lead to reduced tidal volume, complicating oxygenation.
- Nasal tissues will be fragile.
- Kyphosis, an exaggerated forward rounding of the spine, is more likely to be seen in elderly patients.
- Older patients may rely more on diaphragmatic excursion.
Considering the above factors, you must take special consideration and care when managing the airway of a geriatric patient, such as:
- Avoiding nasal intubation, if possible.
- Using extra padding when positioning the patient.
- Being careful not to impede the abdomen if securing the patient on a backboard.
- Having suction equipment close by.
Additionally, due to the possibility of hypoxia progressing rapidly and the increased likelihood a geriatric patient takes medication that will mask physiological responses, a high index of suspicion should be maintained at all times.
Airway Management in an Unhealthy Geriatric Patient
Many older geriatric patients may have a history of cardiovascular disease or other medical conditions that increase in severity with age. In unhealthy or frail patients, it’s important to look for:
- Lacerated or dry lips can make intubation and obtaining a face-mask seal more difficult.
- Decreased tongue pressure.
- Rheumatoid arthritis or myelopathy can cause changes in the neck that reduce mouth opening.
If any of these conditions are present, it’s recommended to use a supraglottic device to create a better seal for ventilation or video laryngoscopy (VL) when intubating to reduce the risk of harm to the patient.
Additionally, for many elderly patients – especially those who have lost integrity in their teeth and gums – suctioning should be avoided if possible as there is a heightened risk of causing a laceration. However, geriatric patients experiencing decreased tongue pressure will likely produce excess saliva. For these patients, it is recommended to use suction equipment, such as SSCOR’s reliable and effective EMS-designed products, before using a VL, as this will enhance visualization and reduce the risk of aspiration.
Managing the airway of geriatric patients presents many unique challenges, some of which may not be easily identifiable by outward appearance. However, by remaining vigilant, being knowledgeable of the health changes and challenges our older population faces, and having the proper equipment on hand, you can provide safe and effective care to the patient while minimizing the risk of complications.
Editor's Note: This blog was originally published in February, 2022. It has been re-published with additional up to date content.
