Geriatric Airway Management: What Paramedics Must Know

Individuals in the United States are living longer thanks to improvements in medications and surgical intervention, and better awareness of healthy lifestyles. And prolonged life spans mean an increase in the number of geriatric patients. Aging ushers in changes in anatomy, physiology, and overall health, all of which require a more targeted approach to patient care on the part of EMS responders. And no area is more critical than airway management.

Let’s discuss some of the changes that take place in the aging body and how these changes require special consideration during patient care.

General Assessment in the Geriatric Patient – Looks Can Be Deceiving

Patient care always begins with patient assessment. The assessment may be rapid, for instance in cardiac arrest, or prolonged, such as a patient with a suspected hip fracture. But gauging the A-B-Cs and levels of consciousness can be a bit trickier in the geriatric patient. So as you begin your assessment, here are a few things to keep in mind when evaluating the elderly: 

• Determining level of consciousness may not be straightforward: confusion may be the norm due to dementia, so involve friends and family when gauging normal mental activity.
• Cardiovascular assessment may be complicated by medications such as beta-blockers or anti-hypertensives, so be sure to obtain a list of the patient’s meds.
• Be alert for pacemakers!
• Volume assessment may also be hampered by the patient’s medications, so be vigilant in cases of suspected shock.
• Delayed capillary refill may be the norm in your elderly patient.
• Temperature regulation may be hampered and slow to respond.
  
  

Airway Management in the Elderly

Airway management, like patient assessment, must take into account special considerations in geriatric patients. Here are a few reminders:

• Be alert to the presence of dentures or other dental devices when managing the airway
• Removing dentures may make intubation easier, but may complicate a good mask seal
• Broken teeth are more likely to become obstructions in the elderly
• If your patient normally has a reduced cough reflex, there is a greater chance of aspiration
• Always have suction ready!
• Chest wall stiffness may lead to reduced tidal volume, complicating oxygenation
• Kyphosis may complicate patient positioning, so use extra padding when positioning your patient.
• Nasal tissues are more fragile in the elderly, a condition complicated by the use of anticoagulants, so keep it in mind when considering nasal intubation.
• Hypoxia can progress, even in minor chest injury, so stay vigilant in your assessments.
• Older patients may rely more on diaphragmatic excursion, so be careful not to impede the abdomen when securing your patient on a backboard.

Our Aging Population

According to the Centers for Disease Control’s latest study, by 2050, 20% of the U.S. population will be ages 65 and older. Much of this increase will happen by 2030 as the last of the large baby-boom cohorts reaches age 65, more than double the number of older adults in the United States in 2010. Roughly 10,000 Americans will celebrate their 65th birthday each and every day. What that means for you, the paramedic, is that calls involving geriatric patients will continue to rise.

So be prepared by being aware. Every time you run on an elderly patient, keep in mind their aging bodies present special challenges (just like pediatrics). Maximize your treatment plans by being attuned to their distinct needs and you will be rewarded with more efficient and effective patient care.

Editor's Note: This blog was originally published in January of 2016. It has been re-published with additional up to date content.