Geriatric patients are more likely to experience respiratory emergencies such as pneumonia, aspiration, and severe respiratory infections. A range of physiological changes, including muscle atrophy, can make airway assessment and management more difficult.
This is why morbidities related to suction and airway management are more common in this population. Proper respiratory assessment is critical for informing treatment and can greatly reduce the risk of complications.
Elderly Emergency Management: Airway First
About 80 percent of seniors have at least one chronic illness. Many of these illnesses—pulmonary disease, cardiovascular disorders, and chest injuries, to name a few—directly affect the airway. This means that in any emergency involving a geriatric patient, respiratory assessment is vital to the patient’s well-being.
In younger patients, consciousness is a straightforward matter. In elderly patients, dementia, nervous system injuries, and circulatory disorders can make a patient seem confused despite being fully conscious. This can complicate the initial assessment, and warrants seeking information from secondary sources, such as nearby family, if possible. Always be alert to the possibility of a patient having a pacemaker.
Respiratory Assessment in Geriatric Patients
Respiratory assessment in geriatric patients should follow the usual protocols, including looking for the standard signs of a blocked airway. Patients may need suction when:
- Oxygen saturation drops on a pulse oximeter.
- There is a clear obstruction in the airway.
- The patient is hoarse, has a barking cough, or is unable to clear their own airway.
- There is a suspected obstruction, or the patient requests suction.
Before beginning suction, it’s critical to visualize the airway. As with all patients, you must be able to see what you are doing. Special considerations for geriatric populations include:
- Looking for broken or missing teeth, which can make obtaining a seal more difficult
- A rigid neck and less muscle tone
- Dementia that impedes communication, increases combativeness, and potentially causes panic
- Bridges, dentures, and other oral hardware that may break loose and obstruct the airway
Special Considerations for Airway Suction in Elderly Patients
Elderly patients have a right to sensitive care and explanations that make sense to them. Don’t make the mistake of assuming that an older person can’t understand or consent to treatment. Instead, speak to them in a respectful tone. Encourage them to talk about their concerns if they are able. Then, explain to them the purposes of suction. Many of the same skills used in pediatric patients can work well in elderly patients with dementia. The key is to remain calm and compassionate—don’t be aggressive or forceful.
Airway suction in elderly patients is not different technically. You should select a catheter approximately half the size of the internal diameter of the endotracheal tube for optimal suction. You should also limit suction to about seven seconds. The key difference with elderly populations is remaining attuned to potential complications. Be mindful of the following:
- How panic can lead to hyperventilation, exacerbating airway issues
- How noncompliance can result in patient injuries
- Decreased airway lubrication and muscle tone, increasing the risk of laryngeal and other injuries
- The role of hypoxia in exacerbating or causing other conditions, including heart failure
By following protocols, remaining sensitive to patient concerns, and carefully monitoring each patient, you can greatly reduce the risk of injuries and increase the potential of successful treatment.
Training and Equipment Issues in Elderly Patients
It’s easy to itemize and drill a list of special concerns elderly patients face. What’s harder is providing exceptional care in stressful, high-stakes situations. Patients may be angry or panicked. Others may have family who intrude upon the assessment or otherwise make the situation more difficult. No textbook can possibly prepare an EMS professional for the challenging realities that real patients present.
This is why preparation is so important. Your team must rehearse and drill real-world scenarios, ideally in high-stress environments. It’s equally important to select the right portable suction unit. Portable suction offers easier access to care, saves time, and ensures you can carry a suction unit in your tactical medical bag.
For help selecting the right portable suction unit for your agency, we’ve published The Ultimate Guide to Purchasing a Portable Emergency Suction Device.