Thanks to modern medicine and advances in genomics, cancer treatment, and longevity research, the aging population across the United States continues to grow. As it grows, the frequency of EMS providers responding to geriatric patients will only increase.
Elderly patients already make up a large proportion of EMS providers’ call load, especially in certain regions of the country (Florida, Arizona), and since many of these patients have preexisting conditions, such as emphysema, COPD, or pulmonary edema, the chance that they may need suctioning is always a possibility.
There are special considerations when suctioning geriatric patients. Here, we will discuss three complexities of treating elderly patients and how these complexities relate to suction. They include:
- Recognizing the anatomical and physiological changes that take place as the body ages
- Special considerations when performing a patient assessment
- Precautions when suctioning elderly patients
The Aging Body
As each of us knows, the body changes dramatically over time. As we move from adolescence to adulthood, we realize the differences more. And as adulthood gives way to middle age and beyond, the changes can be stark.
It is important to anticipate these changes when approaching an elderly patient:
- Body temperature regulation: The elderly may have trouble maintaining body temperature or recognizing when they are running a fever.
- Diminished sensory organs: Patients may have hearing deficits, so speak loudly and clearly and assist those with visual impairments.
- Loss of mobility: Weakening muscles and bones can limit mobility in the elderly, so provide support when needed.
- Dementia and senility: Elderly patients may have diminished faculties, so include family and caregivers when obtaining a medical history.
Some physical changes in the elderly require special consideration when developing your treatment plan. These include:
- Loss of flexibility in the neck/spine: Be sure to pad when providing spinal immobilization.
- Rigidity of the chest: This may hamper auscultation of the chest and air movement.
- Dental hardware (dentures, bridges, and false teeth): These can produce obstructions and affect mask seal when ventilating.
- Inability to effectively swallow: Be alert for the need to suction.
Assessing the Elderly Patient
Performing a patient assessment may take more time and patience with the elderly. If their condition warrants it, allow more time for your assessment and keep in mind that you may have some hurdles to overcome. These hurdles may include:
- Determining level of consciousness: Confusion may be the norm due to dementia or stroke, so question caregivers and family members about the elderly individual’s normal mental activity.
- Cardiovascular assessment: This can be affected by medications (beta blockers or antihypertensives). Obtain a list of the patient’s medications whenever possible.
- Patient may have a pacemaker.
- Volume replacement may be complicated by patient’s medications, especially in cases of suspected shock.
- Delayed capillary refill is common.
- Body temperature may be slow to adjust, especially in serious conditions.
Be alert for signs of distress. The signs of respiratory distress include:
- General appearance
- Vital signs
- Respiratory rate
- Pulse
- Oxygen saturation
- Capnography
- Level of consciousness
- Obvious signs of distress
- Positioning
- Anxiety
- Tachycardia
- Tachypnea
- Skin color and moisture
- Diaphoretic
- Pale or cyanotic
- Signs of imminent respiratory arrest
- Decreasing level of consciousness
- Patient tiring/exhaustion
- Cyanosis
Recognizing the signs of hypoxia are critical. It may be more complicated in the elderly, especially for those with diminished levels of consciousness due to dementia or previous stroke. Signs of hypoxia could indicate the need for suctioning, so be sure to watch for:
- Increased work of breathing
- Restlessness/agitation
- Confusion that isn’t normal for the patient
- Decreased LOC (when not the norm)
- Inadequate breath sounds
- Abnormal breath sounds (gurgling, wheezing, stridor)
- Coma
- Seizures
Aspiration is always a possibility in the elderly, especially when associated with:
- Swallowing disorders
- Impaired mental status
- History of seizures or stroke
- Frequent vomiting
Suction Considerations in Geriatric Patients
Once you have assessed your patient and determined that their condition requires immediate suctioning, there are several precautions to keep in mind with elderly patients. These include:
- Dental hardware, which can come loose and cause an obstruction
- Suctioning with precision to avoid damaging fragile oral/nasal tissues
- Having the appropriate catheters on hand (small tip) for navigating smaller mouths
- Dialing back suction pressure to avoid traumatizing tissues
- Padding the patient when placed in the supine position for suctioning
- Rigid torsos may make for difficult angles, so have a hyper-curved catheter on hand
Assessing and treating geriatric patients require special considerations. A thoughtful,
considerate approach will enhance your assessment, tailor your treatment, and produce better results, especially during suctioning, so be sure to keep these three complexities in mind when suctioning geriatric patients.
2011, Pollak, A., Ed.
Critical Care Transport, American College of Emergency Physicians, Jones and Bartlett.
