Clinics in geriatric medicine
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Symptoms and signs of impaired thermal homeostasis are protean. Clinical encounters with the geriatric patient, whether acute or chronic, are often marked by imprecise historical detail, ambiguous physical findings, differing laboratory values, and unexpected responses to therapeutic modalities. In addition, geriatric patients presenting with disorders of thermoregulation have a greater morbidity and mortality than other groups. This article briefly reviews thermoregulation as well as some of the causes and treatments for both hypothermia and hyperthermia.
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The ethical framework established for most health care decision making should apply to elderly patients in the ED, i.e., the authority to decide should rest either with the competent patient or, in case of incapacity, with the patient's surrogate. Whenever possible, ethical dilemmas in the ED should be prevented from occurring through the judicious use of advance directives crafted in the doctor's office. DNR orders should be based upon the wishes of a competent patient or upon a surrogate's estimation of the patient's values and best interests. ⋯ Attention to these important problems bearing on the substance and procedures for life and death decision making in the ED should not obscure the manifest injustice of the context in which these decisions are often made. At many inner-city hospitals serving a largely poor and elderly clientele, the ED has become nothing short of a torture chamber for many critically ill elderly persons. An ethical framework for decision making, no matter how urgently needed, will not address the unnecessary pain and confusion of frail elderly patients subjected to an impersonal, overcrowded, and depersonalizing environment.
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Elderly individuals not only live longer but are also more active than in the past. Accompanying this increase in activity is the number of older trauma victims. The effect of aging on response to injury is reviewed, and the initial evaluation and treatment of geriatric trauma are delineated in this article. Specific injuries of note include head and chest wall injury; pulmonary and cardiac contusion; abdominal trauma; and aortic, spinal, and musculoskeletal injury.
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Infectious diseases continue to be a common cause for emergency department visits among the elderly population. This phenomenon may be due to the existence of comorbid diseases as well as alterations in immune function with senescence. Diagnosis and acute management of specific infections are discussed in this article, including meningitis, endocarditis, urinary tract and skin infections, septic shock, and fever of unknown origin.