Senior citizens face a collection of safety issues unique to their age range, and hazards that might not pose much of a threat to younger people can nonetheless be a serious concern for older patients. Some of these risks, like falls, are well known and can be mitigated to a large extent. Others, though, are not well understood and do not have such an easy fix. For this reason, physicians pay close attention to the unique risk factors that can affect their elderly patients. It is also important that elderly patients and their physicians maintain a strong sense of communication, as many emerging problems can be managed if given enough attention.
What are some of the major safety issues that elder patients have to manage?
One of the axioms of aging is that as the body gets older, it becomes more vulnerable to a variety of diseases and injuries. Even the most health-conscious patient will eventually have to confront the limitations that age puts on their body. This reiterates the need to build a strong relationship between physician and patient, as it is the familiar physician that is often the most thorough.
But what safety issues should physicians and their elderly patients pay attention to? There are several, including:
1. Falls – Falls have long been a safety issue of paramount concern, as they can happen anywhere and at any time. Even something as innocuous as a rug on the floor can cause a serious tumble, and for people living along, this can produce a great deal of anxiety.
According to the National Council on Aging, 25 percent of Americans over the age of 65 suffer at least one fall every year. Every 11 seconds, an elderly person has to be taken to the emergency room due to a fall, and every 19 minutes, an elderly person sustains fatal injuries due to a fall. That comes out to nearly 3 million fall injuries treated in emergency rooms annually. It’s not just the physical toll either, as the ever present nature of fall risks mean that elderly patients offer suffer from considerable anxiety, depression and social isolation.
The risk of a fall can be reduced by taping down floor rugs, keeping walking paths clear, adding nightlights throughout the home and adding non-slip mats to the bathroom and kitchen, where slipping is more common. It’s also worth considering adding grab supports in higher risk areas, like the staircase and bathroom.
Because falls can disable an elderly person and leave them stranded in their own home, a medical alert device can provide the kind of peace of mind needed to combat the fear of falling. An immediate response can clearly improve medical outcomes for the patient.
2. Hearing or vision loss – The eyes and ears eventually won’t work as well as they once did, and for some elderly patients, this can make elements of day to day life problematic, and even risky. Both hearing and vision loss can, literally, leave an elderly person in the dark, and make accidents like falls much more likely to occur. This risk is magnified when the patient leaves their home and is exposed to less familiar surroundings.
Poor hearing and vision can also lead to deadly medical accidents, like taking the wrong medication or misreading the dosage. And, of course, hearing and vision loss limit what activities a patient can engage in, and this can lead to depression and a feeling that life is losing its quality.
Some conditions associated with vision and hearing loss are progressive, which means if they are addressed early, they can be managed or mitigated to an extent. This may mean something as simple as recalibrating a hearing aid. It may mean trying new medications or adjusting expectations for particular activities. Whatever the course of treatment, hearing and vision loss should be a major priority for patients and their physicians.
3. Medication mistakes – As people age, the number of medications they take tends to increase. In fact, according to the National Council on Aging, more than 90 percent of older adults have at least one chronic disease that requires treatment. Close to 80 percent have at least two chronic diseases. Managing chronic conditions sometimes requires several medications, especially when an initial pattern of treatment is being established. As medications are cycled in and out, the possibility that a patient is given drugs that interact poorly increases.
A 2012 study published in Toxicology International found that among people 65 years old and older, about half take at least five pharmaceutical drugs a week, and approximately 10 percent take 10 drugs or more a week. When handling this many medications at once, close supervision is required, as dangerous drug interactions are much more likely as new drugs are added to a regimen. Consider that nearly 20 percent of hospitalized patients experience some form of adverse drug reaction, and it’s clear that elderly patients need a physician who pays close attention to their patients’ prescribed medications.
It goes beyond simple drug interactions, too, because some patients suffer from conditions that make them particularly vulnerable to certain medications. Patients suffering from renal failure, for example, are at a much higher risk of adverse drug reactions than the general population. It is essential, then, that physicians maintain a detailed medical history of their patients to spot any possible contraindications before they cause a medical emergency.
4. Malnutrition – One of the silent epidemics among the elderly is the sharply increasing prevalence of malnutrition. Every year, about 1/3 of all elderly patients admitted to hospitals suffered from malnutrition to some extent.
Malnutrition has massive effects on a patient’s health outcomes, with one study in Clinical Nutrition determining that patients suffering from malnutrition can expect to incur medical costs that are up to 300 percent higher than patients receiving adequate nutrition. And there is plenty of research that shows that elderly patients suffering from malnutrition experience longer hospital stays, higher readmission rates, more frequent and more serious complications, a poorer immune response and greater mortality.
There are many causes of malnutrition, including changes in taste, functional or cognitive impairments, depression and anxiety. Fortunately, these underlying concerns can be addressed to an extent, but before they can be treated, the physician must be aware of any risk factors that may contribute to possible malnutrition.
5. Delirium – Delirium is not dementia, but it can manifest in similar fashion. During a delirious state, the patient may speak incoherently or about events that have long since occurred. Delirious patients may behave unpredictably, either becoming hyperactive and manic, or withdrawn and depressed. In some cases, patients may experience hyperactive and depressed states in rapidly altering cycles or even simultaneously.
Delirium can affect people of all ages, but it is a much greater concern in elderly patients, though the reasons why aren’t completely understood. It is likely due to a host of physical and cognitive factors, such as a less efficient immune response that may interfere with neuron signaling in the brain.
Elderly patients that are in the throes of a delirious episode can be a danger to themselves, as they may not fully comprehend potential hazards in their environment and may not be able to properly engage in self-care.
The good news is that delirium is not a permanent state and can be managed with close supervision and supportive care. It is typically caused in concert with another illness or disease, so treating the underlying illness is often enough to truncate the episode or prevent future episodes from occurring.
Safety issues among the elderly are so common that every patient should be monitored closely for any changes in health or living circumstances. And this falls to primary care physicians, who are trusted to build close relationships with their patients. It is this dedicated attention that is the lynchpin of effective care for senior citizens.