Geriatric Emergencies¶

Category: Special Populations Sources: UCLA EMT Ultimate Study Guide (2026) Last updated: 2026-05-06

Overview¶

Geriatric patients (generally age 65+) present unique assessment challenges. Normal physiologic changes of aging mask or alter classic presentation of common emergencies. Diseases that cause obvious symptoms in younger patients may present only as altered mental status or vague decline in the elderly. EMT-B must maintain a high index of suspicion and resist anchoring on a "clean" initial assessment.

Key Points¶

AMS in elderly = emergency until proven otherwise — altered mental status may be the only sign of MI, UTI, sepsis, or stroke
UTI is the #1 cause of acute delirium in elderly patients — especially women; fever may be absent
Atypical presentations: elderly patients frequently do NOT have classic symptoms — no chest pain in MI, no fever in infection, no acute belly pain in intra-abdominal emergencies
Polypharmacy: multiple medications interact; beta-blockers blunt tachycardia and mask shock; anticoagulants increase bleed risk dramatically
Falls: highest-risk mechanism for elderly — assume cervical spine and intracranial injury until proven otherwise; rib fractures from low-mechanism falls are common
Skin fragility: thin, easily torn; avoid tape directly on skin; pressure injuries develop rapidly
Physiologic reserve is reduced: elderly patients decompensate faster and have less tolerance for hypoxia, hypotension, and pain medication

Physiologic Changes of Aging¶

System	Change	Clinical Impact
Cardiovascular	Decreased cardiac output; arteriosclerosis; reduced HR response	Slower to compensate for blood loss; HR may not rise in shock
Respiratory	Decreased lung elasticity; reduced cough reflex	Higher aspiration risk; hypoxia develops faster; SpO₂ may be baseline-low
Neurologic	Brain atrophy; slower processing; baseline cognitive changes	More vulnerable to AMS; subdural hematomas may expand slowly over days
Renal	Reduced GFR; decreased drug clearance	Drug toxicity more common; dehydration harder to compensate
Musculoskeletal	Osteoporosis; reduced muscle mass	Fractures from low-force mechanisms; compression fractures from minimal trauma
Thermoregulation	Blunted fever response; reduced shivering	Infection may present with normal or subnormal temperature
Skin	Thin, dry, fragile	Minor trauma = significant injury; pressure necrosis rapidly
Immune	Reduced immune response	Infections may be severe before recognizable signs

Atypical Presentations — High-Yield Grid¶

Condition	Classic (Young Adult)	Atypical (Elderly)
Myocardial Infarction	Crushing chest pain, diaphoresis, radiation to arm/jaw	Fatigue, dyspnea, nausea, weakness, confusion — NO chest pain in up to 40%
Sepsis	Fever, chills, tachycardia, confusion	Normal or low temperature, normal HR (beta-blocker effect), AMS may be only sign
UTI	Dysuria, frequency, urgency	Acute confusion, agitation, or behavioral change — without urinary symptoms
Stroke	Unilateral weakness, facial droop, speech deficit	Subtle: gait change, confusion, dizziness, fall — easy to attribute to "usual" dementia
Appendicitis	RLQ pain, rebound tenderness, fever	Diffuse mild discomfort, minimal guarding, normal temperature — perforation more likely before diagnosis
Pneumonia	Fever, productive cough, pleuritic chest pain	AMS, weakness, decreased appetite, mild cough — fever often absent
Hypoglycemia	Diaphoresis, tremor, anxiety, hunger	AMS, weakness, focal neuro findings — may mimic stroke
Pulmonary Embolism	Sudden dyspnea, pleuritic chest pain, hemoptysis	Gradual dyspnea, fatigue, syncope — often attributed to deconditioning

KEY DIFFERENTIATOR — AMS in Elderly: When an elderly patient has acute mental status change, do NOT assume it is dementia or "just how they are." Acute AMS = new medical or traumatic emergency. The most common causes: UTI, medication effect, hypoglycemia, sepsis, stroke, MI, subdural hematoma. Treat as emergency, establish baseline from family/caregiver.

UTI and Delirium — Special Emphasis¶

UTI is the #1 cause of acute delirium in elderly patients, particularly women. Key facts:

Classic UTI symptoms (dysuria, frequency, urgency) may be absent — urinary changes may be subtle or unnoticed
Presentation: sudden-onset confusion, agitation, behavioral change, or worsening baseline cognitive function
Temperature may be normal — elderly patients have blunted febrile response
History from family/caregiver is essential — "she's not herself today" is a significant complaint
EMT-B action: transport, document exact baseline from caregiver, note timing of mental status change

Falls in the Elderly¶

Falls are the leading cause of injury death in patients over 65. Every fall requires systematic assessment:

High-risk injury patterns: - Head injury / subdural hematoma — even low-mechanism falls; brain atrophy stretches bridging veins; hematoma may expand slowly over days to weeks - Hip fracture — often low-mechanism; classic presentation is inability to bear weight, external rotation and shortening of affected leg - Rib fractures — osteoporotic ribs fracture easily; multiple rib fractures = pulmonary compromise risk - Vertebral compression fractures — thoracic/lumbar; may be minimal pain initially - Cervical spine injury — even from a standing-height fall; always consider SMR for GCS <15 or mechanism

EMT-B assessment: 1. Determine CAUSE of fall — syncope? Weakness? Environmental hazard? — the cause may be the emergency 2. Full head-to-toe assessment: don't assume minor injury from low mechanism 3. Anticoagulant use? (warfarin, rivaroxaban, apixaban) — dramatically increases intracranial bleed risk 4. Check for signs of elder abuse: patterned bruising, inconsistent mechanism, delayed presentation

Polypharmacy — Assessment Considerations¶

Elderly patients average 5–9 medications. Key interactions affecting EMT-B assessment:

Drug Class	Effect on Assessment
Beta-blockers	Blocks tachycardia — HR may be normal even in shock or severe pain
Anticoagulants (warfarin, NOACs)	Minor trauma = major bleed risk; any head injury = high priority transport
Diuretics	Baseline dehydration; electrolyte abnormalities; hypotension
Insulin / oral hypoglycemics	Hypoglycemia risk — check glucose in any AMS
Opioids / benzodiazepines	AMS, respiratory depression, fall risk
ACE inhibitors / ARBs	Hypotension risk; may mask signs of fluid loss

NREMT RULE — Beta-Blockers and Shock: A geriatric patient on beta-blockers may NOT be tachycardic even in severe shock or anaphylaxis. Do not use a normal heart rate to rule out hemodynamic compromise. Assess skin, cap refill, LOC, and BP.

Communication and Assessment Adaptations¶

Speak slowly and clearly — face the patient; many have hearing loss
Hearing aids: check if in place and functioning; do not assume cognitive deficit from communication difficulty
Vision impairment: describe what you are doing before touching the patient
Baseline from caregiver: always ask "is this normal for them?" — establish what changed and when
DNR/POLST: elderly patients frequently have advance directives — ask early, document, follow if valid

Load-and-Go Indicators in Elderly¶

Lower threshold for rapid transport. Consider Load & Go if: - Any AMS that is new or changed from baseline - Fall with head injury in anticoagulated patient - Signs of sepsis (even without fever) - Vital sign abnormality (even subtle hypotension) - Unable to determine baseline

NREMT Relevance¶

UTI = #1 cause of acute delirium in elderly — classic for NREMT scenario questions
AMS in elderly = always a new emergency, never assume it is baseline dementia
Beta-blockers blunt tachycardia — normal HR does not rule out shock
Low-mechanism falls can produce life-threatening injuries (subdural, hip fracture, rib fractures)
Atypical MI presentation in elderly: no chest pain in up to 40% of cases — fatigue and dyspnea instead
Fever may be absent in elderly with serious infection — temperature is unreliable indicator

altered-loc — AEIOU-TIPS causes of AMS; same framework applies
shock — shock may present without tachycardia in elderly/beta-blocker patients
acs-chest-pain — atypical MI presentations
head-injury-tbi — subdural hematoma; lucid interval; anticoagulation risk
primary-assessment — baseline from caregiver; Load & Go criteria

Sources¶

UCLA EMT Ultimate Study Guide (2026) — Ch 22: Special Populations (Geriatric)