As Junior Doctors, it's important to recognise that elderly patients often present with unique challenges and nuances in their healthcare needs. Their symptoms may be non-specific and downplayed, and they might conceal significant pain due to their often stoic nature. When dealing with elderly patients, whether in a hospital or clinical setting, it's crucial to approach their care with a special understanding of their circumstances. In this blog post, we'll delve into some essential considerations and strategies for effectively managing elderly patients' care.

1. Understanding Stoicism and Non-Specific Symptoms

   Elderly patients may understate their symptoms, making it challenging to accurately diagnose and treat their conditions. It's essential to be attuned to subtle cues and inquire about their discomfort persistently, as they might not readily express their pain. Their arrival at the hospital could be triggered by caregivers' concerns or a noticeable decline in their functional abilities.

2. Gathering a Comprehensive Social History

   Elderly patients might struggle to provide an accurate medical history due to confusion or cognitive impairment. Engaging with caregivers, relatives, or their general practitioners can offer invaluable insights into the patient's background, living arrangements, support systems, and self-care abilities. This information forms the foundation for effective care planning and discharge strategies.

3. Essential Questions For a Good Social History

   When interacting with elderly patients, consider asking the following questions to gain a comprehensive understanding of their baseline status:

   • Where do they live, and what type of accommodation do they have?

   • Who do they live with? Are there caregivers involved?

   • What is their mobility like? Do they require assistance in walking?

   • Are they capable of performing essential activities such as dressing, washing, and feeding themselves?

   • What is their urinary and faecal continence status?

   • Are there family members nearby to provide support?

   • Who handles tasks like shopping, cooking, and cleaning?

   • Do they feel capable of managing at home, or do they need additional assistance?

4. Special Considerations During Assessment

   When assessing elderly patients, it's crucial to conduct a thorough evaluation that takes into account their unique vulnerabilities.

   Pay special attention to the following areas:

   • Fractures: Elderly patients might not vocalise pain from fractures, especially after a fall. Be vigilant, particularly in the hips, legs, and wrists.

   • Hypoxia: Watch out for euphoria as a potential indicator of hypoxia. Measure respiratory rate and consider pulse oximetry or blood gas analysis if needed.

   • Fluid Overload and Electrolyte Imbalances: Administer intravenous fluids cautiously at a slow rate, monitoring electrolytes daily. Adjust fluid management as necessary.

   • Hypothermia: Elderly patients might not display peripheral temperature changes accurately. Use a rectal thermometer for core temperature measurement if hypothermia is suspected and consider warmed IV fluids.

   • Malnutrition: Detect signs like flaky skin, poor gums, and unhealed bruises. Address vitamin deficiencies promptly, and perform nutritional screenings.

   • K+ Levels and Diuretics: Monitor and supplement potassium levels, whilst staying mindful of the risk of hyperkalaemia. Educate patients on natural dietary sources of potassium.

5. Respecting Their Dignity

While elderly patients might be vulnerable and require special care, it's essential to treat them with respect and dignity. Avoid infantilisation and remember that most elderly individuals live independently, with only a minority having dementia. Engage with them as you would with any other patient, maintaining their autonomy and agency.

Conclusion

In conclusion, providing comprehensive care for elderly patients demands a holistic approach that addresses their unique physical, emotional, and social needs. By understanding their stoicism, conducting thorough social histories, and tailoring assessments to their vulnerabilities, doctors can deliver the high-quality care these patients deserve. Treating elderly patients with respect and dignity is not only a professional responsibility but also an essential aspect of providing patient-centred care.

By Dr Ahmed Kazie