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Geriatrics & Frailty Syndrome: The Wisdom of the Aged

It's wonderful to know you're aging, because that means you're still on the planet and thriving...right? It comes as no surprise that the "graying of America" is in full swing. The COVID pandemic did stunt longevity in this country, but if you examine data from the past few centuries - we are getting older, and the curve trajectory has largely been positive. As EMS providers we must be prepared to care for an aging population. It can be argued that age and wisdom can go hand in hand. This short blog entry will harness the fact that geriatrics can teach us a great deal as we try to navigate healthcare and understand more about the field of medicine.

The human body is a complex system, and it is extremely resilient, and many times can fix itself with little outside/external interventions... while we are on the topic of extremes and longevity, let me introduce you to the oldest known human with a documented and confirmed life span of 122 years and 164 days.

Source: Reuters - Jeanne Calment (1875-1997)

Several things are known about the aging process, but some things may come as a surprise.... [like Ms. Calment's advanced age]. This may be a little depressing for some, but did you know that many researchers agree that humans reach their biological peak around the age of 30. After that time, we will slowly see a decline in our physiological reserves. Furthermore, it has been stated, that we will lose about 1% function in each body system annually after that biological peak period. That doesn't necessarily mean you're considered frail at your 31st birthday party - several other factors lead to this syndrome and in recent years public health officials have worked tirelessly to understand and intervene -- where they can. There is a natural progression from non-frail (robust) - pre-frail - frail

Additional things to point out regarding the overall age of our population. THE WHY is centered on three main things, in no particular order: (1) Baby boomers, (2) better medicine, and (3) fewer major wars. Collectively, this will contribute to 38 million people being > 80 years of age by 2050 and in just two decades, the number of people > 65 years old will outnumber the number of children for the first time ever.

FRAILTY = [dependency (X) vulnerability (X) co-morbidity] + Environmental and Social Factors - like depression)

Source: Uto, Nanami & Amitani, Haruka & Atobe, Yuta & Sameshima, Yoshihiro & Sakaki, Mika & Rokot, Natasya & Ataka, Koji & Amitani, Marie & Inui, Akio. (2018). Herbal Medicine Ninjin'yoeito in the Treatment of Sarcopenia and Frailty. Frontiers in Nutrition. 5. 126. 10.3389/fnut.2018.00126.

PEARLS around geriatrics + frailty syndrome:

  • Elderly patients have vague and non-specific symptomology

  • Frailty syndrome is an emerging problem in today's medical landscape

  • Community paramedic / MIH programs are valuable in this aged demographic

  • Medico-legal topics and end-of life issues should be reviewed at your agency

  • Patient autonomy vs. Battle with Surrogates (can get messy)

  • Nearly 50% of your calls involve the elderly population

  • Falls are costly (in & out of hospital setting) + 1/5 lead to serious injury

  • Dementia is still on the rise - this one concerns me greatly

  • Dalhousie University (Canada) created a frailty scale - check it out

  • As part of your H&P - look for: (1- unintentional weight loss/poor endurance/muscle weakness/physical slowness/5-low physical activity)

  • If a patient has 3/5 (above) - it predicts worse clinical outcomes

  • Exercise and good nutrition can both counter frailty

January 16, 2023

Author: Joshua Ishmael, MBA, MLS(ASCP), NRP

Pass with PASS, LLC.

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