PARA 3000 - Geriatric Assessment

Question 1

Why is geriatric assessment increasingly important in Australia?

Answer 1

Due to an ageing population, increased life expectancy, and a higher prevalence of chronic disease, leading to more frequent use of emergency services by people over 70.

Question 2

What four conditions should paramedics assess first in elderly patients?

Answer 2

Immobility, Instability, Impaired intellect/memory, Incontinence.

Question 3

What are key environmental checks on scene?

Answer 3

Safety to self and patient, Environmental hazards (e.g., stairs, hygiene, pets), PPE use (especially for contagious patients), Support from caregivers or facility staff.

Question 4

What indicators might suggest neglect or carer fatigue?

Answer 4

Lack of food, hygiene issues, carer disinterest, unsafe environment.

Question 5

What initial questions should be asked after a fall?

Answer 5

What caused the fall? Did you lose consciousness? Are you injured? Are you on blood thinners? What happened after the fall?

Question 6

What should be included in the elderly patient’s history?

Answer 6

HPC, Past medical history (including recent admissions), Medication changes, Functional and social history, Elder abuse screening, Decision-making capacity (ACD, EPOA).

Question 7

What are ADLs and IADLs?

Answer 7

ADLs: Activities of daily living (e.g., bathing, toileting)

IADLs: Instrumental ADLs (e.g., managing money, cooking).

Question 8

What medication classes are particularly important to assess in the elderly?

Answer 8

Anticoagulants, Beta blockers / calcium channel blockers, Antihypertensives, OTC/herbals (e.g., fish oil), Recent medication changes or cessation.

Question 9

What are the risks of polypharmacy in the elderly?

Answer 9

Drug interactions, Increased side effects, Confusion/delirium, Falls, Poor adherence.

Question 10

Why are dentures a risk in airway management?

Answer 10

They can cause airway obstruction. Remove them in unconscious patients.

Question 11

What respiratory changes occur with ageing?

Answer 11

Decreased lung compliance and capacity, Stiff chest wall, Weakened cough reflex, Reduced cilia = ↑ infection risk, Kyphosis = ↓ expansion, Delayed response to hypoxia/hypercapnia.

Question 12

What are common cardiovascular changes in the elderly?

Answer 12

Arterial stiffening (arteriosclerosis), Heart hypertrophy, Loss of pacemaker cells, Arrhythmias (AF), Slower BP/HR compensation during illness.

Question 13

Why is dehydration common and dangerous in elderly patients?

Answer 13

Poor fluid intake, Diuretics, Impaired thirst, Less renal reserve, Can rapidly cause shock, altered mentation.

Question 14

What tools can assess mentation?

Answer 14

AVPU, GCS, Orientation to time, place, person, Rule out delirium vs. dementia.

Question 15

Why is altered mental status dangerous and never to be accepted as ‘normal’?

Answer 15

It may indicate acute pathology (e.g., infection, trauma, stroke) that could be rapidly life-threatening.

Question 16

What are telomeres and why are they important in ageing?

Answer 16

Repetitive DNA at chromosome ends that shorten with cell division. Shorter telomeres = less replication ability = ageing.

Question 17

What is oxidative stress?

Answer 17

Imbalance between ROS (free radicals) and antioxidants, causing DNA, lipid, and protein damage leading to tissue ageing.

Question 18

What is apoptosis?

Answer 18

Programmed cell death. With ageing, excessive or dysregulated apoptosis can lead to organ degeneration.

Question 19

Why are falls so serious in the elderly?

Answer 19

Risk of fractures, head injuries, bleeding (esp. on anticoagulants), Can lead to fear of falling, inactivity, and deconditioning, High mortality and hospitalisation rates.

Question 20

Name common intrinsic causes of elderly falls.

Answer 20

Muscle weakness, Vision problems, Balance disorders, Medications, Hypotension.

Question 21

Name common extrinsic causes of falls.

Answer 21

Environmental hazards (loose rugs, stairs), Poor lighting, Unsafe footwear, Cluttered spaces.

Question 22

What contributes to skin fragility in older adults?

Answer 22

Loss of collagen and elastin, Epidermal thinning, Decreased fat and sweat glands, Reduced vascularity.

Question 23

What musculoskeletal changes increase fracture risk?

Answer 23

Osteoporosis, Decreased bone density, Sarcopenia (muscle loss), Poor balance.

Question 24

Why is urinary incontinence common in the elderly?

Answer 24

Weakened sphincters, Decreased bladder control, Neurological disorders, Medications, BPH in men.

Question 25

What GI issues are common in older patients?

Answer 25

Constipation, Poor nutrient absorption, GORD, Diverticular disease, Liver changes affecting drug metabolism.

Question 26

How does heart failure present differently in elderly patients?

Answer 26

May present with weakness, confusion, or falls—not always classic chest pain or dyspnoea.

Question 27

What is peripheral vascular disease and why is it serious?

Answer 27

Poor perfusion to extremities; causes pain, ulcers, gangrene. Often linked to diabetes and atherosclerosis.

Question 28

What’s the difference between delirium and dementia?

Answer 28

Delirium: acute and often reversible, Dementia: chronic, progressive and irreversible.

Question 29

Why are subdural haemorrhages more common in the elderly?

Answer 29

Brain shrinkage stretches bridging veins, making them more vulnerable to tearing with trauma (even mild).

Question 30

What is the Braden Score used for?

Answer 30

Assessing pressure injury risk.

Question 31

What is the FRAT screening tool?

Answer 31

Falls Risk Assessment Tool used in the NT to assess risk and prevention strategies.

Question 32

What are some signs of elder abuse paramedics should be alert to?

Answer 32

Bruises in unusual areas, Poor hygiene, Fearfulness around caregivers, Malnourishment, Discrepancies in history.

Question 33

What practical support considerations are important after treating a geriatric patient at home?

Answer 33

Secure their home, Notify next of kin, Arrange care for pets, Bring glasses/hearing aids/meds to hospital.

Question 34

What happens to telomeres as people age?

Answer 34

They shorten with every cell division. Once too short, the cell stops dividing (senescence), contributing to ageing.

Question 35

What is the role of oxidative stress in ageing?

Answer 35

Damages DNA, proteins, and lipids, impairing cellular function and increasing vulnerability to disease.

Question 36

Why is mtDNA more vulnerable to oxidative damage?

Answer 36

Mitochondria generate ROS as a byproduct and lack robust DNA repair systems, making mtDNA prone to mutation.

Question 37

How does chronic stress impact the ageing process?

Answer 37

Increases ROS, Alters metabolic processes, Promotes organ remodelling, Weakens antioxidant defences.

Question 38

What are long-term effects of impaired stress response in elderly?

Answer 38

Poor recovery from illness/injury, decreased homeostasis, organ dysfunction.

Question 39

What are AGEs and how do they affect ageing?

Answer 39

Advanced glycation end-products form when sugars bind to proteins/fats. They cause tissue stiffness, organ dysfunction, and accelerate ageing.

Question 40

How can AGEs be reduced in elderly patients?

Answer 40

Manage blood glucose, Avoid highly processed foods, Promote a diet low in refined sugars.

Question 41

Why are elderly patients more prone to pneumonia?

Answer 41

Weak cough reflex, Poor lung expansion, Declining immune response, Reduced cilia function, Co-morbidities and immobility.

Question 42

What is the risk of kyphosis in the elderly?

Answer 42

Reduces lung capacity and chest wall movement, limiting effective ventilation and cough.

Question 43

Why is AF (atrial fibrillation) common in older adults?

Answer 43

Loss of pacemaker cells, Increased atrial size, Fibrosis and fat deposits, Slower conduction.

Question 44

What is arteriosclerosis and how does it affect blood pressure?

Answer 44

Stiffening of arterial walls, leading to increased systolic BP and reduced ability to compensate during illness.

Question 45

How does age-related heart hypertrophy affect cardiac output?

Answer 45

Thicker walls reduce chamber volume, lowering preload and output especially under stress.

Question 46

What causes increased risk of subdural haematomas in the elderly?

Answer 46

Brain atrophy stretches bridging veins, making them vulnerable to rupture from even minor trauma.

Question 47

What cognitive signs differentiate delirium from dementia?

Answer 47

Delirium: Sudden, fluctuating, reversible, Dementia: Gradual, progressive, irreversible.

Question 48

Why is dizziness or unsteadiness in elderly an urgent symptom?

Answer 48

May indicate arrhythmia, TIA, dehydration, hypoglycaemia or early infection—all serious in elderly.

Question 49

What is the difference between osteopenia and osteoporosis?

Answer 49

Osteopenia: Early bone loss, Osteoporosis: Advanced bone demineralisation, high fracture risk.

Question 50

What is sarcopenia?

Answer 50

Age-related muscle loss, reducing strength and increasing fall risk.

Question 51

Why do falls often result in fractures in the elderly?

Answer 51

Combination of osteoporotic bones, muscle weakness, and poor protective reflexes.

Question 52

Why are elderly patients more susceptible to hypothermia or hyperthermia?

Answer 52

Loss of subcutaneous fat, Reduced sweat and vasodilation responses, Impaired thermoregulation.

Question 53

Why are pressure sores common in elderly patients?

Answer 53

Immobility, Thin, fragile skin, Poor perfusion, Low subcutaneous padding.

Question 54

What happens to renal function with age?

Answer 54

GFR declines ~10% per decade, Decreased ability to excrete waste, Risk of electrolyte imbalance, especially K+, Reduced acid/base regulation.

Question 55

What causes incontinence in the elderly?

Answer 55

Weak sphincters, Detrusor overactivity, Neurological disease, BPH in males, Medication side effects.

Question 56

How does social isolation impact elderly health?

Answer 56

↑ risk of depression, ↑ mortality, ↓ motivation to eat/move, Loss of cognitive stimulation.

Question 57

What are some indicators of elder abuse a paramedic might observe?

Answer 57

Poor hygiene, Pressure sores, Fear of caregiver, Conflicting histories, Malnourishment.

Question 58

What key functional domains should be assessed in geriatric patients?

Answer 58

ADLs/IADLs, Cognition, Vision/hearing, Gait/balance, Continence.

Question 59

What types of injuries are common after a fall in the elderly?

Answer 59

Hip fractures, Head trauma, Soft tissue damage, Subdural haemorrhages, Skin tears.

Question 60

What are the most common causes of elderly falls?

Answer 60

Intrinsic: Balance, medications, vision, Extrinsic: Slippery surfaces, poor lighting, clutter.

Question 61

What post-fall conditions may not be immediately visible but are dangerous?

Answer 61

Delayed head bleed, Internal haemorrhage, Dehydration/hypothermia if immobile for hours, Rhabdomyolysis.

Question 62

When should you refer an elderly patient for further care after a fall?

Answer 62

On anticoagulants, Head injury, Lives alone, Cognitive decline, Repeated falls or fear of falling.

Question 63

What should you always consider before leaving scene?

Answer 63

Home safety, Pets or dependents, Keys and belongings for hospital, Notify family.