Emergency Medicine

ELDERLY PATIENT

120 General Medical Emergencies

MANAGEMENT

1 Delirium and acutely decompensated dementia require hospital admission

(do not simply sedate).

2 Depression and a high suicide risk require urgent referral to a psychiatrist

and possible hospital admission.

Falls in the elderly

DIAGNOSIS

Always consider the underlying cause as well as the potential result following any

fall in the elderly:

1 Cause of the fall:

(i) Accidental:

(a) obstacles in the home, such as a trailing flex, the edge of a

carpet, poor lighting, or no handrails

(b) inappropriate footwear.

(ii) Musculoskeletal:

(a) arthritis

(b) obesity

(c) weakness

(d) physical inactivity.

(iii) Visual failure:

(a) cataracts

(b) senile macular degeneration

(c) glaucoma.

(iv) Sedating drugs:

(a) benzodiazepines

(b) antihistamines

(c) psychotropics

(d) alcohol.

(v) Postural hypotension:

(a) occult bleeding

(b) autonomic failure

(c) drug-induced.

(vi) Syncopal episode:

(a) cardiac arrhythmia, myocardial infarction, heart block

(b) vertebrobasilar insufficiency.

(vii) Cerebral disorder:

(a) Parkinson’s disease

(b) ataxia

(c) seizure

(d) stroke.