Editor’s note: The Caregiving Chronicles blog has partnered with Century Health Systems to bring additional expert information and advice to the MetroWest caregivers we strive to serve at CaregivingMetroWest.org. Century Health Systems, the parent corporation of Distinguished Care Options and the Natick Visiting Nurse Association, has allowed Caregiving Chronicles to get some valuable insight from its staff for our ongoing series of Q&A sessions with caregiving experts.
In this entry, we discuss what caregivers should know about basic first aid in the home for older adults. Providing insight is Juanita Allen Kingsley, Wilderness EMT, who is the Director of Business Development for Century Health Systems.
A health educator, she trains more than 2,000 people in the MetroWest region annually through her First Aid, Wilderness First Aid, CPR and AED classes in addition to the variety of health and safety programs she teaches. For more information, visit www.centuryhealth.org or call 508-651-1786.
Caregiving MetroWest: In general, how does administering first aid to an older adult differ from standard first-aid practices for a person of any age?
Juanita Allen Kingsley: Remember that many older adults live with chronic medical conditions that impair their bodies’ temperature regulation. They may feel heat and cold and pain less acutely than younger people. Additionally, they did not grow up drinking water between meals, thus increasing their risk of heat stroke, hypothermia or dehydration. Older adults also feel pain less acutely, so they may have a cut, sore or blister for a few days before a family member or friend brings it to their attention. Finally, lower vision, mobility and medications make elders more prone to falls, thereby increasing their risk of injury requiring first aid.
CGMW: Maintaining a first aid kit in the home is very important, but what should be in it?
JAK: First, make sure you have a working phone in your home as well as an up-to-date history of your health and medication list. The FDA’s My Medicine Record is a great resource to get you started on documenting medication information.
A wonderful book, Life’s Little Emergencies: A Handbook for Active Independent Seniors and Caregivers, by Rod Brouhard, is an important book to have in every home. Brouhard recommends the following items for your first aid kit:
- adhesive bandages of several shapes and sizes
- gauze squares
- hand sanitizer
- paper tape
- non-stick gauze pads
- elastic bandages
- scissors to cut off clothing
- good tweezers
CGMW: What about when you and your loved one leave the home; are there any first aid supplies you should make sure to bring with you?
JAK: Always keep a small, standard first aid kid in your car; Johnson & Johnson makes several that are available at drug stores or online. Even more importantly, however, bring any medications that you might need during your time away from home and stock extra water, continence products and a change of clothes. And bring the following:
- your medical history
- list of medications
- your healthcare proxy
- your DNR order if you have one in place
CGMW: What should you do if your elder loved one falls?
JAK: One third of people over 65 fall each year, leading to ER visits; hospitalization; broken bones; head injuries; and an increased risk for another fall.
Making our homes safe by ensuring that there’s ample lighting; adaptive equipment like grab bars installed in key locations like the bathroom; and elimination of trip and fall hazards like scatter rugs, clutter or electrical wires should be a priority, but so should wearing properly-fitting footwear and using assistive devices like a cane or a walker.
Encourage your loved one to carry a phone at all times, so that she is not rushing to the phone when it rings; this often results in falls.
If your elder loved one falls, don’t hurt yourself by trying to help her up; we already have one injured person. Let’s keep it at that! AgingCare.com has helpful advice on how to pick your loved one up after a fall, though we recommend that you leave the person on the floor so you don’t injure her further and call 911. You will likely be asked to answer some questions about your loved one’s fall, so keep the acronym “SPLAT” in mind, and visit the National Institutes of Health to learn more about it.
[editor’s note: SPLAT refers to S – Symptoms, the symptoms prior to the fall such as dizziness or lightheadedness; P – Previous, any previous falls or near falls suffered; L – Location, the location of the fall to identify any environmental factors; A – Activity , the activity the person was doing when they fell; and T – Time, the time of the fall.]
CGMW: What should you know about treating a cut or wound on an older adult?
JAK: Older skin is much more fragile than younger skin. Washing a wound with soap and water and keeping it covered with a dressing is what we recommend. Paper tape should be used to keep a gauze pad, for example, on older adults’ wounds; they often have very thin and delicate skin, which can come off easily when removing a traditional adhesive bandage. In addition, change dressings or bandages every day or even twice a day to see that the wound or cut is improving and not getting infected.
CGMW: What should you do if your elder loved one suffers a burn?
JAK: If the skin is still intact, rinse the burn with cool running water until the skin cools, which could take up to 20 minutes. If the skin is open, see a doctor to clean it and to make sure that there is no infection.
CGMW: What should you do if loved one is choking? Is it safe to perform the Heimlich maneuver on an older adult?
JAK: If someone can cough, don’t hit their shoulder blades or have them raise their hands; just encourage continued coughing. If they cannot cough or speak, then try the Heimlich maneuver to dislodge the obstruction. If you can’t relieve the choking with a few abdominal thrusts, then call 911. Better to call and not need them than the other way around.
CGMW: Other than immediately calling 911, what should you do if your loved one has a more serious medical emergency, such as a heart attack, stroke or seizure? Is there anything you can do while waiting for help to come after calling 911?
JAK: A more serious medical emergency will require very deliberate help:
- Seizure – Move things out of the way so the patient doesn’t hit anything; don’t put anything in their mouths; and call 911 immediately.
- Stroke – If you think someone is having a stroke, call 911 immediately. Remember FAST: Facial droop, raise your Arms, crooked Smile or slurred Speech and Time (call 911) and stick out your Tongue—not being able to do this is not a good sign.
- Heart Attack – With any chest pain that won’t go away, call 911 immediately. If you have nitroglycerin, take it as prescribed. The 911 operator may tell you to chew an aspirin if you have one. If you don’t, though, the paramedics will probably give you one when they get to you. Above all: DO NOT DRIVE YOURSELF TO THE ER!
CGMW: Are there any other first aid tips someone caring for an elder loved one should know?
JAK: Everyone, but especially the elderly, should carry with them at all times, a list of their medications, any medical conditions, their healthcare proxy and a DNR if they have one in place. In Massachusetts we use a MOLST form (Medical Orders for Life Saving Treatment) that outlines patient preferences for care toward the end of life.