Elderly Care First Aid

Older adults experience more falls, take more medications, and have thinner skin and more fragile bones — so the same incident often has bigger consequences. First aid principles are unchanged but assessment thresholds are lower: call 000 sooner rather than later.

Follow DRSABCD for any serious incident.

Falls

Falls are the leading cause of injury death in Australians over 65.

• Do not rush to lift the person up. Assess first.
• Check for pain in the hip, pelvis, wrist or head. Suspected hip fracture: keep them still, support the limb, call 000.
• Any head strike on anticoagulants (warfarin, apixaban, rivaroxaban, dabigatran) needs hospital assessment even if they seem fine — bleeding can be delayed.
• After the fall, ask why — dizziness, fainting, low blood sugar, stroke or heart rhythm problem may be the underlying cause.

See Fractures, Head Injury and Spinal Injury.

Heart attack and stroke

Symptoms in older adults are often atypical: shortness of breath, sudden fatigue, confusion or a fall instead of classic chest pain.

• Use FAST for stroke: Face droop, Arm weakness, Speech change, Time to call 000. See Stroke.
• Chest discomfort, breathlessness, nausea or sudden sweating — assume heart attack. Sit the person down, call 000, 300 mg aspirin if not allergic.

Medication-related emergencies

• Anticoagulants make minor bumps bleed heavily and cause hidden internal bleeding. Apply firm pressure for at least 15 minutes; seek medical review for any significant impact.
• Blood pressure tablets and diuretics can cause fainting on standing — sit them down with legs raised. See Fainting.
• Diabetes medications (insulin, gliclazide) can cause hypoglycaemia: confusion, sweating, slurred speech. If conscious and able to swallow, give sugary drink or jellybeans.
• Opioid pain relief can suppress breathing. If breathing is slow and the person is hard to rouse, call 000; naloxone reverses opioids if available.
• Always show paramedics the medication list or the Webster pack.

Choking

Older adults choke more often due to poor dentition, dry mouth, and swallowing problems (dysphagia) from stroke or dementia.

• 5 back blows, then 5 chest thrusts. Do not do abdominal thrusts on a frail elderly person if you can avoid it — chest thrusts are safer. See Choking.
• After any choking event with aspirated food, watch for fever, cough or breathlessness over the next 48 hours — aspiration pneumonia is common.

Skin tears and pressure injuries

Thin, fragile skin tears easily.

• Rinse with saline, gently lay the skin flap back into place, cover with a low-adherent silicone dressing. Do not use sticky tape on the skin.
• For a bed- or chair-bound person, reposition every 2 hours to prevent pressure injuries on the heels, sacrum and elbows.

Heat and cold

Older bodies regulate temperature poorly.

• In a heatwave: cool fluids, fan, wet cloths to neck and armpits. See Heat Illness.
• In winter: indoor hypothermia is common in poorly heated homes. Warm the room, warm dry layers, warm drinks if conscious.

Dementia and delirium

A sudden change in behaviour, confusion or agitation in an older person is delirium until proven otherwise — often caused by infection (urine, chest), pain, dehydration or a new medication. It needs medical review, not just reassurance.

When to call 000

• Head strike on a blood thinner.
• Suspected hip fracture, stroke or heart attack.
• Unconscious, drowsy or hard to rouse.
• Sudden confusion that is not normal for them.
• Severe bleeding that does not stop with 15 minutes of pressure.
• Any fall the person cannot get up from.