This article, part of a regular column called "Total Patient Care" in On Scene magazine, appeared in April, 1991.
OLD. An unpopular concept. OLD. A frightening word. OLD. A negative stereotype. OLD . It will never happen to you? If it does not, then you will have met the even worse alternative.
The statistics show that one in three persons in North America will be over the age of 65 by the year 2000. And that 75 percent of hours spent providing health care will go to this population. Indeed, people over age 60 use EMS about 2.5 times as often as younger people. (1) For trauma junkies, this is bad news. For adrenalin users, this does not sound like fun.
So let us consider approaches to geriatric patients which might help instill an improved sense of respect, dignity and tolerance for this important patient population.
Old People Are Wise. Remember how dumb your parents were when you were 16? An how much they learned by the time you were 21 ! The wisdom that blooms with the years cannot be purchased. The physical vigour that accompanies youth often overshadows the more subtle savvy that our elders have acquired. Just because someone is no longer continent does not mean that person's brain is frail. Although interfacility transfers have a bad reputation among prehospital providers, they can be a source of many lessons about life and human nature. Ask your patients about his or her life, and you might be surprised. The "boring" task of moving a body from one place to another will often come alive with stories, insights, even opera singing (as once happened to me!).
Old People Have Feelings. Unfortunately, diminished mental capacity is one of the frustrating aspects of geriatric patients. People who are still physically alive seem so unreachable mentally. How awe-inspiring, then, to see a tear come across the cheek of one such soul after providing gentle, kind care. A tear of gratitude? Perhaps. The sad part to me, though, is that that person perceived my care unusual.
Finding the most compassionate approach is not hard. It just means remembering the Golden Rule: Do Unto Others As You Would Have Them Do Unto You. Calling others by derogatory terms - even when it is tempting to assume they cannot understand you - is unacceptable. Being rough with tender skin and fragile bones is unacceptable. Driving the ambulance roughly is unacceptable. If you act right (and if you nurture right behaviour in others) now, maybe someone will share your value system in, say, the year 2041 when it is your turn.
Old People Have One Last Right of Passage. A "rite of passage" is an event that marks a change of status, such as graduation from school, marriage, parenthood, and eventually, death. The big question about death is that no one exactly knows what happens after death. People facing death as the last big event of life have understandably strong feelings about it! They fear the dying process, the unknown, loss of control, change, ceasing to be. You will too. Why add to the stress of this time of life by being rude, hurried, hassled, burdened - when your job is to provide for every patient, including those you may privately disdain? Old people have been around a long time; they have opinions, and they are often rigid about their world. They are set in their ways. It is difficult to work with many of them, but that is their prerogative. They, too, are EMS "customers."
Who Is Caring For Old People That You Love? The 1990's reality is that the world is scattered. Few people are born, live, and die in the same town anymore. Most families are so dispersed that people increasingly depend on social services (such as EMS) to do things formerly provided by networks of relatives. For this reason, when my private feelings about a patient are negative, the professional in me is conditioned to take over. I do this by reminding myself that I may have to depend, someday, on prehospital personnel to care for the people I love in England, in Connecticut, in the mountains of Colorado, near Boston, and in both northern and southern California. That is where my family is. Where are your loved ones? Will the world of EMS be good enough when it reaches out to them - the way you may already be reaching out to their loved ones?
There are many choices about how to behave in the relative anonymity of prehospital care. You are on your own, usually with only a partner to witness your actions. Doing the right thing is often a challenge, especially when you are tired, or sick, or hungry, or stressed in a thousand other ways. If we are honest, we all know that prehospital personnel are not always as kind, or gentle, or considerate of old people as they could be. Prehospital Professionals are. Which are you: a person with a job? Or a professional.
References
1. Marvin Wayne, lecture on "The Greying of America", EMS Today Conference, Long Beach, California, March 1991.
Kate Dernocoeur, EMT-P is author of Streetsense: Communication, Safety and Control, co-author of Emergency Medical Dispatch, and a well respected lecturer at EMS conferences world wide.