Surveys show that only a small percentage of us knows what to do in a health emergency. Today, in the third part of our essential first aid series with St John Ambulance, we show you how to deal with common health hazards associated with older people.
Many first aid emergencies faced by older people are rooted in conditions we all face as our bodies age. The longer we live, the more likely we are to have more than one chronic disease to manage.
These conditions — and the medication taken to control them — can alter the way our bodies react to injury — and this may have significant consequences for how to help an older person in an emergency.
As we get older, we can become more accident-prone due to deteriorating eyesight, weaker muscles, impaired memory and poor balance.
Surveys show that only a small percentage of us knows what to do in a health emergency (stock image)
Older people can be much more vulnerable to serious injuries from falls, bleeds and burns than a younger person because their bodies do not repair themselves as quickly or efficiently. Skin becomes thinner and papery, particularly on the shins and arms.
KEEPING ON TOP OF MEDICATION
Memory loss and declining eyesight can make it difficult to remember which medicines you’re taking. If possible, keep all the medicines together in a box. This can then be easily and quickly packed into an overnight bag if an emergency stay in hospital is needed.
It’s also a good idea to have a list of medications available at all times to show health professionals in case an accident occurs. Write a list that includes:
- Names of all medicines including over-the counter medicines, herbal remedies and dietary supplements
- The name of the doctor who prescribed each medicine; you may be under the care of different specialists for different conditions
- What each medication is intended to treat
- What dose is recommended and how often you take that medication
- Whether the medicine is to be taken on a full or empty stomach
- When repeat prescriptions are due
- Make sure the list is updated if the person stops taking a medicine, a new medication is added, or the dosage is altered
It can be very easy for an older person to catch themselves on furniture, for instance, and healing can take a long time. If a person takes blood-thinning medication such as warfarin, they are more likely to bleed profusely if cut.
For some, falls and accidents may represent the beginning of a long, slow decline in health and independence — a hospital stay that leads to immobility forces them to lie in bed, followed by a potential need for care once discharged.
Older people also face health hazards that spring from taking different medications to manage several long-term health conditions. It can be difficult for someone who suffers from memory loss or failing sight to keep track of these — and the medicines may react with each other or lead to other health issues if not managed correctly.
For instance, medication to reduce high blood pressure can lead to dizziness when getting up too quickly, and this in turn could result in an accident.
Here, with the help of the experts at St John Ambulance, we focus on first aid advice for older people.
One in three adults over 65 who live at home will have at least one fall a year, and about half of these will have more frequent falls. Doctors say one in two women and one in five men over 50 will suffer a fracture because of osteoporosis.
Falls are a major cause of older people needing to be admitted to hospital. They can be caused by poor vision, problems with balance, or long-term health conditions such as heart disease, dementia or low blood pressure (hypotension), which can lead to dizziness. Old age is also associated with incontinence, leading people to fall when rushing desperately for the loo.
WHAT TO DO
- Assess the person to see if their airway is blocked and if they are responsive.
- If they are responsive, remember they may not have good hearing, so speak loudly and clearly and ask what happened.
- If they are bleeding, apply direct pressure to the wound with a sterile dressing or a clean non-fluffy cloth.
- If they can move and suffered a cut or minor injury, help them to sit down.
- Reassure them, clean the wound with alcohol-free wipes and dress with a bandage.
- Apply an ice pack to the injury site over the bandage to reduce swelling and pain; do not apply ice directly to the skin, but instead wrap it in a tea towel.
Many first aid emergencies faced by older people are rooted in conditions we all face as our bodies age (stock image)
This is a break or crack in the bone. In an open fracture, the bone may pierce the skin; in a closed fracture the skin is intact. Broken bones may cause internal bleeding and the person may develop shock (see overleaf).
- Difficulty moving the limb
- Limb at an odd angle or bent
- Grating noise or feeling from the ends of the broken bones
WHAT TO DO
- Call 999 or 112. Care for the wound and monitor their responsiveness and breathing while waiting for help to arrive.
- For an open fracture, cover the wound with a sterile dressing or clean, non-fluffy cloth.
- Apply pressure around the wound — but not the protruding bone — to control any bleeding.
- Secure with a dressing.
- Encourage the older person not to move. Support the injured limb and place padding around it to prevent it moving.
- Secure an upper limb fracture with a sling and a lower limb fracture with a broad-fold bandage. To make an arm sling, place the bandage with the longest side lengthways against the person’s body, with one tip over their shoulder and the corner at their elbow. Fold the hanging tip back up so that it loops around the neck and secure with a knot.
- Be aware that the bleeding associated with a fall (whether internal or external) can cause an older person to develop shock.
This is a life-threatening condition and not to be confused with emotional shock. It happens when a person’s cells don’t receive enough blood and oxygen to function properly, leading to damage of vital organs such as the heart and the brain. Shock can be caused by anything that reduces the flow of blood, including:
- Heart problems, such as a heart attack, or heart failure
- Severe bleeding
- Loss of body fluids, from dehydration, diarrhoea, vomiting or burns
- Severe allergic reactions and severe infection
WHAT TO DO
- Lie the older person down and raise their legs to improve blood supply to vital organs. But do not raise their legs if you suspect a fractured leg.
- Cover them with a blanket to keep them warm.
- Try to keep them calm and breathing regularly.
- If they become unresponsive prepare to administer CPR (see back page) and call 999 or 112.
CUTS AND BLEEDS
An older person may bleed more profusely than a younger one after sustaining a cut, particularly if they are on medications, such as warfarin, that serve to thin the blood, or if they have high blood pressure. This makes stopping the bleeding a vital priority to prevent undue blood loss.
WHAT TO DO
- Sit or lay the person down and examine the wound.
- If the wound is dirty, clean it by rinsing it under running water or using alcohol-free wipes.
- Apply direct pressure with a clean non-fluffy cloth or gauze to stop the bleeding.
- Dress the wound and seek help if the bleeding hasn’t stopped after 20 minutes.
Nosebleeds are caused when tiny blood vessels inside the nostrils are ruptured. This can be due to hitting, sneezing or blowing the nose. High blood pressure and taking anti-clotting medication such as warfarin can also cause nosebleeds, which is why they can be prevalent in older people.
WHAT TO DO
- Ask the older person to sit down and lean their head forward. Do not tilt the head back.
- Pinch the soft part of the nose.
- Give them a tissue.
- Once bleeding has stopped, advise them to rest.
- Call 999 or 112 if the bleeding is severe or hasn’t stopped after 30 minutes.
- If a nosebleed has been caused by trauma you may not be able to stop the bleeding. You need to apply pressure to try to reduce the flow as blood loss is dangerous. With a wrapped ice-pack apply pressure until help arrives.
RUPTURED VARICOSE VEINS
It is common for older people to have varicose veins — engorged veins that occur, often on the back of the legs, as a result of faulty valves and weakened blood vessels.
Varicose veins can easily be injured by wheelchairs, shopping trolleys or buggies accidentally being knocked into them — but they will bleed profusely.
A ruptured varicose vein is essentially a bleed and is treated as such. However, it can appear more serious due to the quantity of blood it can produce.
WHAT TO DO
- Lie the person down, with their legs raised.
- Apply firm pressure to stop the bleeding.
- Call 999 or 112 for emergency help.
Older people are more likely to fall and knock their heads. Most blows to the head lead to a cut or wound and possibly concussion. Cuts can bleed profusely — particularly if the casualty is taking blood-thinning medication.
All head injuries are potentially serious because they can damage the brain. Concussion is a common form of brain injury that usually results from a blow to the head and may lead to a brief period of unresponsiveness.
- Brief period of unresponsiveness
- Loss of memory surrounding the accident
WHAT TO DO
- Check their responsiveness particularly focusing on whether they can respond to questions and a gentle shake.
- Call 999/112 if they are unresponsive; there is blood or fluid leaking from the nose or mouth; they have unequal pupil sizes; or they take blood-thinning medication.
- Sit them down and give them something cold to hold against the injury, such as a cold gel pack or a bag of frozen vegetables.
- If there are scalp wounds, treat them as a bleed, applying pressure with a clean cloth or dressing.
Sometimes people who have diabetes may have a diabetic emergency, where their blood sugar becomes either too high or too low (stock image)
There are two types of diabetes: type 1, or insulin-dependent diabetes, and type 2, also known as non-insulin-dependent diabetes. Sometimes people who have diabetes may have a diabetic emergency, where their blood sugar becomes either too high or too low. Both conditions are potentially serious and may need to be treated in hospital. Type 2 diabetes — a condition where the body struggles to process sugar properly — affects increasing numbers of people aged 50 and over. Normally our bodies automatically keep the right blood sugar levels, but for someone with diabetes their body can’t.
Instead, they have to control the blood sugar level themselves by monitoring what they eat, and taking medication or insulin injections.
Older people get dehydrated more easily, so it’s especially important for them to drink plenty of water.
They are prone to dehydration because they may not be drinking enough water in hot weather or in a heated house, or because of their medication. Equally, they may have a fever or diarrhoea.
The general advice is for everyone, including older people, to aim to drink two litres (six to eight glasses) of fluid every day to avoid dehydration.
- Headaches and light-headedness
- Dry mouth, eyes and lips
- Small amounts of urine
- Muscle cramps
WHAT TO DO
- Help them to sit down and give them plenty of water.
- Give them an oral rehydration solution to drink to help replace salt and other minerals they’ve lost — you can buy this in sachets from any pharmacy.
- If they have any cramps, encourage them to rest, help them stretch and massage their muscles that hurt.
- Keep checking on them — if they still feel unwell once they’re rehydrated, then encourage them to see a doctor straight away.
Too little insulin can cause high blood sugar. If untreated, the person can go into a diabetic coma.
- Warm, dry skin
- Rapid pulse and breathing
- Fruity, sweet-smelling breath
- Feeling really thirsty
- Drowsiness, leading to unresponsiveness if not treated
WHAT TO DO
- Call 999 or 112 straight away for medical help and say that you suspect hyperglycaemia.
- While you wait for help to arrive, keep checking their breathing, pulse and level of response.
- If they lose responsiveness at any point, open their airway, check their breathing and prepare to either put them in the recovery position or administer CPR.
Too much insulin can cause low blood sugar or hypoglycaemia (hypo). This often happens when someone with diabetes misses a meal or does too much exercise.
It can also happen after someone has had an epileptic seizure or has been binge drinking.
If someone knows they are diabetic, they may recognise the start of a hypo episode, but without help they may quickly become weak and unresponsive. However, older people may have added risk factors that can lead to a hypo.
These include being prescribed five or more medications, chronic kidney problems, poor food intake and other illnesses. In addition they may find their hypo warning signs are more difficult to identify due to an inability to concentrate or if they suffer from headaches or sleep disturbances.
- Weakness, faintness or hunger
- Confused and irrational
- Sweating, cold, clammy
- Rapid pulse
- Deteriorating response
- Check for a medical warning bracelet or chain and if they are carrying glucose gel or sweets
- Check if they are carrying an insulin pen or tablets and a glucose testing kit
WHAT TO DO
- Help them sit down.
- If they have their own glucose gel, help them take it.
- If not, you need to give them something sugary such as fruit juice, a fizzy drink, three teaspoons of sugar, or sugary sweets.
- If they improve quickly, give them more sugary food or drink and let them rest.
- If they have their glucose testing kit with them, help them use it to check their glucose level.
- Stay with them until they feel completely better.
- If they do not improve quickly, look for any other possible causes and then call 999 or 112.
- If they lose responsiveness at any point, open their airway, check their breathing and prepare to treat someone who’s become unresponsive by putting them in the recovery position or administering CPR.
Hypothermia is a condition that occurs when someone’s body temperature drops below 35c (95f). Normal body temperature is around 37c (98.6f).
It is common in older people who don’t move much. Hypothermia can become life-threatening quickly, so it’s important to treat hypothermia straight away.
WHAT TO DO
- Move them somewhere warm and sheltered.
- Remove and replace any wet clothes.
- Wrap them in blankets. If outside, protect them from the cold of the ground, too.
- Call 999 for emergency help.
- Monitor breathing, level of response and temperature.
- If they are alert, give them a warm drink or some chocolate to eat.
Ways to save your own life
What would you do if you fell, felt a crushing pain in your chest or started to choke when you were on your own? It’s a terrifying prospect for many older people who live alone.
More than two million people aged 75 and over live alone in the UK — an increase of nearly a quarter in the past 20 years.
Here we show you the most effective ways you can help yourself if you find yourself alone in an emergency situation.
IF YOU’VE FALLEN
- Lie still for a few minutes and check that you are not injured. Starting with your feet, work systematically up your body, moving your limbs to check for pain or bleeding.
- If you feel able to get up, do so slowly. Roll gently on to your hands and knees and look for a solid piece of furniture such as a chair or bed that won’t move when you lean on it.
- Crawl or manoeuvre your way to the furniture, taking time to rest if you need it.
- Holding the furniture with both hands, kneel with your weight evenly distributed on each knee.
- Bend up one leg and plant your foot firmly on the ground. Grip the furniture firmly and push yourself up. Take your time.
- Remain supported with your head forward until you are sure you have got your balance. Carefully push up to a standing position.
- Take time to rest and then contact someone to tell them what has happened.
- Call 999/112 for emergency help, if necessary.
- If you are unable to get up, bang on the floor or wall to attract a neighbour. If you have your phone close by, press the emergency call button.
- Do not exhaust yourself calling for help. Try to remain calm and cover up with something warm. Get as comfortable as possible and shift your weight frequently to prevent pressure sores.
IF YOU’RE BLEEDING
- Depending on where the wound is, blood could be gushing out at speed, so you must act quickly to stop excessive blood loss and unresponsiveness. Grip the wound as firmly as you can with any clean towel or large cloth you find nearby.
- Apply pressure directly to the wound and raise it to at least the level of the heart, or above, to reduce the blood flow to the affected area.
- If your leg is bleeding, lie down and lift it above the heart. This may help the blood flow back to the core. This reduces how much of it reaches the wound, which in turn reduces the amount of bleeding.
- The majority of severe bleeds can be dealt with effectively using pressure to stop or slow down the flow of blood until emergency help arrives.
- As a general rule, whether you are hurt or tending someone else who is, do not try to apply a tourniquet to stop bleeding.
- Never try to remove anything that is embedded in a wound because it could be forming a plug, so removing it could make the bleeding worse. Wait until you get to A&E, where it will be removed in a sterile environment and the wound can be treated properly.
IF YOU’RE CHOKING
- Coughing as vigorously as you can should work in most cases.
- Bending over with your head down should help move a lodged item.
- You can also try to perform a version of abdominal thrusts on yourself, or pressure to the abdomen to force a lodged object up and out of your throat. Make a fist with one hand and place it just above your belly button. Place the other hand on top for support and push hard, in short, sharp thrusts. Try up to five of these.
‘When people are choking, they may not have the physical strength in their arms to perform abdominal thrusts and there are anecdotes of people dislodging the item by doing these on the back of a chair,’ says Alan Weir, head of clinical operations at St John Ambulance.
This may not be easy in the heat of the moment and you should always seek medical help after using these techniques, in case you have caused internal damage or bruising.
FOR HEART PROBLEMS
- If you feel a central, crushing heart pain, the first step after calling an ambulance is to chew an aspirin — this works faster than if you swallow one whole. Aspirin slows the blood’s clotting mechanism, so will prevent any clots that have already formed from getting bigger.
- Lie down with your head and shoulders slightly raised. This is usually the most comfortable position and avoids extra work for your ailing heart, says Alan Weir.
- While you wait for proper medical care, try to take deep breaths — it’s thought that this can help get oxygen into the lungs more efficiently and keep blood circulating normally.
- If you’ve already been diagnosed with angina, you may also have a nitroglycerin spray or tablet — apply this under the tongue. This acts as a vasodilator, opening up blood vessels to improve blood flow and can possibly reduce some of the symptoms.
- If you have previously been diagnosed with a tachycardia syndrome (an abnormally high heart rate) and you experience palpitations with chest pain, then you may also benefit from performing the Valsalva manoeuvre.
This involves pinching the nose and closing the mouth, then trying to blow out — similar to trying to unblock your ears on a flight. Blowing against resistance may make the heart rate decline — so this could slow a racing heartbeat.
WHAT NOT TO DO
- If you feel faint, do not put your head between your knees. This position will mean you fall directly on to your head if you do end up fainting, which could cause a more serious injury or concussion.
- Instead, lie on the ground and raise your legs to redirect blood flow up your body to your brain. You should feel better straight away because fainting is usually due to reduced blood flow to the brain.
- If you think you have taken too much medication or accidentally swallowed something harmful, don’t drink large quantities of water in an attempt to flush it out of your system.
Also do not try to be sick. Instead, take a note of what was taken and when, and call 999 or 112 to seek urgent medical aid.
Is it just a ‘twinge’ or is it a heart attack? How to tell the difference
Many people get confused between the medical terms used to describe certain heart conditions — but as we will see, knowing how to tell the difference between angina, a heart attack and a cardiac arrest could be vital in a first aid emergency.
All require a different course of action — but in the case of a cardiac arrest every minute counts. This is because a person’s chances of surviving a cardiac arrest reduce by 10 per cent with every minute that passes.
ANGINA, HEART ATTACK OR CARDIAC ARREST?
Act fast if you suspect a stroke
A stroke can occur when blood supply to the brain is disrupted and starves the brain of oxygen. This is normally due to a clot in a blood vessel or a rupture that stops the flow of blood getting to the brain.
The brain needs oxygen, delivered in the blood, to work properly. The long-term effects of a stroke depend on which part of the brain is affected and how large an area is damaged.
A stroke is a medical emergency — the quicker a person receives medical help, the better their chances are of making a good recovery.
- Facial weakness — this could be a droopy mouth, uneven smile or a droopy eye
- Arm weakness and an inability to raise both arms
- Speech problems
WHAT TO DO
- Call 999 or 112 and say you suspect the person you are with has suffered or is suffering a stroke.
- Reassure the person, keep them comfortable and monitor responsiveness until help arrives.
People often use the term heart attack interchangeably with cardiac arrest — but they are not the same and the treatment for each is different.
In a heart attack, the blood supply to the heart is suddenly blocked, usually by a clot.
Meanwhile, a cardiac arrest is where the heart stops pumping blood around the body and the person is unresponsive, not breathing normally and showing no signs of life.
Angina is a type of chest pain someone gets when the arteries carrying blood to their heart muscle become narrowed.
This can restrict blood supply and cause chest pain. Angina attacks are usually caused by physical exertion, stress or excitement. But if someone has unstable angina, their painful attacks can have no obvious cause.
Angina alone is not life-threatening, but it puts one at far greater risk of a life-threatening heart attack or stroke.
Once diagnosed, it can be managed with medication to treat any future attacks, prevent further episodes and reduce the risk of developing heart attacks and strokes.
- Pain in the chest, which may spread to the jaw and arms
- Shortness of breath
- Sudden and extreme tiredness
WHAT TO DO
- Help the person to sit down and reassure them.
- Encourage or help them to take any angina medication they may have.
- If they don’t have any medication and the pain does not go away after a few minutes, call 999 or 112.
- If they are still in pain five minutes after taking medication, suggest a second dose.
- If they are still in pain after a further five minutes, call 999 or 112 immediately.
Knowing how to tell the difference between angina, a heart attack and a cardiac arrest could be vital in a first aid emergency (stock image)
- Shortness of breath
- Crushing chest pain
- Pale skin and blue lips
- Irregular pulse
- Impending sense of doom
- Victim will still be responsive
WHAT TO DO
- Call 999 or 112 and explain that you think the person is having a heart attack.
- Help them to sit down.
- Give them an aspirin (300mg) and ask them to chew it slowly — chewing it will release the medicine into the body quicker than swallowing it whole.
- Ask them to take their own angina medication if applicable and monitor their condition until help arrives.
- If they become unresponsive, start CPR (see right).
- Not breathing normally
- Not moving or showing signs of life
WHAT TO DO
- Call 999 or 112 for emergency help.
- Lie the person flat on their back.
- Perform CPR (detailed right).
- You need to get a defibrillator to shock their heart. But if you are on your own, do not leave the person to find one. Call someone to fetch a defibrillator, or wait for the paramedics.
Perform CPR on an older person in exactly the same way as you would on a younger one.
Do not be deterred by the risk of breaking their ribs, says Alan Weir, head of clinical operations at St John Ambulance.
‘While this risk may be higher in older people, who have weaker bones, it is far better to take action.
‘A broken rib can be repaired, but without CPR the patient may not survive.’
HOW TO PERFORM CPR
- Give 30 chest compressions, pressing down 5-6cm at a rate of 100-120 a minute.
- The beat of The Bee Gees’ song Stayin’ Alive or the nursery rhyme Nellie The Elephant can help you keep the right rate.
- Then give the casualty two rescue breaths.
- Repeat the pattern of 30 compressions and two rescue breaths (30:2) until help finally arrives.
Book a baby first aid course at sja.org.uk/babyfirstaidcourse
COMPILED BY: JUDITH KEELING, JILL FOSTER AND CAROLINE JONES