By Dr Umberto Russo MBBS (Adelaide) FRACGP
In my practice as a Home Doctor, many of the patients I see are retirees, senior citizens, and the elderly. As we get older, we inevitably have an increasing number of acute, episodic medical problems, which while not life-threatening, require urgent medical attention. And if it’s a weeknight, or the weekend, when your GP is closed, a call to 13SICK is often preferable to a trip to the Emergency Department.
The illnesses I see in the after hours are many and varied, but these are the six main reasons why seniors and the elderly, and their worried carers, call 13SICK.
1. Injuries from falls
As we get older, our balance and mobility is affected, and falls are common. If you or a loved one has suffered from a fall, it is important to have a Doctor’s assessment to check for injuries. If it is a serious injury, call an ambulance, but otherwise visit your GP or arrange a visit from the Home Doctor.
Falls do not always result in serious injury, but can leave you with bumps and bruises, and other symptoms, such as headaches, nausea, drowsiness or blurred vision, that might not show up for a few days. That’s why it’s always important to get checked by a Doctor after you’ve had a fall.
Falls are caused by a number of factors, including dizziness, poor muscle strength, poor eyesight, sudden low blood pressure or hazards in the home, such as rugs or slippery floors. Falls and fall related injuries are one of the leading causes of hospitalisation for Australians over 65, so it is worthwhile to take all the steps you can to prevent falls from happening.
2. Respiratory tract infections
Unsurprisingly, especially in the winter months, respiratory infections are extremely
common, and older people are particularly vulnerable.
Respiratory infections can be caused by from viruses or bacteria, and can affect the throat, tonsils, larynx and middle ear, and chest. The list of possible illnesses is long, with the commonest being head colds, influenza, acute sinusitis, bronchitis and pneumonia.
Symptoms for respiratory illnesses can be very similar: runny nose, sore throat, coughing, sneezing, fever and headache, however these classic symptoms do not always appear with elderly influenza or pneumonia. Influenza (‘the flu’) can cause serious complications in older adults, which is why the National Immunisation Program offer free flu vaccines to people aged over 65.
It is wise to seek medical advice if you are concerned about yourself or a loved one. The Doctor will assess the symptoms and may prescribe antibiotics if there is a bacterial infection present. Antibiotics, however, are no use against viruses. In many cases, an over-the-counter cold and flu medication, with rest and fluids, can help relieve symptoms.
For elderly patients with the flu, Doctor may prescribe antiviral medication to lessen the symptoms and the duration.
Remember - frequent and thorough hand washing and keeping away from others while you are sick are the best ways to limit the spread of respiratory tract infections.
3. Skin infections and rashes
Our skin changes as we age, and infections can take hold and take longer to heal. Most skin infections are treatable, but stay alert for any unusual itching, lesions or pain.
Perhaps the worst of skin complaints is the very painful zoster virus, or shingles. If you think you may have shingles, you should seek medical help immediately. There is a shingles vaccine, provided free for people aged 70 years under the National Immunisation Program. You can read my blog about shingles here.
Another common skin complaint among the older generation is cellulitis, a bacterial infection of the skin that tends to occur on the lower legs and in areas that are damaged or inflamed. The bacteria enter broken or normal skin, and can spread easily to the tissue under the skin. The leg is usually red, swollen, warm and tender to touch in the affected area. It is important to seek medical help for this condition and antibiotics are required to treat the infection.
Other skin problems include fungal foot infections, which can affect the patient’s mobility, and drug-resistant infections such as Methicillin-resistant Staphylococcus aureus (MRSA).
Delirium, also known as acute confusional state, is when a person becomes confused, disoriented or delusional. This is particularly common in elderly patients, and can be caused by an infection, such as a UTI or pneumonia, or by a reaction to drugs, recent surgery, a fall, dehydration, emotional distress or sleep deprivation. Delirium can come on very suddenly, and can fluctuate from day to day, or even hour to hour, with patients being more disturbed at night.
Delirium is difficult for Doctors to diagnose, and challenging for both patients and carers. Delirium may be the sign of a serious illness in an older person, and should be urgently assessed. Early detection and treatment of delirium can lead to much better outcomes for the patient.
Gastroenteritis, or ‘gastro’ as we commonly call it, is an inflammation of the digestive tract, caused by bacteria, viruses, parasites or chemicals. It can involve both diarrhoea and vomiting, and other symptoms as well. In fact gastro is sometimes called ‘stomach flu’ because it can also be characterised by nausea, fever and headaches.
The main risk of gastro in the older patient is dehydration. The vomiting and diarrhoea cause the body to lose a lot of fluid, so it is important to keep drinking adequate fluids. Offer the patient water, especially after a bout of vomiting or diarrhoea, even if it’s just a few sips at a time. The patient may even prefer to suck on ice cubes.
Sometimes the symptoms of gastro can drag on, and vulnerable elderly patients can begin to deteriorate. If you are anxious about your own symptoms or someone in your care, it is best to seek a Doctor’s advice.
Remember, gastro is highly contagious. Take care to wash hands with soap and running water to prevent the spread of germs. Read more about gastro here.
6. Urinary Tract Infections
Urinary tract infections (UTIs) are extremely common among elderly men and women.
This is primarily due to the elderly’s lowered resistance to infection, along with age-related weakening of the muscles of the bladder. If the elderly person is not emptying their bladder fully, or suffering from incontinence, or has a catheter, then a UTI can develop.
UTIs in seniors can be difficult to diagnose because the symptoms are quite different to the usual UTI symptoms. The elderly patient with a UTI may not feel any pain or fever, nor tell their carers about any symptoms. Instead, the symptoms can be delirium or confusion, agitation, dizziness or falling, or other behavioural changes. Sometimes the symptoms can be mistaken for early stages of dementia or Alzheimer’s.
Worried sick? Call 13SICK.
When an older person needs urgent medical care in the after hours, when GP Practices are closed, often the first reaction of partner or carer is to call an ambulance. That’s where a call to 13SICK can help. The Home Doctor can assess whether a referral to the Emergency department is warranted. And it is often in the patient’s best interest to be treated in the familiar home environment, rather than go through the ordeal of a trip by ambulance to hospital. Our doctors work collaboratively with our elderly patients’ GPs and other health care workers to ensure continuity of care with medications, treatment and follow up.
Dr Umberto Russo MBBS (Adelaide) FRACGP is Chief Medical Officer at 13SICK, National Home Doctor Service. He has more than 25 years' experience both as a General Practitioner and a visiting home doctor, with a special interest in urgent medical care.