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Lesson

Weakness and Dizziness in Older Adults

12 min Medical Skip to quiz

Objective: Treat nonspecific weakness in an older adult as a high-risk exam. Check blood pressure against their normal, heart rate, glucose, a 12-lead, infection, and stroke. Do not turn the call into a lift assist with no assessment.

Why this matters

Older adults are a large share of EMS calls. People 65 and older are a minority of the population and a large share of ambulance transports. They present as “off.” A heart attack may have no chest pain. Sepsis may have no fever. A stroke may not look like a textbook face, arm, and speech exam. Shock can have a blood pressure you would accept in a 30-year-old. Beta-blockers hide a fast heart rate. If they live at a high pressure, a systolic of 108 can be a crash. The abnormal vital sign that gets missed is often the one that still looks almost normal.

First, read the vital signs against their normal. Check glucose, get a 12-lead, and look for infection and stroke. Do not turn the call into a lift assist with no assessment.

Key points
  • Ask what a normal blood pressure is for them. A systolic of 110 is not fine in someone who lives at 160.
  • A heart rate of 90 in an 80-year-old on a beta-blocker can be their version of 130. Do not ignore an unexplained change in rate.
  • Check glucose, a 12-lead, temperature, and a real neurologic exam, even if dispatch said “sick person.”
  • Read the medication list: blood-pressure drugs, anticoagulants, insulin, opioids, and diuretics. Several medicines at once are the history.

Clinical sequence

  1. Protect the airway, breathing, and circulation. Look at them in the chair: work of breathing, mottled skin, and new confusion.
  2. Read vital signs in context. Compare blood pressure with their normal. Compare heart rate with their blockers. Check saturation, glucose, and temperature if you can.
  3. If this could be a heart attack, with weakness, nausea, or shortness of breath, get a 12-lead. If this could be a stroke, use FAST or BEFAST and last known well. Last known well is the last time they were seen normal. If this could be infection, look for a source and alert per protocol.
  4. Do not close the call as a urinary infection or vertigo because it is 3 a.m. Transport the patients who are sick.

Teaching points

  • Relative hypotension. Trauma triage already treats a lower systolic pressure as more dangerous in older adults, often under 110 in special considerations. The same idea applies to medical shock. A systolic pressure of 90 can be shock in an older adult. Do not call it normal without asking.
  • Hidden tachycardia. The conduction system ages, and beta-blockers and calcium-channel blockers blunt the rate. A “normal” heart rate does not clear sepsis or bleeding.
  • The dangerous atypical presentations. Heart attack without chest pain, sepsis, stroke including posterior stroke, anemia, a medication effect, and an arrhythmia can all show up as weakness.
  • A broader geriatric look. Geriatric Education for EMS uses the patient, the environment (an empty refrigerator, heat, medication bottles), a slower and wider medical exam, and the social question of whether they can stay. You still transport the ones who are sick.
  • Falls and lift assists. The fall is often the symptom. Look for the medical reason before you put them back in bed. Do not document a lift assist with no vital signs.
Verbalize
  • What is a normal blood pressure for you?
  • Weakness is a symptom. I am checking glucose, the ECG, infection, and stroke.
  • A systolic of 110 may be shock in this person.
  • I am not closing this as a urinary infection from the doorway.

Common errors

  • Do not accept a systolic pressure of 112 as stable in a mottled patient with chronic hypertension.
  • Do not skip the 12-lead because they denied chest pain.
  • Do not call new confusion dementia.
  • Do not document a lift assist with no vital signs.

Practice

One-minute check

An 82-year-old is “weak,” with a blood pressure of 108/64 and a heart rate of 78 on metoprolol, and is slightly confused. Dispatch said lift assist. Name the first four things you will actually do.

Related: Sepsis Recognition, ACS Without Chest Pain, Geriatric Trauma.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. In an older adult who lives at SBP 160, a new SBP of 108 with weakness is best treated as:
2. Beta blockers in older adults often:
3. New “weak and dizzy” in an older adult should routinely include:
4. A lift-assist call becomes a medical call when:
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