Defibrillators for the Elderly: Special Considerations and Training Tips

Lucy Dale

Published:4 March 2025

As we get older, our bodies change in ways that impact everything from mobility to heart function. While most people associate cardiac arrest with lifestyle factors or pre-existing conditions, the reality is that age itself is a major risk factor. The elderly are particularly vulnerable to sudden cardiac arrest (SCA), making defibrillators a crucial part of senior healthcare. However, using an automated external defibrillator (AED) on an elderly patient isn’t as simple as just applying pads and pressing a button. Their unique physiology presents a range of challenges that caregivers, first responders, and even family members need to be aware of.

This guide goes beyond the basics to explore the real-world complexities of defibrillating an elderly person, covering everything from fragile skin and pacemakers to CPR adjustments and shock effectiveness.

Why Are Elderly Patients at Greater Risk of Cardiac Arrest?

The aging heart doesn’t beat with the same efficiency it once did. Over time, it weakens, arteries stiffen, and underlying health conditions like high blood pressure, diabetes, and heart disease increase the likelihood of fatal arrhythmias. But that’s not the only reason the elderly are at higher risk. Many seniors take blood thinners, beta-blockers, or other heart medications that can influence how an AED shock is delivered and how effective it is.

Another major concern is response time. Many elderly individuals live alone or in care homes where emergency medical assistance may not arrive quickly enough. A readily accessible home defibrillator can make the difference between life and death. Additionally, a significant number of seniors have pacemakers or implantable cardioverter-defibrillators (ICDs), which means the placement of AED pads must be carefully considered to ensure a successful shock delivery.

4 March 2025

Challenges When Using a Defibrillator on an Elderly Person (and How to Overcome Them)

One of the most immediate challenges when using an AED on an elderly patient is their fragile skin. As skin becomes thinner with age, it is more prone to tearing when AED pads are applied or removed. This can lead to painful abrasions and even infections if not handled correctly. When placing the pads, applying firm but gentle pressure is key. When removing them, use moist gauze to help soften the adhesive and prevent unnecessary tearing.

Another significant concern is the risk of rib fractures during CPR. Osteoporosis weakens the bones, making elderly patients more susceptible to fractures, especially when compressions are performed with excessive force. However, despite this risk, CPR should never be stopped if a rib breaks. Circulating oxygenated blood remains the top priority, and ribs can heal, while the heart cannot restart on its own. Some modern AEDs come with CPR feedback technology, ensuring compressions are firm enough to be effective but not so forceful that they cause avoidable damage.

For seniors with pacemakers or ICDs, pad placement requires extra care. AED pads should never be positioned directly over an implant, as this could interfere with the device’s function. The best approach is to place the pads at least one inch away from the pacemaker, adjusting their placement accordingly. If a senior has a very thin chest structure, an anterior-posterior pad placement, where one pad is positioned on the chest and the other on the back, may be a better alternative.

Blood thinners present yet another complication. Many seniors take medications that make bruising and internal bleeding more likely, which can be a concern when performing CPR. If a patient has been on blood thinners, expect visible bruising around the chest after compressions. While it may look alarming, it should not deter rescuers from continuing lifesaving efforts. The risk of bruising is far less significant than the risk of oxygen deprivation to the brain.

A less commonly discussed challenge is the impact of body temperature on defibrillation effectiveness. Older adults tend to have lower body temperatures due to thinner skin, reduced circulation, and a slower metabolism. In colder conditions, AED pads may not adhere properly, and the shock may not be as effective. In cases where a senior’s skin feels cold to the touch, gently warming the chest before applying the AED pads can improve conductivity and ensure better shock delivery.

What’s the Best AED for Elderly Patients?

Not all defibrillators are the same, and some are better suited for elderly users than others. When choosing an AED for use with senior patients, certain features can make all the difference. A defibrillator with voice and visual prompts is ideal for caregivers and family members who may be unfamiliar with the process, providing clear, step-by-step instructions. CPR feedback technology is another valuable feature, as it helps users apply the right amount of pressure during chest compressions, which is especially important for frail patients.

In terms of operation, there are two main types of AEDs: semi-automatic and fully automatic. Semi-automatic defibrillators require the user to press a button to deliver the shock, making them better suited for trained responders. Fully automatic AEDs, on the other hand, deliver the shock on their own once a shockable rhythm is detected, reducing hesitation for untrained users.

Training Tips for AED Use on Elderly Patients

For an AED to be most effective, the people using it must be confident in their ability to operate it correctly. This is why training is essential for caregivers, family members, and care home staff. Regular hands-on training ensures that in the event of an emergency, responders act quickly and efficiently.

Another useful approach is to simulate real-life scenarios. Running AED training drills in senior living communities allows staff and residents to familiarise themselves with the process so that when a real emergency happens, there is less panic and more action. Additionally, it’s crucial to ensure that AEDs in care facilities and homes are easily accessible, clearly marked, and well-maintained.

Why Every Senior Living Facility and Home Needs an AED

More than 70 percent of cardiac arrests occur outside of hospitals, and the majority involve individuals over the age of 65. Given the increased risks associated with delayed response times, having an accessible AED in every senior care home, retirement facility, and private residence with elderly occupants is crucial.

For families caring for elderly loved ones, investing in a home defibrillator is one of the smartest safety measures they can take. Many modern AEDs are designed for bystanders with no prior training, making them easy to use in emergencies.

Ensuring the Best Outcomes for Elderly Defibrillation

Using a defibrillator on an elderly patient requires more than just pressing a button; it requires awareness, confidence, and preparation. By understanding the unique considerations of senior care, caregivers and loved ones can ensure faster, safer, and more effective interventions when it matters most.

Don’t wait until it’s too late. Make sure you have the right AED, the right training, and the right plan in place.