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Dead End: Challenges In Healthcare Delivery To Older Adults With History Of Dementia And Incarceration- A Case Report, Shruti Anand, Saket Saxena

Journal of Geriatric Emergency Medicine

No abstract provided.

The Geriatric Emergency Department At The University Of California San Francisco: Structures, Roles, And Lessons Learned, Todd James

Journal of Geriatric Emergency Medicine

No abstract provided.

Pre-Hospital Conditions Affecting The Hospitalization Risk In Older Adults At The Emergency Department, Karin Erwander, Kjell Ivarsson, Mona Landin-Olsson, Björn Agvall

Journal of Geriatric Emergency Medicine

BACKGROUND: The Emergency Department (ED) is a common route to hospitalization for critically ill and older adults. Older patients are admitted to hospital at a higher rate and have longer length of stay (LOS) when hospitalized. To be able to confront an increasing aging population, meet their medical needs and influence rising costs of health care, there is a need to focus on the older population. In Scandinavia, few studies are made that focus on the geriatric population at the ED. It is essential to early identify risk factors for hospitalization at the ED to improve the medical care for …

Effect Of Pharmacist Intervention On Emergency Department Geriatric Patients With Polypharmacy, Rachael Sheehan, Ashley Stajkowski, Lee Hraby, Melanie Mommaerts, Tyler Nichols, Marisa Nichols, Alex Beuning, Victor Warne

Journal of Geriatric Emergency Medicine

Background: Polypharmacy is common within the geriatric population due to the commonality of multiple comorbidities and use of multiple providers. The emergency department (ED) is a prime location to capture these patients, especially when they present with chief complaints which may be medication related. Much of this population is prescribed potentially inappropriate medications which increases their risk for adverse drug reactions. Pharmacist review of patient home medication lists has been shown to decrease the number of potentially inappropriate medications, as well as medication-related problems, such as therapeutic duplications and drug interactions. These reductions can increase patient safety.

Objective: The goal …

Key Healthcare Providers’ Perspectives On The Implementation Of Senior-Friendly Emergency Department Care In Quebec, Deniz Cetin-Sahin, Francine Ducharme, Jane Mccusker, Mona Magalhaes, Nathalie Veillette, Paul-André Lachance, Sylvie Cossette, Alain Vadeboncoeur, Rick Mah, T.T. Minh Vu, Simon Berthelot

Journal of Geriatric Emergency Medicine

Background: Senior-friendly emergency department (ED) care is emerging to address large numbers of older adults in healthcare and implementation is variable.

Objectives: We aimed to explore key healthcare providers’ perspectives on factors affecting implementation of senior-friendly ED care during the first five years of the Senior-Friendly Hospital Initiative in the Province of Quebec, Canada.

Methods: We conducted a descriptive qualitative study of four urban EDs. Key healthcare providers involved in care within the ED or after discharge to the community were purposefully selected. Semi-structured telephone interviews were conducted in participants’ preferred language, English or French. Recorded interviews were transcribed. A …

Emergency Medicine Provider Comfort With Physician Orders For Life Sustaining Treatment (Polst) Advanced Directive, Katherine Briggie, Kaitlin Sweeney, Shannon Findlay, Hao Wang, Juan Pagan-Ferrer, Dan Miller, Sangil Lee

Journal of Geriatric Emergency Medicine

Background

Emergency departments (ED) across the United States see many patients with advanced disease nearing the end of life. ED providers make many important decisions that impact a patient’s hospital course, including resuscitation decisions. When patients’ preferences are not known, treatment in the ED frequently defaults to maximally aggressive care. The Physician Orders for Life Sustaining Treatment (POLST) form has been shown to lead to more goal-concordant care for these patients by providing detailed instructions regarding end-of-life interventions, made by the patient and/or medical decision maker.

Methods

In this needs assessment study, we aimed to determine the level of awareness …

The Effect Of The Care Transitions Intervention On Ed Revisits And Outpatient Clinic Follow-Up Among Older Adults Who Live Alone, Clara V. Kuranz, Rebecca K. Green, Angela Gifford, Gwen C. Jacobsohn, Thomas V. Caprio, Amy L. Cochran, Jeremy T. Cushman, Courtney M.C. Jones, Amy J. H. Kind, Michael Lohmeier, Manish N. Shah

Journal of Geriatric Emergency Medicine

INTRODUCTION: Older adults frequently return to an emergency department (ED) within 30 days of an initial visit. In this study, we examined the effectiveness of an adapted Care Transitions Intervention (CTI) at reducing risk of ED revisits within 30 days for older adults who live alone. We also explored the interaction between receiving help with healthcare needs and receiving the CTI on the risk of 30-day ED revisits.

METHODS: We conducted a subgroup analysis of community-dwelling older (age≥60 years) ED patients who reported living alone as part of a randomized controlled trial of CTI effectiveness following discharge home from one …

Research To Accelerate Practice Change In Geriatric Emergency Medicine, Susan Hastings

Journal of Geriatric Emergency Medicine

This is the Keynote Address for the First American Geriatrics Society Geriatric Emergency Department Special Interest Group

Geriatric Emergency Medicine Fellowship Journal Club: Operational Changes For Recognizing Prevalent Delirium And Preventing Incident Delirium, Natalie M. Elder

Journal of Geriatric Emergency Medicine

N/A

Addressing Complex Primary Care Needs For An Older Man Recently Released From Incarceration With Multiple Emergency Department Visits., Saffia Bajwa, Ariba Khan, Michael L. Malone

Journal of Geriatric Emergency Medicine

Purpose: Older prisoners being released into the community need to be placed in a system to help them transition from living in prison to living in a free society. They must adapt in order to find housing, community services, medical, dental and psychiatric care. When the complex social needs of these persons are not fully met, the emergency department is used as a safety net.

Methods and Findings: This paper describes a patient who had multiple emergency department visits which was his routine method of seeking medical care.

Health Care Policy Implications: We believe that public health policy requiring …

Navigating Care Transitions For Older Adults In The Emergency Department When A Social Worker Is Unavailable, Rebecca Weeks, Kathy Sawasky, Adam Perry, Michael Malone

Journal of Geriatric Emergency Medicine

Some Emergency Departments do not have social worker staffing to assess high- risk older adults who have been identified. This is of particular concern in during care transitions for older patients who are at risk for poor health outcomes. We describe triggers for the emergency provider to recognize older patients at high risk and bundles of appropriate services and community supports to mitigate risk.

Emergency Department Policies To Improve Care Experiences For Older Adults During The Covid-19 Pandemic, Anita Chary, Shan Lliu, Lauren Southerland, Lauren Cameron Comasco, Kei Ouchi, Christopher R. Carpenter Md, Msc, Edward W Boyer, Aanand D. Naik, Maura Kennedy

Journal of Geriatric Emergency Medicine

n/a

Cpr-Directive Conversations In The Emergency Department: The Opinion Of Elderly Patients, Kelvin H. Kramp Dr., Rutger De Hond, Mirwais Mehrab, Martijn Van Hooft, Roger A.P.A. Hessels

Journal of Geriatric Emergency Medicine

Background: The average age of patients admitted to the emergency department (ED) continues to rise. Many face difficult discussions about cardiopulmonary resuscitation (CPR) and end-of-life decisions.

Objectives: This study aimed to determine which healthcare professionals elderly patients admitted via the ED preferred to discuss their CPR-directive with and their opinion about the ED as a setting for discussing their CPR-directive.

Methods: A mixed-methods study with an explanatory sequential design was conducted. A questionnaire was administered to 100 patients >65 years of age admitted to nursing wards via the ED that had a CPR-directive conversation during admission 24-48 hours earlier. Patients …

Call To Action: Improving The Care Of Older Patients In Emergency Departments. A Much-Needed Collaboration Between Emergency Medicine Physicians And Geriatricians., Saket A. Saxena

Journal of Geriatric Emergency Medicine

No abstract provided.

Level Of Comfort In Evaluating Older Patients Amongst Medical Students And Emergency Medicine Residents, Lily L. Berrin, Phraewa Thatphet, Anita N. Chary, Surriya C. Ahmad, Don Melady, Shan W. Liu

Journal of Geriatric Emergency Medicine

Introduction

As the population ages, emergency physicians must be better equipped to manage the complex needs of older patients. While geriatric core competencies have been developed for medical students and emergency medicine (EM) residents, little work has been done to evaluate EM trainees’ comfort with these competencies, or their interest in and barriers to learning more about Geriatric Emergency Medicine (GEM).

Methods

We conducted a cross-sectional study of EM residents and medical students in their clinical years of training with interest in EM. We used an online self-administered survey to evaluate trainees’ self-reported comfort with previously reported geriatric competency domains, …

Geriatric Emergency Medicine Fellowship Journal Club: To Ct Or Not, Marie-Pier Lanoue, Kira Gossack-Keenan, Don Melady

Journal of Geriatric Emergency Medicine

No abstract provided.

Covid-19 In Older Adults- A Practical Review For Emergency Providers In 2022, Michael L. Malone, Teresita Hogan, Alice Bonner, Kevin Biese, Patti Pagel, Kathleen Unroe

Journal of Geriatric Emergency Medicine

COVID-19 has posed a considerable threat to all aspects of older Americans’ lives. The pandemic generated acute illness, emergency department (ED) visits, hospitalization, respiratory failure, and death. Pandemic-associated social isolation and loneliness further endangered older adults. Recovery from COVID-19 illness has commonly been followed by chronic symptoms, which may also precipitate ED visits. While vaccination has mitigated risks of serious illness requiring hospitalization, a booster dose is required to sustain protection. New treatments and therapies, including monoclonal antibodies and antiviral agents, have shown efficacy for older adults who are at risk of hospitalization. Older adults remain vulnerable in 2022, after …

What’S In A Name? Understanding Failure To Thrive And Frailty In The Emergency Department, Katherine Selman, Christina Shenvi

Journal of Geriatric Emergency Medicine

No abstract provided.

Pitfalls Of Delirium Screening In Older Adults, Danya Khoujah, Debra Eagles

Journal of Geriatric Emergency Medicine

No abstract provided.

Caring For Older Adults In The Hallway Of A Crowded Emergency Department, Rebecca Weeks, Kathy Sawasky, Michael Malone

Journal of Geriatric Emergency Medicine

This paper describes strategies for emergency department providers to address the needs of older adults when facilities are overcrowded and care extends into the hallway.

A Survey Of Delirium Self-Reported Knowledge And Practices Among Emergency Physicians In The United States, Anita N. Chary, Adriane Lesser, Sharon K. Inouye, Christopher R. Carpenter Md, Msc, Amy R. Stuck, Maura Kennedy

Journal of Geriatric Emergency Medicine

Objective: This study aimed to evaluate United States emergency physicians’ self-reported knowledge and practices regarding the detection, prevention, and management of delirium, a common and deadly syndrome that disproportionately affects older emergency department (ED) patients. Knowledge and practices of the broader emergency physician community about these priority topics in geriatric emergency medicine are understudied.

Design: Electronic self-administered online survey

Setting: United States

Participants: One-hundred ninety-seven emergency physicians of the American College of Emergency Physicians Emergency Medicine Practice Research Network

Measures: Descriptive statistics were generated from survey responses.

Results: Of 734 physicians in the research network who were sent the …

It Takes Courage To Pause: Rapid Goals-Of-Care Conversations In The Emergency Department, Anita N. Chary, Aanand D. Naik, Kei Ouchi

Journal of Geriatric Emergency Medicine

n/a

Polypharmacy And High-Risk Medications In Older Veterans Presenting For Emergency Care, Paige Morizio, Vinita Mistry, Ashley Mcknight, Marc Pepin, William Bryan, Ryan Owenby, Laura Previll, Luna Ragsdale

Journal of Geriatric Emergency Medicine

Background: Guidelines suggest screening for polypharmacy and documentation of high-risk medications in the geriatric Emergency Department (ED) setting. The purpose of this quality improvement initiative was to describe high-risk medications and polypharmacy in older Veterans presenting to the ED in order to inform the workflow of a Geriatric ED pharmacist.

Methods: This was a retrospective, quality improvement project that included patients age 65 years or older who presented to the ED between 10/1/2017 and 9/30/2019. The endpoints included the number of patients with at least one high-risk medication and the mean number of medications on the outpatient medication list. The …

Intermediate Care Technicians-A Novel Workforce For Veterans Affairs Geriatric Emergency Departments, Kristina T. Snell, Thomas Edes, Colleen M. Mcquown

Journal of Geriatric Emergency Medicine

No abstract provided.

Geriatric Emergency Medicine Fellowship Journal Club: Frailty, Sarah Keene, Rebecca Fisher, Lauren Cameron-Comasco

Journal of Geriatric Emergency Medicine

No abstract provided.

Ten Clinical Tips In The Assessment Of Genitourinary Emergencies Of An Older Adult, Nicole Soria, Danya Khoujah

Journal of Geriatric Emergency Medicine

Sentinel Paper Review: Exploring Care Transitions From Patient, Caregiver, And Health-Care Provider Perspectives, Kevin T. Fuji, Aaron Malsch, Pamela Martin

Journal of Geriatric Emergency Medicine

No abstract provided.

Can An Emergency Department Adequately Address An Older Adult Who Has Complex Needs?, Rami Tarabay, Adam Perry, Riwa Al Aridi, Michael Malone

Journal of Geriatric Emergency Medicine

Older adults account for a considerable percentage of all emergency departments (ED) patient encounters. Those with very complex needs or multiple co-morbid conditions often have lengthy ED evaluations culminating in admission, many of which are considered potentially avoidable. Provider and process elements can evolve to create efficient and more comprehensive geriatric assessments in ED. This paper describes an older adult with acute on chronic symptoms admitted through the ED to the Acute Care for Elders (ACE) inpatient unit. We illustrate how elements of the ACE model, when applied in the ED, may avoid hospitalization. We review the Domain Management Model …

Caregiver Support In The Emergency Department, Candace Kim, Dawn Butler, Todd C. James

Journal of Geriatric Emergency Medicine

Caregiver support in the emergency department can lead to improved patient care, decreased suffering and lower costs. Identifying caregivers and inviting them onto the healthcare team enhances care. It is useful to document risk factors for caregiver stress and provide resources. The Kingston Caregiver Stress Scale is a tool suitable for assessing needs of caregivers. Multiple health professionals in the emergency department can be utilized to support caregivers.

Unmet Needs And Social Challenges For Older Adults During And After The Covid-19 Pandemic: An Opportunity To Improve Care, Alyssa Elman, Daniel Baek, Elaine Gottesman, Michael E. Stern, Mary R. Mulcare, Amy Shaw, Morgan Pearman, Michelle Sullivan, Sunday Clark, Timothy F. Platts-Mills, Rahul Sharma, Tony Rosen

Journal of Geriatric Emergency Medicine

Many older adults have unmet needs and social challenges that can negatively impact their health and well-being, particularly during and after the COVID pandemic. These include social isolation, inadequate care or assistance with their daily activities, food insecurity, housing insecurity, poverty, and abuse/neglect/exploitation. An ED visit provides a unique and critical opportunity to identify these issues and initiate intervention for these vulnerable older adults. By assessing for unmet needs and social challenges, considering a team-based approach as to how they may be ameliorated, using online tools, and integrating telehealth and EMS, ED providers have the potential to dramatically improve …