Balancing vision with pragmatism: The geriatric emergency department guidelines‐realistic expectations from emergency medicine and geriatric medicine

Abstract

In 2014 the Geriatric Emergency Department (GED) Guidelines were published and endorsed by four major medical organizations. The multidisciplinary GED Guidelines characterize the complex needs of the older emergency department (ED) patient and current best practices with the goal of promoting more costeffective and patient-centered care. The recommendations are extensive and the vast majority of EDs then and now do not have either the resources nor hospital administrative support to provide this additional service. At the 2021 American Academy of Emergency Medicine's Scientific Assembly, a panel of emergency medicine physicians and geriatricians discussed the GED Guidelines and the current realities of EDs' capacity to provide best practice and guideline recommended care of GED patients. This article is a synthesis of the panel's presentation and discussion. With the substantial challenges in providing guideline recommended care in EDs, this article will explore three high impact GED clinical conditions to highlight guideline recommendations, challenges and opportunities, and discuss realistically achievable expectations for non-Geriatric ED accredited institutions. In 2014 the Geriatric Emergency Department Guidelines were published describing the current best practices for geriatric ED patients. Unfortunately, the vast majority of EDs worldwide do not provide the level of service recommended by the GED guidelines. The GED Guidelines can best be termed aspirational for U.S. EDs at the present time.

Determination of the Geriatric Patient Profile Admitting to the Emergency Department

“…Yapılan çalışmalarda 65 yaş ve üzeri bireylerin büyük çoğunluğunda en az bir tane kronik hastalık varlığı tespit edilmiştir (10,11). Yaşlı bireylerde kronik hastalık prevalansındaki artış, çoklu ilaç kullanımını (polifarmasi) da beraberinde getirmektedir (12). Ünüvar ve arkadaşları çalışmalarında, hastaların yaklaşık yarısının altıdan fazla ilaç kullandığı ve bu hastaların 1/3'ünün ise ilaçlarını doğru şekilde kullanmadıkları tespit etmiştir (13).…”

A Qualitative Study of Emergency Department Delirium Prevention Initiatives

“…Literature suggests that emergency nurses recognize a need for education about delirium and appreciate their role in improving delirium-related patient experience and outcomes. 23,24 However, any ED delirium prevention initiatives must take into account bedside nurses' already extensive patient care responsibilities and attempt to minimize additional workload. 2 There may be a potential role for greater involvement of frontline clinicians in initiating discussions with other care team members and specialists about delirium prevention.…”

Adapting Emergency Care for Persons Living With Dementia: Results of the Geriatric Emergency Care Applied Research Network Scoping Review and Consensus Conference

“…To create interventions with the optimal potential for scale-up via implementation science, future emergency medicine research including PLWD will need to investigate real-world settings with disruptive, pragmatic innovations. 21,22 Transforming geriatric emergency care for a cognitively frail population will require rational adaptations to research methods and more transparent inclusivity. A patient-centered focus on appropriate autonomy and maintaining functional capacity aligns with representative stakeholder's priorities.…”