Current Trends in Geriatric Emergency Medicine

Kahn, Julia; Magauran, Brendan; Olshaker, Jonathan S.; Shankar, Kalpana N.

doi:10.1016/j.emc.2016.04.014

Cited by 45 publications

(26 citation statements)

References 53 publications

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“…3,27 Older adults may differ from other patients in a variety of ways, including the number of (and severity of) co-morbid conditions, post-injury problems that can arise, and the extent of treatment offered to them. Further, the fast-paced, goal-oriented environment of the ED is not always conducive to the treatment of older patients who often have more acute, complex, or atypical presentations of illness, 28 highlighting a need for behavioural or system change. This is the first systematic review to specifically examine risk factors for adverse outcomes among older adults with blunt chest wall trauma.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review

Sawa

Green

Thoma

et al. 2018

CJEM

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Section: Discussionmentioning

confidence: 99%

Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review

Sawa

Green

Thoma

et al. 2018

CJEM

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“…The pharmacist and PT documented their encounter using a standardized note that was integrated into the EHR to enhance information sharing with other hospital‐based and outpatient providers (Supplementary Figures S2 and S3). We purposely included pharmacists and PTs as integral parts of the intervention because most hospitals have these specialists available, face‐to‐face patient‐to‐pharmacist medication therapy management (MTM) sessions were demonstrated to be useful in reducing fall risk, and 35% of older adults have an adverse drug event annually . In addition, ED‐initiated PT was shown to reduce future fall‐related ED visits .…”

Section: Model Of Carementioning

confidence: 99%

“…We purposely included pharmacists and PTs as integral parts of the intervention because most hospitals have these specialists available, 19 faceto-face patient-to-pharmacist medication therapy management (MTM) sessions were demonstrated to be useful in reducing fall risk, 20,21 and 35% of older adults have an adverse drug event annually. 22 In addition, ED-initiated PT was shown to reduce future fall-related ED visits. 23 Because we did not have pharmacists and PTs available in both study sites in the ED, we established an agreement with the health system's director of Pharmacy Services and Rehabilitation Services that inpatient pharmacists and PT personnel would come to the ED for these consultations.…”

Section: The Gapcare Interventionmentioning

confidence: 99%

GAPcare: The Geriatric Acute and Post‐Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data

Goldberg

Marks

Ilegbusi

et al. 2019

J American Geriatrics Society

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OBJECTIVES We aimed to describe a new multidisciplinary team fall prevention intervention for older adults who seek care in the emergency department (ED) after having a fall, assess its feasibility and acceptability, and review lessons learned during its initiation. DESIGN Single‐blind randomized controlled pilot study. SETTING Two urban academic EDs PARTICIPANTS Adults 65 years old or older (n = 110) who presented to the ED within 7 days of a fall. INTERVENTION Participants were randomized to a usual care (UC) and an intervention (INT) arm. Participants in the INT arm received a brief medication therapy management session delivered by a pharmacist and a fall risk assessment and plan by a physical therapist (PT). INT participants received referrals to outpatient services (eg, home safety evaluation, outpatient PT). MEASUREMENTS We used participant, caregiver, and clinician surveys, as well as electronic health record review, to assess the feasibility and acceptability of the intervention. RESULTS Of the 110 participants, the median participant age was 81 years old, 67% were female, 94% were white, and 16.3% had cognitive impairment. Of the 55 in the INT arm, all but one participant received the pharmacy consult (98.2%); the PT consult was delivered to 83.6%. Median consult time was 20 minutes for pharmacy and 20 minutes for PT. ED length of stay was not increased in the INT arm: UC 5.25 hours vs INT 5.0 hours (P < .94). After receiving the Geriatric Acute and Post‐acute Fall Prevention Intervention (GAPcare), 100% of participants and 97.6% of clinicians recommended the pharmacy consult, and 95% of participants and 95.8% of clinicians recommended the PT consult. CONCLUSION These findings support the feasibility and acceptability of the GAPcare model in the ED. A future larger randomized controlled trial is planned to determine whether GAPcare can reduce recurrent falls and healthcare visits in older adults. J Am Geriatr Soc 68:198–206, 2019

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“…Many nursing home (NH) residents are frail with multiple chronic conditions [2–17]. When NH residents have an acute exacerbation or a complication of their chronic illness, an injury (fall-related) or acute infection, they may require acute medical services [11, 12, 14, 18]. General practitioners (GPs), nurses, emergency medical services and emergency departments (EDs) play central roles in providing acute medical care in these situations.…”

Section: Introductionmentioning

confidence: 99%

Appropriateness of transferring nursing home residents to emergency departments: a systematic review

et al. 2019

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BackgroundElderly living in a Nursing Home (NH) are frequently transferred to an Emergency Department when they need acute medical care. A proportion of these transfers may be considered inappropriate and may be avoidable.MethodsSystematic review. Literature search performed in September 2018 using PubMed, Web of Science, the Cochrane Library and the Cumulative Index to Nursing and Allied Health Literature database. Titles and abstracts were screened against inclusion and exclusion criteria. Full-texts of the selected abstracts were read and checked for relevance. All years and all languages were included provided there was an English, French, Dutch or German abstract.ResultsSeventy-seven articles were included in the systematic review: 1 randomised control trial (RCT), 6 narrative reviews, 9 systematic reviews, 7 experimental studies, 10 qualitative studies and 44 observational studies. Of all acute transfers of NH residents to an ED, 4 to 55% were classified as inappropriate. The most common reasons for transfer were trauma after falling, altered mental status and infection. Transfers were associated with a high risk of complications and mortality, especially during out-of-hours. Advance directives (ADs) were usually not available and relatives often urge NH staff to transfer patients to an ED. The lack of availability of GPs was a barrier to organise acute care in the NH in order to prevent admission to the hospital.ConclusionsThe definition of appropriateness is not uniform across studies and needs further investigation. To avoid inappropriate transfer to EDs, we recommend to respect the patient’s autonomy, to provide sufficient nursing staff and to invest in their education, to increase the role of GPs in the care of NH residents both in standard and in acute situations, and to promote interprofessional communication and collaboration between GPs, NH staff and EDs.Electronic supplementary materialThe online version of this article (10.1186/s12877-019-1028-z) contains supplementary material, which is available to authorized users.

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Current Trends in Geriatric Emergency Medicine

Cited by 45 publications

References 53 publications

Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review

Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review

GAPcare: The Geriatric Acute and Post‐Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data

Appropriateness of transferring nursing home residents to emergency departments: a systematic review

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