Moving the needle on fall prevention: A Geriatric Emergency Care Applied Research (GEAR) Network scoping review and consensus statement

Hammouda, Nada; Carpenter, Christopher R.; Hung, William; Lesser, Adriane; Nyamu, Sylviah; Liu, Shan; Gettel, Cameron J.; Malsch, Aaron; Castillo, Edward M.; Forrester, Savannah; Souffront, Kimberly; Vargas, Samuel; Goldberg, Elizabeth M.

doi:10.1111/acem.14279

Cited by 23 publications

(18 citation statements)

References 82 publications

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“…A recent consensus statement on geriatric fall prevention found multifactorial interventions to be most efficacious, focusing on medication review, exercise programs, and elimination of environmental hazards. 14 This supports the importance of geriatric EDs, where several dedicated specialists such as pharmacists, physical therapists, and case managers are available to evaluate patients as needed. 12 Also, a recent randomized control trial showed that an ED-initiated geriatric fall intervention reduced ED revisits by using pharmacists and physical therapists to assess patients prior to discharge.…”

Section: Discussionmentioning

confidence: 57%

Geriatric Falls: Patient Characteristics Associated with Emergency Department Revisits

Cox

Subramony

Supat

et al. 2022

WestJEM

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Introduction: Falls are the leading cause of traumatic injury among elderly adults in the United States, which represents a significant source of morbidity and leads to exorbitant healthcare costs. The purpose of this study was to characterize elderly fall patients and identify risk factors associated with seven-day emergency department (ED) revisits. Methods: This was a multicenter, retrospective, longitudinal cohort study using non-public data from 321 licensed, nonfederal, general, and acute care hospitals in California obtained from the Department of Healthcare Access and Information from January 1–December 31, 2017. Included were patients 65 and older who had a fall-related ED visit identified by International Classification of Diseases codes W00x to W19x. Primary outcome was a return visit to the ED within a seven-day window following the index encounter. Demographics collected included age, gender, ethnicity/race, patient payer status, Charlson Comorbidity Index (CCI), psychiatric diagnoses, and alcohol/substance use disorder diagnoses. We performed multivariate logistic regression to identify characteristics associated with seven-day ED revisit. Results: We identified a total of 2,758,295 ED visits during the study period with 347,233 (12.6%) visits corresponding to fall-related injuries. After applying exclusion criteria, 242,572 index ED visits were identified, representing 206,612 patients. Of these, 24,114 (11.7%) patients returned to an ED within seven days (revisit). Within this revisit population, 6,161 (22.6%) presented to a facility that was distinct from their index visit, and 4,970 (18.2%) were ultimately discharged with the same primary diagnosis as their index visit. Characteristics with the largest independent associations with a seven-day ED revisit were presence of a psychiatric diagnosis (odds ratio [OR] 1.75; 95% confidence interval [CI] 1.69 to 1.80), presence of an alcohol or substance use disorder (OR 1.70; 95% CI 1.64 to 1.78), and CCI ≥ 3 (OR 2.79; 95% CI 2.68 to 2.90). Conclusion: In this study we identified 24,114 elderly fall patients who experienced a seven-day ED revisit. Patients with multiple comorbidities, a substance use disorder, or a psychiatric diagnosis exhibited increased odds of experiencing a return visit to the ED within seven days of a fall-related index visit. These findings will help target at-risk elderly fall patients who may benefit from preventative multidisciplinary intervention during index ED visits to reduce ED revisits.

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Section: Discussionmentioning

confidence: 57%

Geriatric Falls: Patient Characteristics Associated with Emergency Department Revisits

Cox

Subramony

Supat

et al. 2022

WestJEM

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“…As an example, a falls history is often screened for as part of the ED nursing triage assessment 36 ; unfortunately, an ideal ED screening tool for falls history and risk does not currently exist, 43 but this is an area of active investigation. 21 Multiple scoring systems for frailty have been successfully used in the ED setting with good prediction of subsequent complications. 44 Notably, there is currently debate about the best frailty tool 45 and, similar to falls, selecting tools that are feasible and valid for the ED population is an active area of investigation.…”

Section: Considering the Importance Of Geriatric Syndromesmentioning

confidence: 99%

“…This includes the Geriatric Emergency Care Applied Research (GEAR) Network (R23 AG058926), 18 which is establishing research priorities, standardizing data approaches and measures for common geriatric emergency care conditions, developing and validating a data bank to support opportunities for investigators to conduct geriatric emergency care research, and facilitating future multicenter studies. This network has already been very successful 20–22 . Additionally, another collaborative NIH research infrastructure grant, GEAR 2.0‐Advancing Dementia Care (R61 AG069822), is focused on developing collaborative research to improve emergency care for persons living with Alzheimer’s disease and related dementias 23…”

Section: Previous Success Including Older Adults In Emergency Care Re...mentioning

confidence: 99%

Section: Strategies For Inclusion Of Older Adults In Emergency Care R...mentioning

confidence: 99%

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Inclusion of older adults in emergency department clinical research: Strategies to achieve a critical goal

Hunold

Goldberg

Caterino

et al. 2021

Academic Emergency Medicine

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There are over 23 million emergency department (ED) visits by older adults (aged 65 years and older) annually 1 and this number is expected to grow because of longer life spans, the aging of baby boomers, 2,3 and the fact that older adults are increasingly seeking care in the ED rather than other settings. 3 In fact, older adults are expected to account for as much as one-third of ED visits by 2030. 4 Medical research across all fields has historically excluded older adults. [5][6][7][8] Of trials published between 1965 and 2015, 33% had arbitrary upper age limits, and 67% reported on subjects younger than those typically afflicted by the disease under study. 7 Older adults can also be systematically excluded without an explicit age

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“…The original GEAR project (hereafter referred to simply as GEAR) is dedicated to improving ED care of the older adult and focused on the priority topics of: care transitions, cognitive impairment—delirium, medication safety, elder abuse and falls. Four of the five GEAR research priorities have already been published using this approach 13–16. GEAR 2.0 ADC is focused on optimising emergency care for PLWD and their care partners in the priority areas of: ED practices, ED care transitions, detection and communication and shared decision-making.…”

Section: Introductionmentioning

confidence: 99%

The Geriatric Emergency Care Applied Research (GEAR) network approach: a protocol to advance stakeholder consensus and research priorities in geriatrics and dementia care in the emergency department

et al. 2022

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IntroductionIncreasingly, older adults are turning to emergency departments (EDs) to address healthcare needs. To achieve these research demands, infrastructure is needed to both generate evidence of intervention impact and advance the development of implementation science, pragmatic trials evaluation and dissemination of findings from studies addressing the emergency care needs of older adults. The Geriatric Emergency Care Applied Research Network (https://gearnetwork.org) has been created in response to these scientific needs—to build a transdisciplinary infrastructure to support the research that will optimise emergency care for older adults and persons living with dementia.Methods and analysisIn this paper, we describe our approach to developing the GEAR Network infrastructure, the scoping reviews to identify research and clinical gaps and its use of consensus-driven research priorities with a transdisciplinary taskforce of stakeholders that includes patients and care partners. We describe how priority topic areas are ascertained, the process of conducting scoping reviews with integrated academic librarians performing standardised searches and providing quality control on reviews, input and support from the taskforce and conducting a large-scale consensus workshop to prioritise future research topics. The GEAR Network approach provides a framework and systematic approach to develop a research agenda and support research in geriatric emergency care.Ethics and disseminationThis is a systematic review of previously conducted research; accordingly, it does not constitute human subjects research needing ethics review. These reviews will be prepared as manuscripts and submitted for publication to peer-reviewed journals, and the results will be presented at conferences.Open Science Framework registered DOI: 10.17605/OSF.IO/6QRYX, 10.17605/OSF.IO/AKVZ8, 10.17605/OSF.IO/EPVR5, 10.17605/OSF.IO/VXPRS.

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Moving the needle on fall prevention: A Geriatric Emergency Care Applied Research (GEAR) Network scoping review and consensus statement

Cited by 23 publications

References 82 publications

Geriatric Falls: Patient Characteristics Associated with Emergency Department Revisits

Geriatric Falls: Patient Characteristics Associated with Emergency Department Revisits

Inclusion of older adults in emergency department clinical research: Strategies to achieve a critical goal

The Geriatric Emergency Care Applied Research (GEAR) network approach: a protocol to advance stakeholder consensus and research priorities in geriatrics and dementia care in the emergency department

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