Reconsidering orthostatic vital signs in older emergency department patients

Geriatric emergency medicine: Complexity evolves with age

“…Older adult ED presentations often involve falls/trauma, delirium, acute pain management, palliative care discussions, and infections, many of which, are complicated by atypical physiological changes and vague presentations 21,22 . Palliative care conversations can be a difficult subject with patients; however, the, ‘“gold standard” question for initiating palliative care remains “would I be surprised if this patient died in the next 12 months?”’ 23 Patients with delirium (acute brain failure) have a 38% higher mortality and 200% higher rate of institutionalisation post‐hospitalisation 24 .…”

Safe to send home? Discharge risk assessment in the emergency department

“…It may be that a tiered response is useful with early screening using one of these tools and then progressing to more complex evaluations, similarly to fall risk evaluations. Although there is no perfect fall risk tool (see the articles on falls and postural hypotension in this series 31,32 ), using a tool can give you and the patient objective evidence of their need for further fall risk evaluation.…”

Avoiding anchoring bias by moving beyond ‘mechanical falls’ in geriatric emergency medicine

“…How much of this assessment is performed in the ED versus other environments (ward, community office) will depend on both patient factors and health system factors, but the principles of evaluation are the same. Detailed methods of evaluating for delirium and orthostatic hypotension have been previously published in this series . Falls evaluation, whether in the ED or following ED discharge, should objectively assess gait, balance, proprioception, vision, muscle strength and cognitive function.…”

“…Detailed methods of evaluating for delirium and orthostatic hypotension have been previously published in this series. 27,28 Falls evaluation, whether in the ED or following ED discharge, should objectively assess gait, balance, proprioception, vision, muscle strength and cognitive function. In the ED, the Aged Services Emergency Team nurses or multi-disciplinary team members can perform some of these evaluations.…”