This month we are looking at advance directives, DNR orders, living wills, MOST, and POLST forms. If you don’t understand what all of those are, then you should definitely listen! I am joined by Drs. Ferdinando Mirarchi and Marie-Carmelle Elie who are researchers and leaders in the realm of palliative care and advance care planning.
Unfortunately, advance care planning is complicated by regional differences, policies, and differing scopes of definitions for orders. Listen for more information and ideas.
This episode is timed to coincide near April 16th which is National Healthcare Decisions Day! This exists (per their website here) “to inspire, educate, and empower the public and providers about the importance of advance care planning.”
Older adults often present to the ED for or with confusion or agitation. It is important to have a framework for assessing these patients, diagnosing the presence of delirium or dementia, looking for underlying causes, preventing worsening, treating the underlying condition, and sometimes treating the symptoms. The 
There is some confusion, disagreement, and misunderstanding surrounding orthostatic vitals in the ED. Older patients have a high rate of incidentally-found positive orthostatic vital signs, typically because of heart-rate changes. So emergency physicians may be reluctant to request orthostatics. However, in patients with syncope or falls, the presence of orthostatic hypotension and of symptoms may actually be helpful. It can help clarify the cause of syncope, potentially help avoid unnecessary testing or hospitalization, and can also help direct treatment and interventions to prevent future syncope or falls. In this episode, Maura Kennedy (
IV subdissociative dose ketamine (SDK) is used with increasing frequency for acute pain management in the ED. However, most studies have excluded older adults in assessing its efficacy and safety. In this episode, 
UTIs, UICs, and CAUTIs in older adults! In this episode, 
Older adults who suffer traumatic injuries have worse outcomes than younger patients. In this episode Dr. Zara Cooper (acute care and trauma surgeon at Brigham and Women’s hospital) and I discuss some of the reasons for this, and also ways to avoid missing injuries in older adults. Falls are the most common cause of trauma in older patients, and understanding how falls are a geriatric syndrome can help you understand how to help prevent future falls.
The way we currently provide geriatric emergency care is not sustainable. With the growing aging population, the dwindling medicare dollars, and the recognition that we need to improve the quality of geriatric care, we have to find ways to transform the systems in which we care for our older patients. Now there is a new step forward in this direction: EDs around the country can become accredited through ACEP as a Geriatric EDs (or geriatric-friendly ED) at three different levels. This accreditation is setting a new standard for geriatric care and for what it means to be a geriatric ED (GED). The accreditation is set up to work for any hospital from the smallest, rural ED, to a large, urban center with its own, separate GED space. Chris Carpenter, a major force behind the GED guidelines and accreditation, talks with me about why this is important, why you should care, and responds to potential criticisms and concerns.
The risk of falls increases as we age. Unfortunately, so does the risk of injury, morbidity, and mortality following a fall. Falls risk is considered a geriatric syndrome, with multi-factorial causes. Falls are a the #1 cause of trauma-related mortality in older adults, and a major cause of ED visits, hospital admissions, and admission to nursing facilities. Often, a patient at high risk for falls is not identified until after they have suffered an injury. Orange County EMS developed a system to help identify patients who were at high risk for falls, perform a comprehensive home visit, and connect those individuals with appropriate services to help reduce the rate of future falls and help those patients maintain their independence and functionality in their home environment.
ACEP’s 2013 
