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.
New Geriatric ED Accreditation – and why you should care
Preventing Falls in the Elderly: An EMS Story
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.
Practical Tips for Providing Palliative Care in the ED
ACEP’s 2013 Choosing Wisely campaign identified engaging palliative care or hospice services in the ED as one of their 10 recommendations. Palliative care can help with symptom management, support families and patients, and help clarify their goals of care. Most EDs, however, do not have real-time palliative care consults available at all times, or at all! So the emergency physician is usually the person providing palliative care for patients in the ED. In this episode Alisha Benner discusses what palliative care is and shares pearls for better symptom management, communication with patients, and active management at the end of life.
Eye Emergencies in the Elderly – Part 2
This is a continuation of our discussion of Eye Emergencies in the elderly with ophthalmologist and retina specialist, Dr. Bryan Hong. Many thanks to the Life in the Fast Lane blog for including eye emergencies part 1 in their LITFL Weekly Review!
Eye Emergencies in the Elderly – Part 1
Eye concerns are a common reason for elderly patients to visit the ED. Their causes can range from benign to serious, time-sensitive, vision-threatening entities. In this episode, ophthalmologist and retina-specialist Dr. Bryan Hong talks us through his approach and initial management of four common ophthalmologic emergencies.
Continue reading
How to Reverse Oral Anticoagulants
The number of new oral anticoagulants has grown dramatically in the last few years. And with that growth has come the need for new reversal agents. Reversing anticoagulation in patients with acute intra-cranial hemorrhages can be complex and dependent on what medication your hospital stores. It is important to know what is out there, what you can use, and how effective it is likely to be.
How to Identify and Intervene in Cases of Elder Abuse
Elder abuse is a common and under-recognized problem among older adults. In the Emergency Department, we are uniquely positioned to identify patients who may be at risk. In this episode, Tony Rosen (https://weillcornell.org/anthonyrosen), an Emergency Physician and researcher with fellowship training in Geriatric Emergency Medicine, who works at Cornell in NYC discusses what constitutes elder abuse, its prevalence, how to identify it, and what to do when you suspect it.
The Atypical is Typical for ACS in Older Adults
Chest pain is one of the most common reasons why people present to the ED. The chief complaint of “Chest Pain” typically triggers an automatic EKG, and potentially a workup for acute coronary syndrome (ACS). However, many patients who are having ACS do not present with chest pain. Instead, they may have dyspnea, diaphoresis, nausea, vomiting, abdominal pain, or other non-specific symptoms. Which patients are most likely to present this way? Older adults. In this GEMCAST, Amal Mattu talks about ACS presentations, workup, and management in older adults, and why the atypical is typical!
5 Ways to Geriatricize Your ED
Geriatric EDs, or Senior EDs, have been popping up around the country. The idea behind them is that having a separate space, a distinct staff, and specialized protocols, can help provide better care to older adults. However, for many EDs and hospital systems this is simply not feasible. In this episode, Chris Carpenter (@GeriatricEDnews) presents five high-yield, low-cost ways that those of us working in non-senior EDs can take some of the principles of geriatric emergency medicine and apply them either to our own practice or implement them in our own EDs, without a lot of funding. For more about Geriatric EDs, check out this ALiEM blog post.
Pulmonary Emboli in Older Adults
Not a day goes by that an Emergency Physician doesn’t at least consider PE in a patient who presents with chest pain, dyspnea, or syncope. We have become familiar with using risk stratification tools like the Wells Score and the PERC criteria. But what do you do in older adults? All of them will automatically NOT be PERC negative because of their age. In this episode, with PE guru Jeff Kline (@klinelab), we discuss the presentation of PE in older adults, including the demographics, diagnosis, and how treatment may differ from younger adults in small, sub-massive, and massive PEs.
