Journal of geriatric emergency medicine最新文献

{"title":"Assessing medication self-management challenges and self-efficacy during emergency department medication reconciliation: An evidence-based quality improvement project","authors":"Mitchel Erickson, Jyu-Lin Chen, Yoonmee Joo, Stephanie Rogers, Thomas Hoffman, Claire Bainbridge","doi":"10.17294/2694-4715.1069","DOIUrl":"https://doi.org/10.17294/2694-4715.1069","url":null,"abstract":"Introduction Older adult patients (≥65) accessing emergency departments (ED) represent a significant demographic. Recidivism secondary to adverse drug events (ADE) ranges between 6-24% and levels of prescribed medication non-adherence is common among older adults. The ED pharmacist medication reconciliation workflow may mitigate self-management challenges in real time and reduce medication-related harm while potentially impacting recidivism, medication adherence, and patient self-efficacy. The purposes of this evidence-based project were to (1) evaluate the impact of a modified Medication Management for Deficiencies in the Elderly (MedMalDE) intervention on Self-Efficacy for Appropriate Medication Use (SEAMS) and 30-day return to care and (2) identify factors associated with medication self-management challenges (MedMalDE) in the participating institution. Methods As part of an evidence-based quality improvement (QI) effort to build an accredited geriatric emergency department (GED) and meet State legislated acute care medication history requirements, a new medication reconciliation workflow was deployed. To assess the intervention’s impact on self -efficacy in a pre/post design, 21 older adult patient’s underwent SEAMS assessment at two time points: the intervention and 7-14 days post-discharge from the emergency department. Baseline data and medication self-management challenges for an ED convenience sample of 167 older adult patients completed the MedMalDE. Descriptive statistics and a logistic regression model were used to evaluate the impact of the intervention and factors associated with medication management deficiencies. Wilcoxon Signed Rank was used for pre/post SEAMS score change. Results The self-efficacy (SEAMS) scores of 21-patients participating in the intervention were significantly improved from 19.88 to 21 (p=0.0077, p10%, included lack of knowledge regarding medication names, ease of opening or manipulating medications, ease of swallowing medications, and affordability. MedMalDE total scores were significantly associated with female gender (OR=","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"231 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139241652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GeriCarED: Feasibility of a pilot program of a geriatric personal care attendant addressing mentation, mobility and matters most in an Emergency Department Observation Unit","authors":"Ilianna Santangelo, Anne Marie Thompson, Aileen Tubridy, Kendra cull, Bridget Conly, Benjamin A. White, Maura Kennedy","doi":"10.17294/2694-4715.1070","DOIUrl":"https://doi.org/10.17294/2694-4715.1070","url":null,"abstract":"The aging of the population has a significant impact on the health care system, as older adults have higher rates of emergency department (ED) visits and hospitalization, different care needs, and are at higher risk of iatrogenic harm in the hospital setting. In addition, there has recently been a rapid growth in ED observation units (EDOUs), to which older adults are frequently admitted. Recognizing the specific needs of older adults, our EDOU implemented an ‘Up by 10’ program which incorporates key components of delirium prevention programs. We took an iterative approach to the implementation of this program, resulting in a pilot program of a GeriCarED personal care attendant (PCA) focusing on the care needs of older adults. In this manuscript we report on a quality improvement study describing the feasibility of this pilot program, the role of the GeriCarED personal care attendant, and the number and type of interventions delivered to older adults. The GeriCarED PCA focused on the care of patients 75 years of age and older, as well as younger patients with cognitive or physical impairments. She systematically rounded on each patient, opening the blinds in the room to let in natural light, identifying assistance needed with activities of daily living, addressing sensory impairment, promoting mobilization, providing activities for cognitive engagement, and assessing for mental status changes. Over the 6 months of this pilot program, she saw a total of 586 patients with a median of 6 patients per day (interquartile range 3). She provided nutritional assistance to 90% of her patients, including cutting up food for 29% of patients and feeding 6% of patients. She mobilized 88% of patients, assisted 75% with washing, provided emotional support for 69% of patients, and identified an acute change in mentation in 2% of patients. Though not designed as an Age-Friendly intervention, this program aligned with the mentation, mobility and what matters components of the 4M framework.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135919184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prioritizing Care of Older Adults in Times of Emergency Department Overcrowding","authors":"April L Ehrlich, Mitchel Erickson, Esther Oh, Todd James, Saket A Saxena","doi":"10.17294/2694-4715.1067","DOIUrl":"https://doi.org/10.17294/2694-4715.1067","url":null,"abstract":"creation of multi/transdisciplinary efforts to address the overcrowding of older adults in the ED. There has also been great success in improving outcomes with modified Hospital Elder Life Programs (HELP) 17 and Geriatric Surgical Verification (GSV) programs. 18 In addition, the Nurses Improving Care for Health System Elders (NICHE) program 19 has had great success in training nurses to be geriatric resource nurses within successful programs. More such 3I initiatives are needed. With the above recommendations we can begin to address this critical epidemic by leveraging transdisciplinary expertise, local and national partners, and policymakers. We urge local and national leaders to address the boarding crises of older adults and how to mitigate its impact, consolidate strengths","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135146165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Novel Multi-Specialist Telemedicine Consultation Program Model of Care for Homebound Older Adults","authors":"Samir K Sinha, Kristina Marie Kokorelias, Nicoda Foster, Pauline Kabitsis, Alfiya Mukharyamova, Mary Ann Hamelin, Nga Truong, Anna Grosse, Janny Lee","doi":"10.17294/2694-4715.1063","DOIUrl":"https://doi.org/10.17294/2694-4715.1063","url":null,"abstract":"BACKGROUND: In 2015, a centralised Multi-Specialist Telemedicine (TM) Consultation Program was established to improve access to specialist care and enhance continuity of care for homebound older adults in Toronto, Canada. Community-dwelling patients were referred to the program by their primary care providers (PCP), treating specialists, and inpatient physicians for specialist-led post hospital discharge follow-up care. A clinical nurse specialist (CNS) thereafter collaborated with hospital-based consulting specialists, utilizing videoconferencing technology to facilitate consultations and follow-up visits for homebound patients","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"225 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135207088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Missed and the Misdiagnosed: Geriatric Delirium in the Emergency Department","authors":"Christienne Shams, Yashar Eshman, Ronan Factora, Stephen Meldon, Saket Saxena","doi":"10.17294/2694-4715.1061","DOIUrl":"https://doi.org/10.17294/2694-4715.1061","url":null,"abstract":"Background: Older patients with delirium are at increased risk for prolonged hospitalization, poor outcomes, higher costs and a greater risk for institutionalization. By identifying those at risk early, interventions can be implemented to prevent or minimize the severity of the delirium. Per hospital policy, our geriatric emergency department (ED) screens for delirium by performing a 4AT only if changes in mental status are noted by caregivers or healthcare providers familiar with the patient. We hypothesize this approach underestimates the prevalence of delirium on presentation to the ED, particularly among high-risk older patients. The aim of this study is to determine how many cases of delirium that are present on admission are missed using this traditional approach.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135259575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shared Disposition Decision-Making in the Emergency Department for Persons Living with Dementia.","authors":"Justine Seidenfeld, Fernanda Bellolio, Anita Vashi, Courtney Van Houtven, Susan Hastings","doi":"10.17294/2694-4715.1057","DOIUrl":"10.17294/2694-4715.1057","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11378982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47813022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Experience After Geriatric Emergency Medicine Assessment","authors":"Jessica Kuxhause, Natalie Liogas, S. Keene, R. Fisher, Lauren Cameron Comasco","doi":"10.17294/2694-4715.1048","DOIUrl":"https://doi.org/10.17294/2694-4715.1048","url":null,"abstract":"Introduction The geriatric population is increasing in size and is expected to represent 20% of the United States population by 2030 per US census data estimates, with an expectant increase in geriatric emergency department (ED) visits. 1 Prior research has demonstrated older adults evaluated in the ED are more likely to have an increased length of stay, more diagnostic tests, and higher overall costs than their younger counterparts, but despite consuming greater resources and staff time, older adults are still more likely to be dissatisfied with their treatment outcomes and less likely to feel that their presenting complaint has been resolved. 2,4 In 2013 the American Academy of Emergency Physicians began a formal accrediting process for Geriatric Emergency Departments, 3 and the Beaumont Royal Oak ED implemented a Geriatric Assessment Team (GAT) while in the process of obtaining this accreditation. The primary objective of this qualitative study was to assess the older patient’s experience and perception of the care they received in the emergency department after evaluation by the Geriatric Assessment Team and determine if patients would recommend the continuation of this program. Methods Patients aged 65 and older that do not live in a nursing home and presented to the ED from the community Monday through Friday between 9 AM to 5 PM were screened using the Identifying Seniors at Risk Questionnaire. Those who scored 2 or higher underwent additional testing to further assess cognition, fall risk, risk of polypharmacy. Patients who screened positive on any of these tests received additional care coordination including physical and occupational therapy evaluations, home care, and medical equipment. When workup was completed, a 6-question survey was administered to assess satisfaction with the program elements on a scale from 1 (very dissatisfied) to 5 (very satisfied), with opportunity to provide additional comments. Results From November 2020 through May 2021, 258 surveys were collected. The average age of responders was 79 and 40% of responders identified as male. 46.1% of surveyed patients were discharged, 34% admitted, 18% placed in the observation unit, 1.6% were discharged directly to a subacute rehab facility,","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44368947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geriatric Emergency Medicine Fellowship Journal Club: Screening for High-Risk Alcohol Use Among Older Adults in the Emergency Department","authors":"K. Gossack-Keenan","doi":"10.17294/2694-4715.1058","DOIUrl":"https://doi.org/10.17294/2694-4715.1058","url":null,"abstract":",","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44367577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Top 10 Things to Know about Falls in Older Adults","authors":"Alexander Zirulnik, Sha Liu","doi":"10.17294/2694-4715.1053","DOIUrl":"https://doi.org/10.17294/2694-4715.1053","url":null,"abstract":"Assessing falls among the older adult population in the emergency department (ED) is challenging. Multi-factorial fall assessments often take time, a resource that is limited in crowded and under-resourced EDs. Nonetheless, EDs have a unique opportunity to intervene to prevent recurrent falls. Patients may present soon after their fall and may be more open to interventions that can change their fall risk. Given the aging population, visits for falls among the older adult population will likely increase.1 This brief report outlines the top 10 considerations when caring for older adult patients who present to the ED with a fall.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41353458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"End-of-life Care In The Trauma Bay: Six Key Points","authors":"L. Christie","doi":"10.17294/2694-4715.1051","DOIUrl":"https://doi.org/10.17294/2694-4715.1051","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"16 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41260637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}