{"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}
{"title":"Geriatric Trauma Triage - The Scope of the Problem","authors":"Mya Cubitt, Rachel Key","doi":"10.17294/2694-4715.1052","DOIUrl":"https://doi.org/10.17294/2694-4715.1052","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136135993","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":"Current Best Practice in Pelvic and Hip Fracture Management in the Older Adult Population","authors":"A. Joseph","doi":"10.17294/2694-4715.1055","DOIUrl":"https://doi.org/10.17294/2694-4715.1055","url":null,"abstract":"Pelvic ring fractures (PRFs) are a leading cause of preventable deaths in trauma patients. A 2007 Australian study 1 found that the incidence of PRFs over a 12-month period was approximately 23/100,000 population with 10/100,000 population incidence of high-energy (HE) PRFs (mostly young males) and 10/ 100,000 population incidence of low-energy (LE) PRFs (mostly older females). The incidence of major bleeding was 1.3 /100,000 population. 60%","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46085383","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":"Head Injury in Older Adults: To Scan or Not to Scan? Ten Tips to Make the Best Decision","authors":"A. Brousseau, É. Mercier","doi":"10.17294/2694-4715.1050","DOIUrl":"https://doi.org/10.17294/2694-4715.1050","url":null,"abstract":"Ground-level falls are a leading cause of emergency department (ED) visits by older adults. In addition to understanding the cause of the fall, the assessment of potential fall-induced injuries such as traumatic intracranial hemorrhage can be highly challenging for emergency clinicians. Premorbid conditions, medications, and concomitant injuries can all interfere with the physical examination and impact the prevalence of signs traditionally associated with traumatic brain injury (TBI). When it comes to the decision to potentially investigate for a traumatic intracranial hemorrhage with brain imaging such as head computed tomography (CT), many potential predictors and factors will be considered. Symptoms, history, medications, frailty, functional status, level of care, cost, and access to imaging will all potentially influence that decision-making process. This brief review article will help make that decision in the interest of the patient and the health care system. 1. Explore goals of care early. Goals of care are often one of the last things we explore with patients in the ED. However, for frail older adults, exploring goals of care should be among the first things we do, particularly relative to the decisions to investigate or not. If the head CT shows a traumatic intracranial hemorrhage, would this patient consider neurosurgery as an option? Is it aligned with their wishes? If not, you can likely stop there. Imaging is not needed and you need to focus on what is important for the patient. 2. A patient over 65 years old and mild traumatic brain injury = head CT scan Not all head traumas are TBI. A TBI is defined as a head impact associated with at least one neurologic symptom (loss of consciousness, amnesia, confusion, etc.). The recommendation for older adults who have sustained a TBI is clear: A patient ≥ 65 years old following a TBI should be investigated with brain imaging. New data suggests that this 65+ age threshold could potentially be adjusted to >75, but the safety of this cutoff needs to be confirmed with more robust data. 3. TBI-related symptoms are less predictive of intracranial hemorrhage and are often delayed. Different physiological changes associated with aging such as cerebral atrophy increase the risk of traumatic intracranial hemorrhage, even following a minor head impact. These changes leave more places for a hemorrhage to expand before becoming symptomatic compared to younger adults. Therefore, it often requires more time and a larger intracranial hemorrhage before the patient displays neurological signs or a decreased GCS. A normal physical examination cannot rule out a traumatic intracranial hemorrhage. 4. Temporal and occipital external signs of trauma increased risk of intracranial hemorrhage. The absence of external signs of trauma decreases the odds of intracranial traumatic hemorrhage. In the opposite, external signs of trauma (bruising, hematoma, or laceration) located on temporoparietal or occipital regions are","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44760385","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":"Older Person Fracture Presentation and Management Including Tips for Pain Management","authors":"Timothy D W Arnold","doi":"10.17294/2694-4715.1056","DOIUrl":"https://doi.org/10.17294/2694-4715.1056","url":null,"abstract":"Falls leading to hip injuries represent a quarter of all fall-related injury hospitalizations.1 A fall in a patient over 65 necessitating an Emergency Department (ED) visit carries a 15% mortality rate at one year.2 A neck of femur fracture is a common sequela that an Emergency Physician will manage after an older person falls. In Australia and New Zealand (ANZ) in 2021, there were 15,331 episodes of neck of femur fracture reported.3 Despite ongoing advances in standardization of care, the mortality rate of neck of femur fractures sits at 7.6% and 8.3% at one month in ANZ and the UK respectively with the 1-year mortality in ANZ sitting at 24.8% for 2021.3,4 The morbidity for this fracture is complex. An average length of stay of between 4 and 23 days illustrates the complexity of managing these patients on the wards. There is a 29.5% rate of postoperative delirium carrying its own mortality risk.5 At 120 days, only 70% of these patients will return home if they came from home and 60% will require mobility aid.3,4 Other issues that arise include pressure area prevention, comorbidity management, and frailty. The ANZ Hip Fracture Registry3 provides an approach for hospitals to audit the management of neck of femur fractures “against key markers of safe, high-quality care”. This registry aligns closely with the Australian Hip Fracture Clinical Care Standard.6 Issues highlighted in the standard and registry most pertinent to the ED include:","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49156430","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":"An Inflection Point to Improve Emergency Care for Older Adults","authors":"Jonny Macias Tejada, Michael Malone, Kevin Biese","doi":"10.17294/2694-4715.1054","DOIUrl":"https://doi.org/10.17294/2694-4715.1054","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135663480","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 History of Geriatric Emergency Medicine","authors":"T. Hogan, L. Gerson, Aurthur B Sanders","doi":"10.17294/2694-4715.1044","DOIUrl":"https://doi.org/10.17294/2694-4715.1044","url":null,"abstract":"Excellent emergency care does not happen by chance. The standard emergency approach that excels in the young, fails in older patients. Older adults experience unnecessary morbidity and excess mortality in our emergency departments. This article describes the pursuit of excellent emergency care in the historically challenging older adult population. A pivotal point occurred once emergency physicians recognized older patients as a distinct population in need of unique evaluation and treatment. In the early 1990s, a group of geriatricians, philanthropists, and emergency physicians joined forces to improve older patient care. Geriatric Emergency Medicine (GEM) emerged as a subspecialty as these individuals systematically identified its distinctive knowledge, skills, competencies, literature, champions, research, fellowship programs, service lines, staffing, accredited geriatric emergency departments, and now its own journal. Early GEM advocates recognized that a legion of older patients would overwhelm providers lacking the training and resources to deliver adequate care for the aging population. They created education and grant programs, developed leaders, and overcame barriers of ageism, ignorance, and indifference. A review of this progress can inform new strategies and innovations providing a future of excellence in the emergency care of older adults.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45342314","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 Depression Screening and Chief Complaint: What is the Risk for 30- and 90-day Readmission?","authors":"E. James, J. M. Moccia, V. Lucia","doi":"10.17294/2694-4715.1045","DOIUrl":"https://doi.org/10.17294/2694-4715.1045","url":null,"abstract":"Introduction Readmission to the hospital within 30-days has a high cost and represents a gap in care for older adults. Older adults are at significant risk for depression, particularly given their medical comorbidities and social factors such as isolation due to SARS-CoV-2. Many patients who screen positive for depression may have no known history of depression. This investigation examines the relationship between a positive geriatric depression screen and chief complaint as a function of 30-and 90-day readmission risk. Methods We examined the electronic medical record of 329 older adults aged 65 and older from February 1, 2020, to January 31, 2021, with a positive depression screen during an emergency department visit at a Midwest Geriatric Emergency Department. Their admission and final ICD-10 diagnosis coding groups (used as a surrogate to standardize chief complaint), social factors such as marital status, living environment, Orientation-Memory-Concentration Test score, and level of independence, were analyzed and considered as potential contributory factors. Results","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47336086","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}
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