Journal of geriatric emergency medicine最新文献

{"title":"Caring for Older Adults in the Hallway of a Crowded Emergency Department","authors":"Rebecca Weeks, K. Sawasky, Michael Malone","doi":"10.17294/2694-4715.1019","DOIUrl":"https://doi.org/10.17294/2694-4715.1019","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47198955","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":"Patterns of Care Partner Communication for Persons Living with Dementia in the Emergency Department.","authors":"Adrian D Haimovich, Aidan Gilson, Evangeline Gao, Ling Chi, Cameron J Gettel, Mara Schonberg, Ula Hwang, Richard Andrew Taylor","doi":"10.17294/2694-4715.1043","DOIUrl":"10.17294/2694-4715.1043","url":null,"abstract":"<p><strong>Introduction: </strong>Nearly half of all persons living with dementia (PLwD) will visit the emergency department (ED) in any given year and ED visits by PLwD are associated with short-term adverse outcomes. Care partner engagement is critical in the care of PLwD, but little is known about their patterns of communication with ED clinicians.</p><p><strong>Methods: </strong>We performed a retrospective electronic health record (EHR) review of a random sampling of patients ≥ 65 years with a historical diagnosis code of dementia who visited an ED within a large regional health network between 1/2014 and 1/2022. ED notes within the EHRs were coded for documentation of care partner communication and presence of a care partner in the ED. Logistic regression was used to identify patient characteristics associated with the composite outcome of either care partner communication or care partner presence in the ED.</p><p><strong>Results: </strong>A total of 460 patients were included. The median age was 83.0 years, 59.3% were female, 11.3% were Black, and 7.6% Hispanic. A care partner was documented in the ED for 22.4% of the visits and care partner communication documented for 43.9% of visits. 54.8% of patients had no documentation of care partner communication nor evidence of a care partner at the bedside. In multivariate logistic regression, increasing age (OR, (95% CI): 1.06 (1.04-1.09)), altered mental status (OR: 2.26 (1.01-5.05)), and weakness (OR: 3.38 (1.49-7.65)) significantly increased the probability of having care partner communication documented or a care partner at the bedside.</p><p><strong>Conclusion: </strong>More than half of PLwD in our sample did not have clinician documentation of communication with a care partner or a care partner in the ED. Further studies are needed to use these insights to improve communication with care partners of PLwD in the ED.</p>","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10698392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48211937","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":"Examination of geriatric care processes implemented in level 1 and level 2 geriatric emergency departments.","authors":"Ilianna Santangelo, Surriya Ahmad, Shan Liu, Lauren T Southerland, Christopher Carpenter, Ula Hwang, Adriane Lesser, Nicole Tidwell, Kevin Biese, Maura Kennedy","doi":"10.17294/2694-4715.1041","DOIUrl":"10.17294/2694-4715.1041","url":null,"abstract":"<p><strong>Introduction: </strong>Older adults constitute a large and growing proportion of the population and have unique care needs in the emergency department (ED) setting. The geriatric ED accreditation program aims to improve emergency care provided to older adults by standardizing care provided across accredited geriatric EDs (GED) and through implementation of geriatric-specific care processes. The purpose of this study was to evaluate select care processes at accredited level 1 and level 2 GEDs.</p><p><strong>Methods: </strong>This was a cross-sectional analysis of a cohort of level 1 and level 2 GEDs that received accreditation between May 7, 2018 and March 1, 2021. We <i>a priori</i> selected five GED care processes for analysis: initiatives related to delirium, screening for dementia, assessment of function and functional decline, geriatric falls, and minimizing medication-related adverse events. For all protocols, a trained research assistant abstracted information on the tool used or care process, which patients received the interventions, and staff members were involved in the care process; additional information was abstracted specific to individual care processes.</p><p><strong>Results: </strong>A total of 35 level 1 and 2 GEDs were included in this analysis. Among care processes studied, geriatric falls were the most common (31 GEDs, 89%) followed by geriatric pain management (25 GEDs, 71%), minimizing the use of potentially inappropriate medications (24 EDs, 69%), delirium (22 GEDs, 63%), medication reconciliation (21 GEDs, 60%), functional assessment (20 GEDs, 57%), and dementia screening (17 GEDs, 49%). For protocols related to delirium, dementia, function, and geriatric falls, sites used an array of different screening tools and there was heterogeneity in who performed the screening and which patients were assessed. Medication reconciliation protocols leveraged pharmacists, pharmacy technicians and/or nurses. Protocols on avoiding potentially inappropriate medication administration generally focused on ED administration of medications and used the BEERs criteria, and few sites indicated whether pain medications protocols had dosing modifications for age and/or renal function.</p><p><strong>Conclusion: </strong>This study provides a snapshot of care processes implemented in level 1 and level 2 accredited GEDs and demonstrates significant heterogeny in how these care processes are implemented.</p>","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10035774/pdf/nihms-1883085.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9197754","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":"Emergency Department Policies to Improve Care Experiences for Older Adults During the COVID-19 Pandemic.","authors":"Anita Chary,&nbsp;Shan W Liu,&nbsp;Lauren Southerland,&nbsp;Lauren Cameron-Comasco,&nbsp;Kei Ouchi,&nbsp;Christopher R Carpenter,&nbsp;Edward W Boyer,&nbsp;Aanand D Naik,&nbsp;Maura Kennedy","doi":"10.17294/2694-4715.1031","DOIUrl":"https://doi.org/10.17294/2694-4715.1031","url":null,"abstract":"risk stratification","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"3 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9473422/pdf/nihms-1829689.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9555227","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":"It Takes Courage to Pause: Rapid Goals-of-Care Conversations in the Emergency Department","authors":"A. Chary, A. Naik, K. Ouchi","doi":"10.17294/2694-4715.1020","DOIUrl":"https://doi.org/10.17294/2694-4715.1020","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46999723","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":"Polypharmacy and High-risk Medications in Older Veterans Presenting for Emergency Care","authors":"Paige L. Morizio, V. Mistry, Ashley McKnight, Marc J Pepin, William E. Bryan, R. Owenby, Laura Previll, L. Ragsdale","doi":"10.17294/2694-4715.1007","DOIUrl":"https://doi.org/10.17294/2694-4715.1007","url":null,"abstract":"Patients age 60 and older represented 20% of Emergency Department (ED) visits between 2014 and 2017.1 Within the Veterans Affairs Health Care System (VAHCS), 49% of patients presenting to the ED were age 65 and older in 2019.2 Older adults often have more prescription medications and increased medical complexity.3 One study suggests that at least 39% of patients over the age of 65 years are prescribed at least 5 medications, and that overall number of prescribed medications increases with age.4 Although 5 or more medications is the most cited definition, polypharmacy has been described ranging from 2 to 11 or more medications.5 Specific medication classes that increase the risk of harm or falls in older adults include antiarrhythmics, anticholinergics, anticoagulants, anticonvulsants, antidepressants, antihyperglycemics, antihypertensives, antipsychotics, anxiolytics, opioids, sedatives, and skeletal muscle relaxants.6,7 In addition, over 50% of older adults have been prescribed at least one medication that is potentially inappropriate.8","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45253244","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: Frailty","authors":"S. Keene, R. Fisher, L. Cameron-Comasco","doi":"10.17294/2694-4715.1011","DOIUrl":"https://doi.org/10.17294/2694-4715.1011","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41968958","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":"Intermediate Care Technicians-A Novel Workforce for Veterans Affairs Geriatric Emergency Departments","authors":"Kristina T. Snell, T. Edes, C. McQuown","doi":"10.17294/2694-4715.1014","DOIUrl":"https://doi.org/10.17294/2694-4715.1014","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48137657","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":"Ten Clinical Tips in the Assessment of Genitourinary Emergencies of an Older Adult","authors":"Nicole Soria, D. Khoujah","doi":"10.17294/2694-4715.1017","DOIUrl":"https://doi.org/10.17294/2694-4715.1017","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48550966","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":"Sentinel Paper Review: Exploring Care Transitions From Patient, Caregiver, and Health-Care Provider Perspectives","authors":"K. Fuji, A. Malsch, Pamela Martin","doi":"10.17294/2694-4715.1018","DOIUrl":"https://doi.org/10.17294/2694-4715.1018","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45143372","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}