Academic Emergency Medicine,
Journal Year:
2022,
Volume and Issue:
29(5), P. 572 - 580
Published: Feb. 9, 2022
To
validate
the
Clinical
Frailty
Scale
(CFS)
for
prediction
of
1-year
all-cause
mortality
in
emergency
department
(ED)
and
compare
its
performance
to
Emergency
Severity
Index
(ESI).
Journal of the American Medical Directors Association,
Journal Year:
2022,
Volume and Issue:
23(8), P. 1313.e1 - 1313.e13
Published: March 2, 2022
ObjectivesWe
aimed
to
describe
emergency
department
(ED)
care
transition
interventions
delivered
older
adults
with
cognitive
impairment,
identify
relevant
patient-centered
outcomes,
and
determine
priority
research
areas
for
future
investigation.DesignSystematic
scoping
review.Setting
ParticipantsED
patients
impairment
and/or
their
partners.MethodsInformed
by
the
clinical
questions,
we
conducted
systematic
electronic
searches
of
medical
databases
publications
following
published
guidelines.
The
results
were
presented
a
stakeholder
group
representing
ED-based
non-ED-based
clinicians,
individuals
living
partners,
advocacy
organizations.
After
discussion,
they
voted
on
potential
prioritize
investigations.ResultsFrom
3848
identified,
78
eligible
studies
underwent
full
text
review,
10
articles
abstracted.
Common
ED-to-community
included
interdisciplinary
geriatric
assessments,
home
visits
from
personnel,
telephone
follow-ups.
Intervention
effects
mixed,
improvements
observed
in
30-day
ED
revisit
rates
but
most
largely
ineffective
at
promoting
connections
outpatient
or
improving
secondary
outcomes
such
as
physical
function.
Outcomes
identified
important
partners
coordination
between
providers
inclusion
management
within
setting.
highest
area
investigation
stakeholders
was
identifying
strategies
tailor
transitions
complicated
other
vulnerabilities
social
isolation
economic
disadvantage.Conclusions
ImplicationsThis
review
key
gaps
impairment.
Combined
assessment
prioritization,
it
clarifies
improve
impaired
cognition,
an
critical
need
given
current
population
trends.
Journal of the American Geriatrics Society,
Journal Year:
2022,
Volume and Issue:
70(6), P. 1838 - 1849
Published: March 11, 2022
Abstract
Background
This
systematic
review
was
conducted
to
evaluate
any
interventions
prevent
incident
delirium,
or
shorten
the
duration
of
prevalent
in
older
adults
presenting
emergency
department
(ED).
Methods
Health
sciences
librarian
designed
electronic
searches
were
from
database
inception
through
September
2021.
Two
authors
reviewed
studies,
and
included
studies
that
evaluated
for
prevention
and/or
treatment
delirium
excluded
non‐ED
studies.
The
risk
bias
(ROB)
by
Cochrane
ROB
tool
Newcastle‐Ottawa
(NOS)
scale.
Meta‐analysis
estimate
a
pooled
effect
multifactorial
programs
on
prevention.
Results
Our
search
strategy
yielded
11,900
which
10
met
study
inclusion
criteria.
RCTs
pharmacologic
prevention;
three
non‐RCTs
employed
multi‐factorial
program;
regional
anesthesia
hip
fractures;
one
use
Foley
catheter,
medication
exposure,
delirium.
Only
four
demonstrated
significant
impact
incidence
delirium—one
RCT
melatonin
reduced
(OR
0.19,
95%
CI
0.06
0.62),
non‐RCT
program
decreased
inpatient
prevalence
(41%
19%)
other
(RR
0.37,
0.22
0.61).
One
case–control
ED
catheters
increased
(proportional
OR
3.1,
1.3
7.4).
A
odds
ratio
0.46
(95%
0.31–0.68,
I
2
=
0).
Conclusion
Few
initiated
found
consistently
reduce
Delirium
trials
are
still
rare
should
be
prioritized
future
research.
Academic Emergency Medicine,
Journal Year:
2021,
Volume and Issue:
28(11), P. 1214 - 1227
Published: May 12, 2021
Abstract
Background
Although
falls
are
common,
costly,
and
often
preventable,
emergency
department
(ED)‐initiated
fall
screening
prevention
efforts
rare.
The
Geriatric
Emergency
Medicine
Applied
Research
Falls
core
(GEAR‐Falls)
was
created
to
identify
existing
research
gaps
prioritize
future
foci.
Methods
GEAR’s
49
transdisciplinary
stakeholders
included
patients,
geriatricians,
ED
physicians,
epidemiologists,
health
services
researchers,
nursing
scientists.
We
derived
relevant
clinical
questions
summarized
the
applicable
evidence,
adhering
Preferred
Reporting
Items
for
Systematic
Reviews
Meta‐Analyses
Scoping
Reviews.
highest‐priority
foci
were
identified
at
GEAR
Consensus
Conference.
Results
two
our
review
(1)
interventions
(32
studies)
(2)
risk
stratification
care
plan
(19
studies).
For
21
of
32
(66%)
a
assessment
15
(71%)
these
combined
with
an
exercise
program
or
physical
therapy.
11
tools
identified,
but
none
feasible
sufficiently
accurate
patients.
both
questions,
most
frequently
reported
study
outcome
recurrent
falls,
various
process
patient/clinician‐centered
outcomes
used.
Outcome
ascertainment
relied
on
self‐reported
in
18
(56%)
studies
nine
19
(47%)
(2).
Conclusion
Harmonizing
definitions,
methods,
is
needed
direct
comparison
studies.
need
ED‐appropriate
role
medical
(EMS)
personnel
persists.
Multifactorial
interventions,
especially
involving
exercise,
more
efficacious
reducing
compare
appropriate
bundle
combinations.
prioritizes
five
priorities:
EMS
improving
fall‐related
outcomes,
identifying
optimal
tools,
(3)
clarifying
patient‐prioritized
(4)
standardizing
uniform
measured
(5)
exploring
ideal
intervention
components.
Western Journal of Emergency Medicine,
Journal Year:
2023,
Volume and Issue:
24(3)
Published: May 3, 2023
Incident
delirium
in
older
patients
is
associated
with
prolonged
hospitalization
and
mortality.
A
recent
study
suggested
an
association
between
emergency
department
(ED)
length
of
stay
(LOS),
time
ED
hallways,
incident
delirium.
In
this
we
further
evaluated
the
emerging
LOS,
number
non-clinical
patient
moves
ED.We
performed
retrospective
cohort
at
a
single,
urban,
academic
medical
center.
All
data
were
extracted
from
electronic
health
record.
We
included
aged
≥65
years
presenting
to
admitted
family
or
internal
medicine
services
over
two-year
period.
Patients
any
other
service,
transferred
another
hospital,
discharged
ED,
who
underwent
procedural
sedation
excluded.
The
primary
outcome
was
delirium,
defined
as
positive
screen,
receipt
sedative
medications,
use
physical
restraints.
Multivariable
logistic
regression
models
including
age,
gender,
language,
history
dementia,
Elixhauser
Comorbidity
Index,
within
total
spent
hallway,
LOS
fitted.We
studied
5,886
age;
median
age
77
(69-83)
years;
3,031
(52%)
female,
1,361
(23%)
reported
dementia.
Overall,
1,408
(24%)
experienced
multivariable
models,
development
(odds
ratio
[OR]
1.02,
95%
confidence
interval
[CI]
1.01-1.03,
per
hour),
while
[OR
0.97,
(95%
CI
0.91-1.04)
hallway
0.99,
0.98-1.01,
hour)
not
delirium.In
single-center
study,
adults,
not.
Health
systems
should
systemically
limit
for
adults.
Age and Ageing,
Journal Year:
2021,
Volume and Issue:
51(1)
Published: Dec. 1, 2021
delirium
is
common
in
older
emergency
department
(ED)
patients,
but
vastly
under-recognised,
part
due
to
lack
of
standardised
screening
processes.
Understanding
local
context
and
barriers
are
integral
for
successful
implementation
a
protocol.we
sought
identify
facilitators
by
nurses
ED
patients.we
conducted
15
semi-structured,
face-to-face
interviews
based
on
the
Theoretical
Domains
Framework
with
bedside
nurses,
nurse
educators
managers
at
two
academic
EDs
2017.
Two
research
assistants
independently
coded
transcripts.
Relevant
domains
themes
were
identified.a
total
717
utterances
into
14
domains.
Three
dominant
emerged:
(i)
clinical
prioritisation
because
competing
demands,
time
heavy
workload;
(ii)
discordance
between
perceived
capabilities
knowledge
(iii)
hospital
culture.this
qualitative
study
explored
nursing
patients.
We
found
that
was
recognised
as
an
important
problem;
however,
it
not
clinically
prioritised;
there
false
self-perception
ability
recognise
culture
strong
influencer
behaviour.
Successful
adoption
protocol
will
only
be
realised
if
these
issues
addressed.
Journal of the American Geriatrics Society,
Journal Year:
2022,
Volume and Issue:
70(5), P. 1368 - 1373
Published: March 12, 2022
In
2014
the
Geriatric
Emergency
Department
(GED)
Guidelines
were
published
and
endorsed
by
four
major
medical
organizations.
The
multidisciplinary
GED
characterize
complex
needs
of
older
emergency
department
(ED)
patient
current
best
practices
with
goal
promoting
more
cost-effective
patient-centered
care.
recommendations
are
extensive
vast
majority
EDs
then
now
do
not
have
either
resources
nor
hospital
administrative
support
to
provide
this
additional
service.
At
2021
American
Academy
Medicine's
Scientific
Assembly,
a
panel
medicine
physicians
geriatricians
discussed
realities
EDs'
capacity
practice
guideline
recommended
care
patients.
This
article
is
synthesis
panel's
presentation
discussion.
With
substantial
challenges
in
providing
EDs,
will
explore
three
high
impact
clinical
conditions
highlight
recommendations,
opportunities,
discuss
realistically
achievable
expectations
for
non-Geriatric
ED
accredited
institutions.
describing
geriatric
Unfortunately,
worldwide
level
service
guidelines.
can
be
termed
aspirational
U.S.
at
present
time.
BMJ Open,
Journal Year:
2022,
Volume and Issue:
12(4), P. e060974 - e060974
Published: April 1, 2022
Introduction
Increasingly,
older
adults
are
turning
to
emergency
departments
(EDs)
address
healthcare
needs.
To
achieve
these
research
demands,
infrastructure
is
needed
both
generate
evidence
of
intervention
impact
and
advance
the
development
implementation
science,
pragmatic
trials
evaluation
dissemination
findings
from
studies
addressing
care
needs
adults.
The
Geriatric
Emergency
Care
Applied
Research
Network
(
https://gearnetwork.org
)
has
been
created
in
response
scientific
needs—to
build
a
transdisciplinary
support
that
will
optimise
for
persons
living
with
dementia.
Methods
analysis
In
this
paper,
we
describe
our
approach
developing
GEAR
infrastructure,
scoping
reviews
identify
clinical
gaps
its
use
consensus-driven
priorities
taskforce
stakeholders
includes
patients
partners.
We
how
priority
topic
areas
ascertained,
process
conducting
integrated
academic
librarians
performing
standardised
searches
providing
quality
control
on
reviews,
input
large-scale
consensus
workshop
prioritise
future
topics.
provides
framework
systematic
develop
agenda
geriatric
care.
Ethics
This
review
previously
conducted
research;
accordingly,
it
does
not
constitute
human
subjects
needing
ethics
review.
These
be
prepared
as
manuscripts
submitted
publication
peer-reviewed
journals,
results
presented
at
conferences.
Open
Science
Framework
registered
DOI:
10.17605/OSF.IO/6QRYX
,
10.17605/OSF.IO/AKVZ8
10.17605/OSF.IO/EPVR5
10.17605/OSF.IO/VXPRS
.
