Delirium and Delirium Prevention in the Emergency Department

Clinics in Geriatric Medicine, Journal Year: 2023, Volume and Issue: 39(4), P. 535 - 551

Published: June 15, 2023

Language: Английский

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A Comprehensive, Home‐Based, Fall Prevention Initiative: Preliminary Data From the Raise'Age Program

Journal of the American Geriatrics Society, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 4, 2025

ABSTRACT Background Although falls among older adults pose substantial health risks and are often preventable, many fallers do not seek medical care. The Raise'Age program addresses this challenge by offering proactive fall prevention for who require “lift assistance” but taken to hospital. includes (i) screening emergency services (EMSs), (ii) referrals a comprehensive geriatric assessment, (iii) in‐home evaluations mobile team (MGT), (iv) primary care physicians (PCPs). Here, we outline the program's design, development, implementation. Methods activity in 2023 was assessed with regard number of EMS reports, reports' completeness, eligibility, acceptance patients, assessments, adherence follow‐up programs, coordination delays. Results In 2023, received 959 accounting 48% lift assistances paramedics. Of these, 37% reports were reviewed eligibility. Reports archived due irrelevance, recent hospital stay, or difficulty contacting PCPs. Among eligible 77% approved evaluations, remainder referred geriatrician scheduled admission. median processing time 26 days. 228 patients home visits, 150 accepted intervention. Visit rates higher when PCP endorsed program. Follow‐up provided 36% patients‐ primarily via teleconsultation. Finally, 15.6% whom assistance report sent MGT completed Conclusions demonstrates that collaboration MGTs feasible, although some may decline offered. Continuous interventions community‐based social effectively address needs adults.

Language: Английский

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Team-based, Multidisciplinary Care in the Emergency Department

Emergency Medicine Clinics of North America, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 1, 2025

Language: Английский

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Emergency Department Programs to Support Medication Safety in Older Adults

JAMA Network Open, Journal Year: 2025, Volume and Issue: 8(3), P. e250814 - e250814

Published: March 11, 2025

Importance Given that older adults are at high risk for adverse drug events (ADEs), many geriatric medication programs have aimed to optimize safe ordering, prescribing, and deprescribing practices. Objective To identify emergency department (ED)–based associated with reductions in potentially inappropriate medications (PIMs) ADEs. Data Sources A systematic search of Scopus, Embase, PubMed, PsycInfo, ProQuest Central, CINAHL, AgeLine, Cochrane Library was conducted on February 14, 2024, no date limits applied. Study Selection Randomized clinical trials or observational studies focused ED-based (aged ≥65 years) provide ED clinician support avoid PIMs reduce Extraction Synthesis Preferred Reporting Items Systematic Reviews Meta-Analyses guidelines abstracting data the risk-of-bias tool were used assess quality validity. Abstract screening full-text review independently by 2 reviewers, a third reviewer acting as an adjudicator. Main Outcomes Measures Process (ordering, PIM rates) (ADE, health care utilization, falls) outcomes. Results The strategy identified 3665 unique studies, 98 assessed eligibility review, 25 44 640 participants, included: 9 pharmacist reviews (with 28 360 participants), 1 geriatrician teleconsultation 50 8 educational interventions 5888 4 computerized decision systems (CDSS; 9462 3 fall risk–increasing (FRID) 880 participants). Clinical not decreased hospital admission length stay, but showed 32% reduction from (odds ratio [OR], 0.68 [95% CI, 0.50-0.92]; P = .01). One study also found enhanced PIMs. Three intervention 19% prescribing (OR, 0.81 0.68-0.96]; .02). Two CDSS 40% ordering 0.60 0.48-0.74]; < .001). FRID reduced time first recurrence 12 months. Conclusions Relevance In this meta-analysis safety programs, multidisciplinary team, including pharmacists and/or geriatricians, improved deprescribing. Furthermore, CDSS, alone combination education, These findings will inform Geriatric Guidelines version 2.0 update.

Language: Английский

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Pragmatism and feasibility: A qualitative study of experiences implementing and upgrading care in geriatric emergency departments

Journal of the American College of Emergency Physicians Open, Journal Year: 2024, Volume and Issue: 5(4)

Published: June 26, 2024

Abstract Objectives Implementation and sustainability of new care processes in emergency departments (EDs) is difficult. We describe experiences implementing geriatric EDs that upgraded their accreditation level for the Geriatric Emergency Department Accreditation (GEDA) program. These can provide a model adopting sustaining guidelines evidence‐based care. Methods performed qualitative interviews with ED nurse physician leaders overseeing ED's processes. The interview guide was based on Consolidated Framework Research (CFIR), framework consisting comprehensive set factors impact implementation interventions. used inductive analysis to elucidate key themes from deductive map onto CFIR constructs. Results Clinician 15 19 status by March 1, 2023 participated interviews. Motivations upgrade centered improving patient (73%) achieving recognition (56%). Rationales choosing specific were more commonly related feasibility (40%) ability integrate into electronic health record (33%) than site‐specific needs (20%). Several common identified: (1) financing larger system or philanthropy crucial; (2) translating Guidelines clinical practice challenging clinician leaders; (3) motivational barriers existed among frontline staff; (4) longitudinal staff education needed given attrition turnover; (5) facilitated screenings. Conclusions involves significant time, resource allocation, commitment. pursuing balance aspirations improve availability implement competing priorities.

Language: Английский

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Assessing Physiologic Reserve and Frailty in the Older Emergency Department Patient

Clinics in Geriatric Medicine, Journal Year: 2023, Volume and Issue: 39(4), P. 475 - 489

Published: June 15, 2023

Language: Английский

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Geriatric Emergency Medicine: The Need Has Never Been Greater

Clinics in Geriatric Medicine, Journal Year: 2023, Volume and Issue: 39(4), P. xv - xvii

Published: July 2, 2023

Language: Английский

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The geriatric emergency literature of note 2023

The American Journal of Emergency Medicine, Journal Year: 2024, Volume and Issue: 88, P. 34 - 44

Published: Nov. 12, 2024

Language: Английский

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Geriatric Emergency Departments as Laboratories for Innovation

Journal of Geriatric Emergency Medicine, Journal Year: 2023, Volume and Issue: 4(1)

Published: March 1, 2023

Increasing numbers of emergency department (ED) visits are being made by older adults.Unfortunately, there is widespread recognition that current ED systems poorly designed to serve this population's unique needs, both in terms addressing acute illnesses and injuries managing complex medical psychosocial issues.One strategy address these needs create geriatric EDs with a specific focus on caring for adults.To end, the American College Emergency Physicians (ACEP) created Geriatric Department Accreditation (GEDA) Program, accrediting institutions as (GEDs) based their ability assess intervene improve care meeting certain criteria.During accreditation, apply become level 1, 2, or 3 facilities resources available policies processes place adhere best practices care.To achieve 1 status, GEDs must have protocols 20 27 GED guidelines, 10 necessary 2 status.Furthermore, individual may specify how they each policy process.This article Santangelo et.al. analyzes application materials all accredited roughly three-year period. The authors summarize inclusion approach five important abstracting applications 35 36 approved met criteria.The study identified significant heterogeneity which were included, well achieved.Results ranged from fall prevention, 89% studied used one 13 different screening protocols, dementia, 49% screened at least some patients, using seven protocols.The noted similar among responses positive screens personnel carrying out screening.This has few key limitations consider: Data was only collected not reflect sustained included GEDs.After multiple years experience, topics changed.Additionally, many cases, report "subsets" adult patients.While identifying appropriate subsets adults interventions workflows an goal creating feasible effective workflows, details regarding chosen unavailable.For example, subset patients could be falls preselected risk factors availability additional nurse who performed screening.Finally, while face validity, limited data support effectiveness.Thus, we do actually know if presence majority leads measurable impact patient-centered outcomes.Despite limitations, provides excellent overview initial activities planned GEDs.The variation between sites seen AFFILIATIONS

Language: Английский

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Comparing Geriatric and Nongeriatric Emergency Departments: A First Step on a Critical Avenue of Research

Annals of Emergency Medicine, Journal Year: 2023, Volume and Issue: 82(6), P. 690 - 693

Published: Sept. 19, 2023

Language: Английский

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