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Geriatric Emergency Medicine: Research Update - Tried and True to Somewhat new. Jacques Lee MD, MSc, FRCPC. Objectives. To review existing research literature on “Geriatric Emergency Medicine” Tried and (probably) True Somewhat New! To finish before Christmas!.

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Geriatric emergency medicine research update tried and true to somewhat new

Geriatric Emergency Medicine: Research Update - Tried and True to Somewhat new

Jacques Lee MD, MSc, FRCPC


Objectives
Objectives True to Somewhat new

  • To review existing research literature on “Geriatric Emergency Medicine”

    • Tried and (probably) True

    • Somewhat New!

  • To finish before Christmas!


Gem literature search methods
GEM Literature Search: Methods True to Somewhat new

1. Geriatric.m_titl.

2. elder.m_titl.

3. older.m_titl.

4. senior.m_titl.

5. 1 or 2 or 3 or 4

6. Emergency.m_titl.

7. (accidents and emergencies).m_titl.

8. ER.m_titl.

9. ED.m_titl.

10. 6 or 7 or 8 or 9

11.5 and 10 = 323

12.Limit English & Human = 299


Gem research update tried true
GEM Research Update: Tried & True True to Somewhat new

  • Important reviews:

  • Grief et al. J Em Nurse 2003

  • Aminzadeh et al. Ann Em Med 2002

  • Samaras et al. Ann Em Med 2010


Gem research update epidemiology descriptive studies
GEM Research Update: Epidemiology & Descriptive Studies True to Somewhat new

  • Older patients:

    • Higher users of ED

    • More Frequently arrive by Ambulance

    • More likely to be admitted

    • More likely to require Critical Care

    • More likely to develop delirium

    • More likely to die


Gem research update epidemiology descriptive studies1
GEM Research Update: Epidemiology & Descriptive Studies True to Somewhat new

  • Older patients:

    • Receive More Tests / More resources

    • Have longer ED lengths of stay

    • Less likely to understand discharge instructions

    • More likely to return for the same problem


Gem research update epidemiology descriptive studies2
GEM Research Update: Epidemiology & Descriptive Studies True to Somewhat new

Emergency physicians with:

  • Less experience

  • Less training

  • Lower pay

  • Higher perceived volume of older patients,

  • Associated with higher perceived “burden of care” 6


Gem research update prediction and screening
GEM Research Update: Prediction and Screening True to Somewhat new

Good data on clinical prediction tools for use in the ED

  • ISAR

  • TRST

  • PERIL


Gem research update prediction and screening1
GEM Research Update: Prediction and Screening True to Somewhat new

Good data on clinical prediction tools for use in the ED

  • ISAR

  • TRST

  • PERIL


Gem research update prediction and screening2
GEM Research Update: Prediction and Screening True to Somewhat new

  • Any studies comparing screening tool? 10

  • Are screening tools being used? 11


Gem research update prediction and screening3
GEM Research Update: Prediction and Screening True to Somewhat new

Something New?

  • Any studies comparing screening tool? 10

  • Are screening tools being used? 11


Gem research update interventions
GEM Research Update: Interventions True to Somewhat new

  • McCusker J, Verdon J. Do geriatric interventions reduce emergency department visits? A systematic review..


Gem research update interventions1
GEM Research Update: Interventions True to Somewhat new

Something New?

  • Courtney et al.12

  • 24 Weeks case management and customized exercise program

  • Cost Effective ? 13


Gem research update delirium
GEM Research Update: Delirium True to Somewhat new

Tried & True

  • Delirium increases length of stay 14

  • Prolonged ED stay increases Delirium

  • Delirium is an independent risk factor for mortality

  • Delirium can takes months to clear and can be permanent


Gem research update delirium1
GEM Research Update: Delirium True to Somewhat new

Something New?

  • Genetic markers for delirium “predisposition”?

  • Computerized testing for delirium?


References
References True to Somewhat new

  • Grief CL. Patterns of ED use and perceptions of the elderly regarding their emergency care: a synthesis of recent research. J Emerg Nurs. Apr 2003;29(2):122-126.

  • Aminzadeh F, Dalziel WB. Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med Mar 2002;39(3):238-247

  • Samaras N, Chevalley T, Samaras D, Gold G. Older patient in the Emergency Department. Ann Emerg Med Sept 210;56(3):261-269.

  • Singal BM, Hedges JR, Rousseau E, et al. Geriatric patient emergency visits. Part I: comparison of visits by geriatric and younger patients. Ann Emerg Med. 1992;21:802-807.

  • Hedges J, Singal B, Rousseau E. Geriatric patient emergency visits. Part II: Perceptions of visits by geriatric and younger patients. Ann Emerg Med. July 1992;21((7)):808-813.


References1
References True to Somewhat new

  • Schumacher JG, Deimling GT, Meldon S, Woolard B. Older adults in the Emergency Department: predicting physicians' burden levels. Journal of Emergency Medicine. 2006;30(4):455-60.

  • McCusker J, Bellavance F, Cardin S, Trepanier S, Verdon J, Ardman O. Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool.. Journal of the American Geriatrics Society. 1999;47(10):1229-37.

  • Meldon SW, Mion LC, Palmer RM, Drew BL, Connor JT, Lewicki LJ, Bass DM, Emerman CL. A brief risk-stratification tool to predict repeat emergency department visits and hospitalizations in older patients discharged from the emergency department.. Acad Emerg Med. 2003;10(3):224-32.


References2
References True to Somewhat new

  • Lee JS, Schwindt G, Langevin M, Moghabghab R, Alibhai SM, Kiss A, Naglie G. Validation of the triage risk stratification tool to identify older persons at risk for hospital admission and returning to the emergency department.. JAGS. 2008;56(11):2112-7.

  • McCusker J, Verdon J, Veillette N, Berg K, Emond T, Belzile E. Standardized screening and assessment of older patients in the emergency department: a survey of implementation in Quebec.. Canadian Journal on Aging. 2007 [cited 2007];26(1):49-57.

  • McCusker J, Verdon J. Do geriatric interventions reduce emergency department visits? A systematic review. J Geront Series A. 2006;61(1):53-62.


References3
References True to Somewhat new

  • Courtney M, Edwards H, Chang A, Parker A, Finlayson K, Hamilton K. Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program.. Journal of the American Geriatrics Society. 2009 [cited 2009 Mar];57(3):395-402.

  • Graves N, Courtney M, Edwards H, Chang A, Parker A, Finlayson K. Cost-effectiveness of an intervention to reduce emergency re-admissions to hospital among older patients.. PLoS ONE [E- Resource]. 2009;4(10):e7455.

  • McCusker J, Cole MG, Dendukuri N, Belzile E. Does Delirium increase hsopital stay? JAGS, 2003;51(11):


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