Justine Seidenfeld, Karen M Stechuchak, Valerie A Smith, Catherine Stanwyck, Chelsea Perfect, Courtney Van Houtven, Susan Nicole Hastings
Introduction: Older adults were critically vulnerable to disruptions in health care during the COVID-19 pandemic, but it is not known if changes in ED utilization varied based on patient characteristics. Using a cohort of older Veterans, we examined changes in ED visit rates based on four characteristics of interest: age, race, area deprivation index, and frailty.
Methods: Participants were aged ≥65, with ≥2 visits in primary or geriatric clinics between 02/02/2018-05/07/2019. An adjusted negative binomial regression model was constructed for each characteristic. We report mean counts of all ED visits by quarter for subgroups separately, and report rate ratios to compare ED visits in the first year of the COVID-19 pandemic to the year before.
Results: Patients with complete case data numbered 38,871. During the first two quarters, all subgroups had decreased ED visits, with more variation in the third and fourth quarters. The very highly frail, who had the highest mean estimated count of ED visits per person through both pre-COVID and COVID periods, also had a significant decrease in their ED visits during multiple quarters of the pandemic to a greater degree than other frailty subgroups.
Conclusion: Stratifying older adults by frailty identified patient subgroups with the greatest variation in ED visits during COVID. Very highly frail patients warrant special attention to understand how variation in ED utilization affects patient outcomes.
{"title":"Frailty Explains Variation in Emergency Department Use for Older Veterans During the COVID-19 Pandemic.","authors":"Justine Seidenfeld, Karen M Stechuchak, Valerie A Smith, Catherine Stanwyck, Chelsea Perfect, Courtney Van Houtven, Susan Nicole Hastings","doi":"10.17294/2694-4715.1080","DOIUrl":"10.17294/2694-4715.1080","url":null,"abstract":"<p><strong>Introduction: </strong>Older adults were critically vulnerable to disruptions in health care during the COVID-19 pandemic, but it is not known if changes in ED utilization varied based on patient characteristics. Using a cohort of older Veterans, we examined changes in ED visit rates based on four characteristics of interest: age, race, area deprivation index, and frailty.</p><p><strong>Methods: </strong>Participants were aged ≥65, with ≥2 visits in primary or geriatric clinics between 02/02/2018-05/07/2019. An adjusted negative binomial regression model was constructed for each characteristic. We report mean counts of all ED visits by quarter for subgroups separately, and report rate ratios to compare ED visits in the first year of the COVID-19 pandemic to the year before.</p><p><strong>Results: </strong>Patients with complete case data numbered 38,871. During the first two quarters, all subgroups had decreased ED visits, with more variation in the third and fourth quarters. The very highly frail, who had the highest mean estimated count of ED visits per person through both pre-COVID and COVID periods, also had a significant decrease in their ED visits during multiple quarters of the pandemic to a greater degree than other frailty subgroups.</p><p><strong>Conclusion: </strong>Stratifying older adults by frailty identified patient subgroups with the greatest variation in ED visits during COVID. Very highly frail patients warrant special attention to understand how variation in ED utilization affects patient outcomes.</p>","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"5 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11378967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156790","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":"Geriatric Emergency Medicine Fellowship Journal Club – Community Paramedicine","authors":"Priyank Bhatnagar, Don Melady","doi":"10.17294/2694-4715.1077","DOIUrl":"https://doi.org/10.17294/2694-4715.1077","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"76 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141817847","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 Adult with Transplanted Kidney Failure from Ureteral Obstruction Within a Hernia","authors":"Joel Glotfelty, Hannah Grainger, Christina Shenvi","doi":"10.17294/2694-4715.1082","DOIUrl":"https://doi.org/10.17294/2694-4715.1082","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"102 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141657457","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":"Bilateral corneal perforations due to elder neglect: a case report","authors":"Jaclyn Jordan, Katherine Selman, Richard Byrne","doi":"10.17294/2694-4715.1076","DOIUrl":"https://doi.org/10.17294/2694-4715.1076","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" 347","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141127690","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":"Emergency Care of an Older Adult with Complex Care Needs","authors":"Muhammad Adnan Khan, Himika Dalia, Michelle Dietz","doi":"10.17294/2694-4715.1075","DOIUrl":"https://doi.org/10.17294/2694-4715.1075","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"46 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140978993","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":"Best Practices in the Care of Older Adults During an Unplanned Acute Observation Stay","authors":"Jonny Macias Tejada, Michael Malone","doi":"10.17294/2694-4715.1079","DOIUrl":"https://doi.org/10.17294/2694-4715.1079","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" 33","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140996013","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}
Matthew B Downer, Kristina Kokorelias, Andrew P Costa, Don Melady, Samir K Sinha
{"title":"Describing and Predicting Trajectories of Healthcare Utilization Among Older Adults Presenting to an Emergency Department Using the interRAI Emergency Department Screener","authors":"Matthew B Downer, Kristina Kokorelias, Andrew P Costa, Don Melady, Samir K Sinha","doi":"10.17294/2694-4715.1072","DOIUrl":"https://doi.org/10.17294/2694-4715.1072","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"1 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139000397","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}
Josette Hartnett, Isabel Muronzi-Belfon, Suzanne J. Rose
{"title":"Evaluation of a Community Based Teaching Hospital’s Geriatric Emergency Medicine Initiative","authors":"Josette Hartnett, Isabel Muronzi-Belfon, Suzanne J. Rose","doi":"10.17294/2694-4715.1065","DOIUrl":"https://doi.org/10.17294/2694-4715.1065","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"85 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138981813","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}
Introduction Older adult patients (≥65) accessing emergency departments (ED) represent a significant demographic. Recidivism secondary to adverse drug events (ADE) ranges between 6-24% and levels of prescribed medication non-adherence is common among older adults. The ED pharmacist medication reconciliation workflow may mitigate self-management challenges in real time and reduce medication-related harm while potentially impacting recidivism, medication adherence, and patient self-efficacy. The purposes of this evidence-based project were to (1) evaluate the impact of a modified Medication Management for Deficiencies in the Elderly (MedMalDE) intervention on Self-Efficacy for Appropriate Medication Use (SEAMS) and 30-day return to care and (2) identify factors associated with medication self-management challenges (MedMalDE) in the participating institution. Methods As part of an evidence-based quality improvement (QI) effort to build an accredited geriatric emergency department (GED) and meet State legislated acute care medication history requirements, a new medication reconciliation workflow was deployed. To assess the intervention’s impact on self -efficacy in a pre/post design, 21 older adult patient’s underwent SEAMS assessment at two time points: the intervention and 7-14 days post-discharge from the emergency department. Baseline data and medication self-management challenges for an ED convenience sample of 167 older adult patients completed the MedMalDE. Descriptive statistics and a logistic regression model were used to evaluate the impact of the intervention and factors associated with medication management deficiencies. Wilcoxon Signed Rank was used for pre/post SEAMS score change. Results The self-efficacy (SEAMS) scores of 21-patients participating in the intervention were significantly improved from 19.88 to 21 (p=0.0077, p10%, included lack of knowledge regarding medication names, ease of opening or manipulating medications, ease of swallowing medications, and affordability. MedMalDE total scores were significantly associated with female gender (OR=
{"title":"Assessing medication self-management challenges and self-efficacy during emergency department medication reconciliation: An evidence-based quality improvement project","authors":"Mitchel Erickson, Jyu-Lin Chen, Yoonmee Joo, Stephanie Rogers, Thomas Hoffman, Claire Bainbridge","doi":"10.17294/2694-4715.1069","DOIUrl":"https://doi.org/10.17294/2694-4715.1069","url":null,"abstract":"Introduction Older adult patients (≥65) accessing emergency departments (ED) represent a significant demographic. Recidivism secondary to adverse drug events (ADE) ranges between 6-24% and levels of prescribed medication non-adherence is common among older adults. The ED pharmacist medication reconciliation workflow may mitigate self-management challenges in real time and reduce medication-related harm while potentially impacting recidivism, medication adherence, and patient self-efficacy. The purposes of this evidence-based project were to (1) evaluate the impact of a modified Medication Management for Deficiencies in the Elderly (MedMalDE) intervention on Self-Efficacy for Appropriate Medication Use (SEAMS) and 30-day return to care and (2) identify factors associated with medication self-management challenges (MedMalDE) in the participating institution. Methods As part of an evidence-based quality improvement (QI) effort to build an accredited geriatric emergency department (GED) and meet State legislated acute care medication history requirements, a new medication reconciliation workflow was deployed. To assess the intervention’s impact on self -efficacy in a pre/post design, 21 older adult patient’s underwent SEAMS assessment at two time points: the intervention and 7-14 days post-discharge from the emergency department. Baseline data and medication self-management challenges for an ED convenience sample of 167 older adult patients completed the MedMalDE. Descriptive statistics and a logistic regression model were used to evaluate the impact of the intervention and factors associated with medication management deficiencies. Wilcoxon Signed Rank was used for pre/post SEAMS score change. Results The self-efficacy (SEAMS) scores of 21-patients participating in the intervention were significantly improved from 19.88 to 21 (p=0.0077, p10%, included lack of knowledge regarding medication names, ease of opening or manipulating medications, ease of swallowing medications, and affordability. MedMalDE total scores were significantly associated with female gender (OR=","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"231 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139241652","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}
Ilianna Santangelo, Anne Marie Thompson, Aileen Tubridy, Kendra cull, Bridget Conly, Benjamin A. White, Maura Kennedy
The aging of the population has a significant impact on the health care system, as older adults have higher rates of emergency department (ED) visits and hospitalization, different care needs, and are at higher risk of iatrogenic harm in the hospital setting. In addition, there has recently been a rapid growth in ED observation units (EDOUs), to which older adults are frequently admitted. Recognizing the specific needs of older adults, our EDOU implemented an ‘Up by 10’ program which incorporates key components of delirium prevention programs. We took an iterative approach to the implementation of this program, resulting in a pilot program of a GeriCarED personal care attendant (PCA) focusing on the care needs of older adults. In this manuscript we report on a quality improvement study describing the feasibility of this pilot program, the role of the GeriCarED personal care attendant, and the number and type of interventions delivered to older adults. The GeriCarED PCA focused on the care of patients 75 years of age and older, as well as younger patients with cognitive or physical impairments. She systematically rounded on each patient, opening the blinds in the room to let in natural light, identifying assistance needed with activities of daily living, addressing sensory impairment, promoting mobilization, providing activities for cognitive engagement, and assessing for mental status changes. Over the 6 months of this pilot program, she saw a total of 586 patients with a median of 6 patients per day (interquartile range 3). She provided nutritional assistance to 90% of her patients, including cutting up food for 29% of patients and feeding 6% of patients. She mobilized 88% of patients, assisted 75% with washing, provided emotional support for 69% of patients, and identified an acute change in mentation in 2% of patients. Though not designed as an Age-Friendly intervention, this program aligned with the mentation, mobility and what matters components of the 4M framework.
{"title":"GeriCarED: Feasibility of a pilot program of a geriatric personal care attendant addressing mentation, mobility and matters most in an Emergency Department Observation Unit","authors":"Ilianna Santangelo, Anne Marie Thompson, Aileen Tubridy, Kendra cull, Bridget Conly, Benjamin A. White, Maura Kennedy","doi":"10.17294/2694-4715.1070","DOIUrl":"https://doi.org/10.17294/2694-4715.1070","url":null,"abstract":"The aging of the population has a significant impact on the health care system, as older adults have higher rates of emergency department (ED) visits and hospitalization, different care needs, and are at higher risk of iatrogenic harm in the hospital setting. In addition, there has recently been a rapid growth in ED observation units (EDOUs), to which older adults are frequently admitted. Recognizing the specific needs of older adults, our EDOU implemented an ‘Up by 10’ program which incorporates key components of delirium prevention programs. We took an iterative approach to the implementation of this program, resulting in a pilot program of a GeriCarED personal care attendant (PCA) focusing on the care needs of older adults. In this manuscript we report on a quality improvement study describing the feasibility of this pilot program, the role of the GeriCarED personal care attendant, and the number and type of interventions delivered to older adults. The GeriCarED PCA focused on the care of patients 75 years of age and older, as well as younger patients with cognitive or physical impairments. She systematically rounded on each patient, opening the blinds in the room to let in natural light, identifying assistance needed with activities of daily living, addressing sensory impairment, promoting mobilization, providing activities for cognitive engagement, and assessing for mental status changes. Over the 6 months of this pilot program, she saw a total of 586 patients with a median of 6 patients per day (interquartile range 3). She provided nutritional assistance to 90% of her patients, including cutting up food for 29% of patients and feeding 6% of patients. She mobilized 88% of patients, assisted 75% with washing, provided emotional support for 69% of patients, and identified an acute change in mentation in 2% of patients. Though not designed as an Age-Friendly intervention, this program aligned with the mentation, mobility and what matters components of the 4M framework.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135919184","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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