J. V. van Oppen, E. Regen, K. Phelps, T. Coats, J. Valderas, S. Conroy, N. Mackintosh
The Covid-19 pandemic has prompted changes to healthcare processes unseen in recent history, causing substantial stress for both patients and healthcare professionals. Daily life has changed dramatically for older people with frailty. Those living in our local (Leicester City) community have experienced the UK’s longest movement restrictions, with the clinically vulnerable having minimal direct contact with others for more than eighteen months. We are researchers in geriatric emergency medicine with both clinical and non-clinical backgrounds. Our recent qualitative studies have focused on understanding healthcare experiences and outcome goals among older people with frailty and acute care needs, aiming for their robust measurement and ultimate improvement. We had been performing interview and ethnographic studies when Covid-19 restrictions were imposed. In this article, we report our experience of the barriers and benefits for qualitative research presented by pandemic restrictions.
{"title":"Barriers and Benefits Experienced in Qualitative Geriatric Emergency Care Research during the Covid-19 Era","authors":"J. V. van Oppen, E. Regen, K. Phelps, T. Coats, J. Valderas, S. Conroy, N. Mackintosh","doi":"10.17294/2694-4715.1012","DOIUrl":"https://doi.org/10.17294/2694-4715.1012","url":null,"abstract":"The Covid-19 pandemic has prompted changes to healthcare processes unseen in recent history, causing substantial stress for both patients and healthcare professionals. Daily life has changed dramatically for older people with frailty. Those living in our local (Leicester City) community have experienced the UK’s longest movement restrictions, with the clinically vulnerable having minimal direct contact with others for more than eighteen months. We are researchers in geriatric emergency medicine with both clinical and non-clinical backgrounds. Our recent qualitative studies have focused on understanding healthcare experiences and outcome goals among older people with frailty and acute care needs, aiming for their robust measurement and ultimate improvement. We had been performing interview and ethnographic studies when Covid-19 restrictions were imposed. In this article, we report our experience of the barriers and benefits for qualitative research presented by pandemic restrictions.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48840960","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}
Rami Tarabay, Adam Perry, Riwa Al Aridi, M. Malone
he Emergency Department (ED) is a critical component of the geriatric continuum of care. Older adults comprise up to 25% of ED attendance and 38% of patients transported by emergency medical services (EMS.)2-4 Despite this, the traditional rapid linear ED treatment framework remains illequipped to meet the complex care needs of many vulnerable older adults.5-8 Upon discharge, the ED-to-home transition is a high-risk time for older adults. About one third of older adults will suffer an adverse result including ED revisit, eventual hospital referral, admission to a long-term care institution, or death within 3 months of the ED visit.9 Moreover, extended or frequent ED visits and repeated hospitalizations are costly. It has been reported that the cost of two potentially preventable geriatric syndromes, hospital delirium and repeated falls, is projected to be $83 billion a year in the United States.10,11
{"title":"Can an Emergency Department Adequately Address an Older Adult who has Complex Needs?","authors":"Rami Tarabay, Adam Perry, Riwa Al Aridi, M. Malone","doi":"10.17294/2694-4715.1015","DOIUrl":"https://doi.org/10.17294/2694-4715.1015","url":null,"abstract":"he Emergency Department (ED) is a critical component of the geriatric continuum of care. Older adults comprise up to 25% of ED attendance and 38% of patients transported by emergency medical services (EMS.)2-4 Despite this, the traditional rapid linear ED treatment framework remains illequipped to meet the complex care needs of many vulnerable older adults.5-8 Upon discharge, the ED-to-home transition is a high-risk time for older adults. About one third of older adults will suffer an adverse result including ED revisit, eventual hospital referral, admission to a long-term care institution, or death within 3 months of the ED visit.9 Moreover, extended or frequent ED visits and repeated hospitalizations are costly. It has been reported that the cost of two potentially preventable geriatric syndromes, hospital delirium and repeated falls, is projected to be $83 billion a year in the United States.10,11","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47463265","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}
Emily Franzosa, U. Hwang, Maya L. Genovesi, O. Intrator, T. Edes, M. Malone
The COVID-19 crisis has exposed deep problems in the way we care for medically complex older adults. However, it has also accelerated opportunities to support and keep these individuals safely in their homes both during the pandemic and in the future. Mrs. C’s situation represents the common ED dilemma of an independently living, medically complex older person with declining health who doesn’t necessarily require hospitalization. Many ED providers would admit Mrs. C to the hospital, potentially increasing her risk for COVID-19 or other nosocomial infection and filling a bed potentially needed by a sicker patient. Alternatively, she might be sent home alone, but risk returning to the ED quickly. However, there is a third option, where providers could ensure Mrs. C’s safe transition back home by discussing her goals and preferences, assessing her medical and social needs, identifying gaps, and arranging in-home services right from the ED. We propose that by investing in transitional care coordination encompassing comprehensive assessments, onsite case management and referrals to health and social services at home, EDs can meet the medical and social needs and the preferences of patients like Mrs. C.
{"title":"“I’m not staying in the hospital tonight”: How Emergency Departments can leverage health and social services at home to support care transitions for older patients","authors":"Emily Franzosa, U. Hwang, Maya L. Genovesi, O. Intrator, T. Edes, M. Malone","doi":"10.17294/2694-4715.1008","DOIUrl":"https://doi.org/10.17294/2694-4715.1008","url":null,"abstract":"The COVID-19 crisis has exposed deep problems in the way we care for medically complex older adults. However, it has also accelerated opportunities to support and keep these individuals safely in their homes both during the pandemic and in the future. Mrs. C’s situation represents the common ED dilemma of an independently living, medically complex older person with declining health who doesn’t necessarily require hospitalization. Many ED providers would admit Mrs. C to the hospital, potentially increasing her risk for COVID-19 or other nosocomial infection and filling a bed potentially needed by a sicker patient. Alternatively, she might be sent home alone, but risk returning to the ED quickly. However, there is a third option, where providers could ensure Mrs. C’s safe transition back home by discussing her goals and preferences, assessing her medical and social needs, identifying gaps, and arranging in-home services right from the ED. We propose that by investing in transitional care coordination encompassing comprehensive assessments, onsite case management and referrals to health and social services at home, EDs can meet the medical and social needs and the preferences of patients like Mrs. C.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49058166","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}
Martinus Megalla, Roopa Avula, Chris R. Manners, Portia Chinnery, Lindsey Perrella, D. Finefrock
continued specialized Geriatric consultative services, either as an inpatient or as an outpatient. In order to provide simple, standard communication we created a screening model based on the 4M model of geriatric care that would trigger an indication for referral to a geriatrician. The purpose of this paper is to outline a screening method we have developed based on the geriatric 4M model for older patients presenting to the ED. This screening tool is used to identify patients who may benefit from referral to specialized geriatrics care. Once implemented, we hope to use this screen in the future to track data of referred patients longitudinally in order to both identify high risk features of these patients, fine tune the screening method, and track outcomes of those patients referred.
{"title":"Using the 4M Model to Screen Geriatric Patients in the Emergency Department","authors":"Martinus Megalla, Roopa Avula, Chris R. Manners, Portia Chinnery, Lindsey Perrella, D. Finefrock","doi":"10.17294/2694-4715.1013","DOIUrl":"https://doi.org/10.17294/2694-4715.1013","url":null,"abstract":"continued specialized Geriatric consultative services, either as an inpatient or as an outpatient. In order to provide simple, standard communication we created a screening model based on the 4M model of geriatric care that would trigger an indication for referral to a geriatrician. The purpose of this paper is to outline a screening method we have developed based on the geriatric 4M model for older patients presenting to the ED. This screening tool is used to identify patients who may benefit from referral to specialized geriatrics care. Once implemented, we hope to use this screen in the future to track data of referred patients longitudinally in order to both identify high risk features of these patients, fine tune the screening method, and track outcomes of those patients referred.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45143312","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}
Katherine Selman, Christine Binkley, K. Davenport, Shan Lliu, Maura Kennedy
{"title":"Management of Fall Patients – What Should be Done for Emergency Department Fall Patients?","authors":"Katherine Selman, Christine Binkley, K. Davenport, Shan Lliu, Maura Kennedy","doi":"10.17294/2694-4715.1006","DOIUrl":"https://doi.org/10.17294/2694-4715.1006","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49050478","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}
Suzanne Ryer, A. Gallo, Adam Perry, Michael Malone
Falls and injurious falls are common causes for emergency department visits in older adults. Prior literature describing ED care of older adults has focused on the patients' injuries and their ED care. There is a gap in the literature describing communitybased falls prevention strategies and interventions deployed by community organizations, beyond health systems. We identified variation in approaches to older adults among paramedic programs from one community to the next within Milwaukee County, Wisconsin. We also noted no organized falls prevention program spanning all communities, emergency departments and health systems in the county. We describe the implementation of the Milwaukee County Falls Prevention Coalition. We document participation in the coalition, the dissemination of a fall’s prevention toolkit, and participation in outreach events. We document baseline falls rates, as an outcome measure which we will track over time. Emergency Department Community programs can be implemented with the goal to prevent falls for older adults. Next steps include refining the falls prevention strategy and setting county-wide targets for reduction in falls rates based on implementation of targeted fall prevention interventions.
{"title":"Emergency Department - Community Partnership to Coordinate Older Adults Falls Prevention Programs","authors":"Suzanne Ryer, A. Gallo, Adam Perry, Michael Malone","doi":"10.17294/2694-4715.1009","DOIUrl":"https://doi.org/10.17294/2694-4715.1009","url":null,"abstract":"Falls and injurious falls are common causes for emergency department visits in older adults. Prior literature describing ED care of older adults has focused on the patients' injuries and their ED care. There is a gap in the literature describing communitybased falls prevention strategies and interventions deployed by community organizations, beyond health systems. We identified variation in approaches to older adults among paramedic programs from one community to the next within Milwaukee County, Wisconsin. We also noted no organized falls prevention program spanning all communities, emergency departments and health systems in the county. We describe the implementation of the Milwaukee County Falls Prevention Coalition. We document participation in the coalition, the dissemination of a fall’s prevention toolkit, and participation in outreach events. We document baseline falls rates, as an outcome measure which we will track over time. Emergency Department Community programs can be implemented with the goal to prevent falls for older adults. Next steps include refining the falls prevention strategy and setting county-wide targets for reduction in falls rates based on implementation of targeted fall prevention interventions.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"7 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41281538","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":"Caregiver Support in the Emergency Department","authors":"Candace Kim, D. Butler, T. C. James","doi":"10.17294/2694-4715.1016","DOIUrl":"https://doi.org/10.17294/2694-4715.1016","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42137846","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}
Anita N Chary, Adriane Lesser, Sharon K Inouye, Christopher R Carpenter, Amy R Stuck, Maura Kennedy
{"title":"A SURVEY OF DELIRIUM SELF-REPORTED KNOWLEDGE AND PRACTICES AMONG EMERGENCY PHYSICIANS IN THE UNITED STATES.","authors":"Anita N Chary, Adriane Lesser, Sharon K Inouye, Christopher R Carpenter, Amy R Stuck, Maura Kennedy","doi":"10.17294/2694-4715.1010","DOIUrl":"10.17294/2694-4715.1010","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9387655/pdf/nihms-1776563.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40713904","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}
Alyssa Elman, Daniel Baek, Elaine Gottesman, M. Stern, M. Mulcare, Amy L. Shaw, Morgan Pearman, Michelle Sullivan, S. Clark, T. Platts-Mills, Rahul Sharma, T. Rosen
Many older adults in the United States are affected by unmet needs and social challenges that negatively impact their health and well-being. These include social isolation, inadequate care, inability to perform daily activities, food insecurity, housing insecurity, poverty, and abuse/neglect/exploitation. Such challenges make it more difficult to obtain medical and dental care and manage vision / hearing impairments. Affected patients have trouble obtaining medications and remaining adherent to medication regimens. These issues may compromise an older adults’ nutrition. They may contribute to anxiety, depression, and loneliness, which in turn can also negatively affect a person’s physical health and function.
{"title":"Unmet Needs and Social Challenges for Older Adults During and After the COVID-19 Pandemic: An Opportunity to Improve Care","authors":"Alyssa Elman, Daniel Baek, Elaine Gottesman, M. Stern, M. Mulcare, Amy L. Shaw, Morgan Pearman, Michelle Sullivan, S. Clark, T. Platts-Mills, Rahul Sharma, T. Rosen","doi":"10.17294/2694-4715.1004","DOIUrl":"https://doi.org/10.17294/2694-4715.1004","url":null,"abstract":"Many older adults in the United States are affected by unmet needs and social challenges that negatively impact their health and well-being. These include social isolation, inadequate care, inability to perform daily activities, food insecurity, housing insecurity, poverty, and abuse/neglect/exploitation. Such challenges make it more difficult to obtain medical and dental care and manage vision / hearing impairments. Affected patients have trouble obtaining medications and remaining adherent to medication regimens. These issues may compromise an older adults’ nutrition. They may contribute to anxiety, depression, and loneliness, which in turn can also negatively affect a person’s physical health and function.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46684547","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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