GeriCarED: Feasibility of a pilot program of a geriatric personal care attendant addressing mentation, mobility and matters most in an Emergency Department Observation Unit

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.