Rural-dwelling older adults experience unique issues related to accessing medical and social services. We describe the development, implementation, and experience of a novel, community-based program to identify rural-dwelling older adults with unmet medical and social needs. The program leveraged the existing emergency medical services (EMS) system. The program specifically included: 1) geriatrics training for EMS providers; 2) screening of older adult EMS patients for falls, depression, and medication management strategies by EMS providers; 3) communication of EMS findings to community-based case managers; 4) in-home evaluation by case managers; 5) referral to community resources for medical and social interventions. Measures used to evaluate the program included patient needs identified by EMS or the in-home assessment, referrals provided to patients, and patient satisfaction. 1231 of 1444 visits to older patients (85%) were screened by EMS. Of those receiving specific screens, 45% had fall-related, 69% had medication management-related, and 20% had depression-related needs identified. 171 of eligible EMS patients who could be contacted accepted the in-home assessment. For the 153 individuals completing the assessment, 91% of patients had identified needs and received referrals or interventions. This project demonstrated that screening by EMS during emergency care for common geriatric syndromes and linkage to case managers is feasible in this rural community, although many will refuse the services. Further patient evaluations by case managers, with subsequent interventions by existing service providers as required, can facilitate the needed linkages between vulnerable rural-dwelling older adults and needed community-based social and medical services.

Objectives-To evaluate older adult emergency department (ED) patients for depression and cognitive impairment, and compare those findings to re-evaluation 2-weeks later. Design-Prospective cohort study. Setting-Emergency department.Participants-Community-dwelling older adult ED patients. 1206 patients consented to participate; 811 (67%) completed 2 week follow-up.Measurements-Screening for depression (Patient Health Questionnaire-9) and cognitive impairment (Six Item Screener) was performed. Changes were evaluated through paired comparisons.Results-1206 patients consented to participate; 811 (67%) completed 2 week follow-up. For depression, 27/97 (28%) with baseline positive tests remained positive on 2 week follow-up and 22/706 (3%) who initially tested negative were positive on follow-up. For cognitive impairment, 5/43 (12%) with baseline positive tests remained positive at 2 week follow-up and 11/765 (1%) who initially tested negative were positive at 2 week follow up. Author Contributions: Dr. Shah-Developed the study, designed the study, analyzed data, interpreted data, and prepared the manuscript. Dr. Richardson-Developed the study, designed the study, analyzed data, interpreted data, and prepared the manuscript. Ms. Jones-Analyzed data, interpreted data, and prepared the manuscript. Mr. Swanson--Developed the study, recruited subjects, interpreted data, and edited the manuscript. Dr. Schneider-Developed the study, interpreted data, and edited the manuscript. Dr. Katz-Developed the study, interpreted data, and edited the manuscript. Dr. Conwell-Developed the study, interpreted data, and edited the manuscript. Sponsor's Role: None. Conclusions-Significant variability exists for depression and cognitive impairment testing completed during and after the ED visit, with markedly fewer subjects testing positive in followup. The variability may reflect changes in clinical state, confounding from other conditions, or poor validity of the instruments in the ED setting. Further studies are needed to explain these findings before case finding for these conditions is implemented in the ED setting. NIH Public Access