Geriatric Emergency Department Guidelines

Rosenberg, Mark; Carpenter, Christopher R.; Bromley, Marilyn; Caterino, Jeffrey M.; Chun, Audrey; Gerson, Lowell W.; Greenspan, Jason; Hwang, Ula; John, David P.; Lichtman, Joelle; Lyons, William; Mortensen, Betty; Platts‐Mills, Timothy F.; Ragsdale, Luna; Rispoli, Julie; Seaberg, David C.; Wilber, Scott T.

doi:10.1016/j.annemergmed.2014.02.008

Cited by 240 publications

(66 citation statements)

References 136 publications

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“…Aging adults represent a uniquely challenging population for emergency medicine (McNamara, Rousseau, & Sanders, 1992), which has led to an increasing emphasis on quality indicators (Schnitker et al, 2015), medical education priorities (Hogan et al, 2010), policy statements (Hwang et al, 2013), and professional society guidelines (American College of Emergency, American Geriatrics, Emergency Nurses, Society for Academic Emergency, & Geriatric Emergency Department Guidelines Task, 2014). Older emergency department (ED) patients with acute delirium or unrecognized dementia represent approximately 10% and 30% of community dwelling older adults, respectively and the majority is never diagnosed (Carpenter, Bassett, et al, 2011; Carpenter, DesPain, Keeling, Shah, & Rothenberger, 2011; Han et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

Informed Consent to Research with Cognitively Impaired Adults: Transdisciplinary Challenges and Opportunities

Prusaczyk

Cherney

Carpenter

et al. 2016

Clinical Gerontologist

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Introduction Due to issues related to informed research consent, older adults with cognitive impairments are often excluded from high-quality studies that are not directly related to cognitive impairment, which has led to a dearth of evidence for this population. The challenges to including cognitively impaired older adults in research and the implications of their exclusion are a transdisciplinary issue. Discussion The ethical challenges and logistical barriers to conducting research with cognitively impaired older adults are addressed from the perspectives of three different fields – social work, emergency medicine, and orthopaedic surgery. Issues related to funding, study design, intervention components, and outcomes are discussed through the unique experiences of three different providers. Clinical Implications A fourth perspective – medical research ethics – provides alternatives to exclusion when conducting research with cognitively impaired older adults such as timing, corrective feedback and plain language, and capacity assessment and proxy appointments. Given the increasing aging population and the lack of evidence on cognitively impaired older adults, it is critical that researchers, funders, and institutional review boards not be dissuaded from including this population in research studies.

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Section: Discussionmentioning

confidence: 99%

Informed Consent to Research with Cognitively Impaired Adults: Transdisciplinary Challenges and Opportunities

Prusaczyk

Cherney

Carpenter

et al. 2016

Clinical Gerontologist

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“…Given that older patients who have fallen in the past year are more likely to fall again [ 9 ] and that the incidence of a subsequent second hip fracture after the first hip fracture is substantial [ 10 ], evaluation and interventions to address polypharmacy in older patients with hip fracture are important. In fact, The American College of Emergency Physicians Geriatric Emergency Department Guidelines recommend a multidisciplinary team intervention for all elderly patients prescribed more than five medications who present to the emergency department, regardless of the presenting complaint [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Intervention to improve the appropriate use of polypharmacy for older patients with hip fractures: an observational study

Komagamine

Hagane

2017

BMC Geriatr

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BackgroundPolypharmacy is frequently observed in hip fracture patients. Although it is associated with an increased risk of hip fracture, polypharmacy often continues after hip fracture recovery. This study aimed to evaluate the effectiveness of an intervention to improve appropriate polypharmacy for elderly patients admitted to the hospital for hip fractures.MethodsWe conducted a retrospective observational study to compare the outcomes of patients receiving the intervention (n = 32) with those of patients who received usual care (n = 132). All hip fracture patients aged 65 years or older and prescribed 5 or more medications at admission from January 2015 to December 2016 were included in the study. The intervention consisted of an assessment by internal medicine physicians of the appropriateness of polypharmacy and the de-prescription of any unnecessary medications during the patients’ hospital stay. The primary composite outcome was death or the first occurrence of any new fracture. Comparisons between the intervention and usual care groups were analyzed using binary logistic regression.ResultsA total of 164 patients were included in the study. The mean patient age was 84.8 years, and the mean numbers of prescribed medications and potentially inappropriate medications at admission were 8.0 and 1.3, respectively. The mean follow-up period was 8.0 months. The primary composite outcome occurred in 35 (21.3%) patients. The total number of potentially inappropriate medications at discharge was significantly lower in the intervention group than in the usual care group (0.8 ± 0.8 for the intervention group vs 1.1 ± 1.0 for the usual care group; p = 0.03). However, no significant differences in the primary composite outcome were found between the intervention and usual care groups (7 in the intervention group and 28 in the usual care group, odds ratio 1.04, 95% CI 0.41–2.65; p = 1.00).ConclusionsThe intervention to improve appropriate polypharmacy was associated with a reduction in potentially inappropriate medications but not an improvement in clinical outcomes. This intervention, which focused only on polypharmacy, may not effectively improve outcomes for elderly patients with hip fractures.Trial registrationUMIN-CTR UMIN000025495. Retrospectively registered 2 January 2017.Electronic supplementary materialThe online version of this article (10.1186/s12877-017-0681-3) contains supplementary material, which is available to authorized users.

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“…6 The ED offers an ideal additional site to capture high risk patients. 7 Despite numerous guidelines recommending screening for fall risk in the ED, 7,8 ED-specific data are more scant. 9 Several small prospective cohort studies have suggested that patients presenting to the ED have an increased risk of future falls as compared to baseline community dwelling adults.…”

Section: Introductionmentioning

confidence: 99%

Using Chief Complaint in Addition to Diagnosis Codes to Identify Falls in the Emergency Department

Patterson

Smith

Repplinger

et al. 2017

J American Geriatrics Society

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Objectives We compared incidence of falls in an emergency department (ED) cohort using a traditional ICD-9 code-based scheme and an expanded definition that included chief complaint information. We further examined the clinical characteristics of those visits “missed” in the ICD-9-based scheme. Design Retrospective Electronic Record Review Setting Academic medical center ED Participants All ED visits of individuals aged 65 and older between 1/1/2013 and 9/30/2015. Measurements Two fall definitions were applied (both individually and in unison) to the cohort: an ICD-9-based definition, and a chief complaint definition. Admission and 30-day mortality rates (per encounter) were measured for each definition. Results 23,880 older adult visits occurred during the study period. Using the most inclusive definition (either ICD-9 code or chief complaint indicating a fall) 4,363 visits (18%) were fall related. Among these visits, 3,506 (80%) met the ICD-9 definition for a fall related visit, while 2,664 (61%) met the chief complaint definition. Among visits meeting the chief complaint definition, 857 (19.6%) were missed when applying the ICD-9 definition alone. Encounters missed by the ICD-9 definition had a lower admission rate (42.9%, 95% CI 39.7–46.3) than those identified (54.4%, 95% CI 52.7–56.0). Conclusion Identifying ED fall patients based on diagnosis codes underestimates the true burden of disease. Patients missed by the code-based definition were less likely to have been admitted than those captured. These findings call attention to the value of using chief complaint information to identify fall patients in the ED setting, whether it be for research, clinical care, or policy reasons.

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Geriatric Emergency Department Guidelines

Cited by 240 publications

References 136 publications

Informed Consent to Research with Cognitively Impaired Adults: Transdisciplinary Challenges and Opportunities

Informed Consent to Research with Cognitively Impaired Adults: Transdisciplinary Challenges and Opportunities

Intervention to improve the appropriate use of polypharmacy for older patients with hip fractures: an observational study

Using Chief Complaint in Addition to Diagnosis Codes to Identify Falls in the Emergency Department

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