The Psychogeriatric Patient in the Emergency Room: Focus on Management and Disposition

Tang, Sherry; Patel, Priyanka; Khubchandani, Jagdish; Grossberg, George T.

doi:10.1155/2014/413572

Cited by 5 publications

(2 citation statements)

References 14 publications

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“…This finding is consistent with prior literature showing that minority patients often have higher levels of baseline cognitive impairment and are at greater risk of developing delirium in the hospital, where it is often undertreated [27-30]. …”

Section: Discussionsupporting

confidence: 92%

The Impact of Race on Intensity of Care Provided to Older Adults in the Medical Intensive Care Unit

Chima-Melton

Murphy

Araujo

et al. 2015

J. Racial and Ethnic Health Disparities

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Background African Americans and Hispanics receive disproportionately less aggressive non-critical treatment for chronic diseases than their Caucasian counterparts. However when it comes to end of life care, minority races are purportedly treated more aggressively in Medical Intensive Care Units (MICU) and are more likely to die there. Objective We sought to determine the impact of race on the intensity of care provided to older adults in the Medical Intensive Care Unit (MICU) using the Therapeutic Intervention Scoring System-28 (TISS-28) and other MICU interventions. Methods A prospective study of a cohort of 309 patients aged 60 years and older in the MICU. Interventions such as mechanical ventilation, vasopressors, new onset dialysis, feeding tubes and pulmonary artery catheterization were recorded. Primary outcomes were TISS-28 scores and MICU interventions. Results Non-white patients were younger, had more dementia and delirium although there was no difference in ICU mortality. The amount of critical care delivered to non-white and white patients were equivalent at p≤0.05 based on their respective TISS-28 scores. Non-white patients received more renal replacement therapy than white patients. Conclusions Our study adds to the growing body of literature demonstrating that the relationship between race, patient preference and the intensity of care provided in MICUs is multifaceted. Although prior studies have reported that non-white populations often opt for more aggressive care, the similar proportions of non-white and white ‘Full code’ patients in this study suggests that this idea is overly simplistic.

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Section: Discussionsupporting

confidence: 92%

The Impact of Race on Intensity of Care Provided to Older Adults in the Medical Intensive Care Unit

Chima-Melton

Murphy

Araujo

et al. 2015

J. Racial and Ethnic Health Disparities

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“…8,9 Delirious states occur more frequently in people already suffering chronic brain dysfunction, such as dementia. 4,[10][11][12] Like the rest of the world, Australia's population shifts toward older ages, 13 with the implication that more older people, including those with cognitive impairment, will seek care in EDs in coming years. Growing awareness has resulted in a greater focus on the quality of care for older people presenting to EDs, leading to the publication of guidelines for evidencebased practice and suggestions for research initiatives.…”

mentioning

confidence: 99%

Structural Quality Indicators to Support Quality of Care for Older People With Cognitive Impairment in Emergency Departments

Schnitker

Martin‐Khan

Burkett

et al. 2015

Academic Emergency Medicine

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Objectives: The purpose of this study was to identify the structural quality of care domains and to establish a set of structural quality indicators (SQIs) for the assessment of care of older people with cognitive impairment in emergency departments (EDs).Methods: A structured approach to SQI development was undertaken including: 1) a comprehensive search of peer-reviewed and gray literature focusing on identification of evidence-based interventions targeting structure of care of older patients with cognitive impairment and existing SQIs; 2) a consultative process engaging experts in the care of older people and epidemiologic methods (i.e., advisory panel) leading to development of a draft set of SQIs; 3) field testing of drafted SQIs in eight EDs, leading to refinement of the SQI set; and 4) an independent voting process among the panelists for SQI inclusion in a final set, using preestablished inclusion and exclusion criteria.Results: At the conclusion of the process, five SQIs targeting the management of older ED patients with cognitive impairment were developed: 1) the ED has a policy outlining the management of older people with cognitive impairment during the ED episode of care; 2) the ED has a policy outlining issues relevant to carers of older people with cognitive impairment, encompassing the need to include the (family) carer in the ED episode of care; 3) the ED has a policy outlining the assessment and management of behavioral symptoms, with specific reference to older people with cognitive impairment; 4) the ED has a policy outlining delirium prevention strategies, including the assessment of patients' delirium risk factors; and 5) the ED has a policy outlining pain assessment and management for older people with cognitive impairment.Conclusions: This article presents a set of SQIs for the evaluation of performance in caring for older people with cognitive impairment in EDs.ACADEMIC EMERGENCY MEDICINE 2015;22:273-284

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Administration of New Telepsychiatry Programs in Public Psychiatry and Applications in Geriatrics

Mazumder

Ratliff

2017

Geriatric Telepsychiatry

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The Psychogeriatric Patient in the Emergency Room: Focus on Management and Disposition

Cited by 5 publications

References 14 publications

The Impact of Race on Intensity of Care Provided to Older Adults in the Medical Intensive Care Unit

The Impact of Race on Intensity of Care Provided to Older Adults in the Medical Intensive Care Unit

Structural Quality Indicators to Support Quality of Care for Older People With Cognitive Impairment in Emergency Departments

Administration of New Telepsychiatry Programs in Public Psychiatry and Applications in Geriatrics

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