This book introduces the unique medical needs of aging patients in the emergency department and outlines the challenges that leave many clinicians struggling to adequately care for this demographic, including limited resources, management concerns, and other barriers. The text presents strategies for screening, diagnosing, and treating geriatric syndromes seen in the emergency care of the older adult patient. Topics include pharmacological interventions, transitioning care, and sustainability. The text includes complex cases that demonstrate the caution necessary to treat this delicate patient group. Each case concludes with a set of concise "take-home points" to make the guidelines easy to remember and/or reference. Geriatric Emergencies: A Case-Based Approach to Improving the Acute Care of Seniors is an excellent resource for geriatricians, emergency medicine specialists, internal medicine physicians, hospitalists, nurses, social workers, students, residents, trainees, and all medical professionals working with older patients in an emergency setting.

Autorentext
Lee A. Lindquist, MD MPH MBA
Associate Professor of Medicine
Section Chief of Geriatrics
Northwestern University Feinberg School of Medicine
750 N. Lake Shore Drive, 10th Floor
Chicago, IL 60611 Scott Dresden, MD
Assistant Professor of Medicine
Department of Emergency Medicine
Northwestern University Feinberg School of Medicine
211 E. Ontario, Room 200
Chicago, IL 60611

Zusammenfassung
Care for older adults in Emergency Departments (EDs) has historically been focused on acute medical conditions with little emphasis on geriatric-specific issues. In 2010, emergency departments (EDs) throughout the nation saw almost 130 million patients, 15% of whom were 65 or older. The number of older adults who visit an ED has doubled in the last decade and continues to grow rapidly. Older adults receiving care in an ED are highly likely to be admitted to the hospital, much more so than their younger counterparts. Preventing a hospital admission saves older adults from frequently encountered adverse events, including hospital-acquired delirium, functional status impairment, cognitive loss, and nursing home admission.

It is unknown how many older adults are hospitalized for reasons other than acute medical illness, such as functional decline, polypharmacy, progressive dementia, caregiver stress, or unstable living situation. These non-emergent conditions are rarely addressed during a typical ED visit due to lack of resources, significant patient volumes, and the need for rapid turnover of care spaces. The predominant management strategy of emergency physicians to handle these important but not imminently life-threatening geriatric issues is to recommend hospital admission.

Northwestern has pioneered the Geriatric Emergency Department through the creation of the Geriatric Emergency Department Innovation model (GEDI), with goals to prevent admissions for older adults by assessing and meeting their geriatric-specific, non-acute care needs in the ED. The GEDI model at Northwestern centers on a multi-disciplinary curriculum composed of clinical, didactic, and practical arms developed by emergency medicine and geriatrics educational experts.

In this title, we will present case studies of older adults seen in the Emergency Department through the GEDI model and discuss means of identifying/screening for, diagnosing, and treating geriatric syndromes seen in the emergent care of the older adult patient. In addition, there will be a set of concise take-home points for each case study that will be easy to commit to memory and implement in clinical care of older adults.

As the number of seniors seeking emergent care will continue to increase, the ED setting must become responsive to geriatric-specific needs. This book will provide a variety of models detailing how to offer comprehensive, state-of-the-art, optimal care for managing the full range of geriatric syndromes that regularly present in the emergent care setting.

Inhalt

1. Growing Older in the Emergency Department

Authors: Lee A. Lindquist, MD MPH MBA and Paul A. Nelson, BArch

2. Components of an effective Geriatric Emergency Department

Author: Scott M. Dresden, MD, MS

3. Cognitive Impairment in the ED

Authors: Jill M Huded, MD and Todd I Smith, MD, FACP, FHM

4. Syncope in a rural emergency department setting

Authors: Lucy Morse, BS, MD & Lee A. Lindquist, MD, MPH, MBA

5. ER referrals and hospitalizations from Post-Acute and Long-Term Care Facilities

Author: Fernanda Heitor, MD

6. Can Home Visits Make a Difference to Emergency Department Visits? "I will just stop by his place on the way home: Who knew it would be a journey?"

Authors: Dwayne Dobschuetz, APRN, MSN and Katherine O'Brien, MD

7. Medication Errors in Aging Adults: A Case-Based Approach to Medication Management

Authors: Abbie Lyden, PharmD BCPS and Katherine Allen, PharmD

8. Pain, Opioid Use, and Palliative Care of Older Adults in the Emergency Department

Author: William P. Burns, MD

9. Acute Mental Status Changes and Over-the-Counter Medications in Older Adults

Author: Katherine M. Hunold, MD

10. Identifying fall risk in the Emergency Department Author: Chirley M. Rodriguez, MD

11. Capacity, Advance Care Planning, and Buying Time.

Author: Hashim Q. Zaidi, MD