Geriatric Emergency Medicine

This book discusses all important aspects of emergency medicine in older people, identifying the particular care needs of this population, which all too often remain unmet. The up-to-date and in-depth coverage will assist emergency physicians in identifying patients at risk for adverse outcomes, in conducting appropriate assessment,and in providing timely and adequate care. Particular attention is paid to the commonpitfalls in emergency management andmeans of avoiding them. Between 1980 and 2013, the number of older patients in emergency departmentsworldwide doubled. Compared with younger patients, older people suffer from more comorbidities, a higher mortality rate, require more complex assessment and diagnostic testing, and tend to stay longer in the emergency department. This book, written by internationally recognized experts in emergency medicine and geriatrics, not only presents the state of the art in the care of this population but also underlines the increasing need for adequate training and development in the field.

This comprehensive volume provides a practical framework for evaluation, management and disposition of this growing vulnerable patient population.

An essential, experience-based, practical guide for anyone looking to improve the care of older patients in the emergency department.

This volume, sponsored by the American College of Emergency Physicians, is a comprehensive, practical, ready-reference for the ED physician. Content focuses on how to effectively and accurately diagnose and treat this unique population. Each chapter is structured as follows: High Yield Facts: a bulleted list of 5 high yield facts Introduction: definition of problem and relevancy to older population Epidemiology (if applicable): scope, incidence/prevalence, mortality Pathophysiology: causative factors, predispositions, risk factors, mechanisms of disease process or injury, organ systems affected and disease course Clinical Features: chief complaint, presenting symptoms key historical information, physical examination including general appearance, vital signs, specific findings, and associated findings Diagnosis and Differential: laboratory findings and ancillary testing (including indications for same and also predictive value of such tests, differential diagnosis Emergency Department Care and Disposition: immediate management priorities (overview), initial ED management (to include both pharmacological and non-pharmacological care of the patient), subsequent care (if applicable). Can also include prognosis. Additional Aspects: complications, controversies, pitfalls, medical/legal issues, ethical issues, and costs

In this issue of Clinics in Geriatric Medicine, guest editors Drs. Maura Kennedy and Shan Liu bring their considerable expertise to the topic of Geriatric Emergency Care. Top experts in the field cover critical topics or concepts in geriatric emergency medicine and topics for which there is new research, including guidance on “geriatricizing the ED and ED observation unit, caring for persons with dementia, and examining the intersection of DEI and care of an aging population. Contains 13 relevant, practice-oriented topics including the aging process: physiologic changes and frailty; elder abuse and neglect: recognition and management in the emergency department; best practices in end of life and palliative care in the ED; falls and other trauma in the older adult; and more. Provides in-depth clinical reviews on geriatric emergency care, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

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.

This issue of Emergency Medicine Clinics focuses on Geriatric Emergencies. Articles include: Recent Trends in Geriatric Emergency Medicine, Resuscitation of the Elderly, Pharmacology in the Geriatric Patient, Trauma and Falls in the Elderly, Sepsis and Infectious Emergencies in the Elderly, Evaluation of the Geriatric Patient with Chest Pain, Evaluation of Dyspnea in the Elderly, Abdominal Pain in the Geriatric Patient, Neurologic Emergencies in the Elderly, Evaluation of Syncope, Altered Mental Status and Delirium, and more!

This issue of Clinics in Geriatric Medicine features expert clinical reviews on Geriatric Emergency Medicine which includes current information on topics such as palliative medicine and emergency care, alternative management strategies, transitions of care, the emergency department observation unit and the older patient, generalized weakness, altered mental status, trauma management, acute pain management, acute visual changes, orthopedic emergencies, dizziness, palpitations, acute stroke syndromes, abuse and neglect, and electrolyte and endocrine emergencies.