Improving Acute Care For The Frail Elderly

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.

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.

Acute Care for Elders (ACE) is a model of care designed to improve functional outcomes and to improve the processes for the care of older patients. This model includes: an environment of care designed to promote improved function for older patients; an interdisciplinary team that works together to identify/address the vulnerabilities of the older patients; nursing care plans for prevention of disability; early planning to help prepare the patient to return home and a review of medical care to prevent iatrogenic illness. Acute Care for Elders: A Model for Interdisciplinary Care is an essential new resource aimed at assisting providers in developing and sustaining an ACE program. The interdisciplinary approach provides an introduction to the key vulnerabilities of older adults and defines the lessons learned from the Acute Care for Elders model. Expertly written chapters describe critical aspects of ACE: the interdisciplinary approach and the focus on function. The fundamental principles of ACE described in this book will further assist hospital leaders to develop, implement, sustain and disseminate the Acute Care for Elders model of care. Acute Care for Elders: A Model for Interdisciplinary Care is of great value to geriatricians, hospitalists, advance practice nurses, social workers and all others who provide high quality care to older patients.

This book offers an up-to-date review on the principles and practice of multidimensional assessment and management of the older individual, which represents the cornerstone of modern clinical practice in the elderly. The early chapters cover the main elements and scope of the comprehensive geriatric approach and explain the pathways of care from screening and case finding through to in-depth assessment and treatment planning. Subsequent chapters review the evidence of how best to apply the multidimensional assessment and management approach in defined healthcare settings and within specific clinical areas, such as cancer and surgery. Finally, the education and training challenges are reviewed and the prospects for future clinical service and research in this important field are examined. The book is very timely given the recent advances in application of this approach, which reflect the growing international realization that older people are “core business” in many clinical areas where the role of specialist geriatric medicine has hitherto been limited. Accordingly, the book will be relevant to a wide range of clinicians. The authorship comprises many of the best known and widely published experts in their respective fields.

Frail older people now contribute the majority of the acute emergency take both medical and surgical. Despite this there is often a lack of confidence and knowledge among doctors and nurses in treating older people in the Emergency Department and on Emergency Assessment Units.From the Preface Emergency care of frail older people is challenging but very rewarding. Older patients tend to be complex and therefore their assessment needs to be more extensive and include comprehensive geriatric assessment. It is the extras in their assessment that are not usually needed in younger patients, such as cognitive, functional and social evaluations that make the difference in achieving a better outcome. This book describes the key features of high quality care for frail elderly patients in acute hospital settings. With chapters on assessment and the characteristic non-specific ways that patients tend to present (such as 'confusion', 'collapse query cause' and 'off legs'), this practical guide is ideal to have on-hand. As well as common medical and surgical conditions, it also covers medication management, elder abuse, pressure ulcers and hypothermia, including the physiological changes seen in ageing and ways to define frail patients. Tables, diagrams and images are ideal for quick reference, and key points are summarised throughout the text to aid comprehension, providing doctors, nurses and therapists with both background and essential information to provide the excellent acute care older people deserve.

This issue of Clinics in Geriatric Medicine, guest edited by Drs. Michael Malone and Kevin Biese, is devoted to Care for the Older Adult in the Emergency Department. Articles in this outstanding issue include: Approach to the Older Patient in the Emergency Department; Ten Best Practices for Older Adults in the Emergency Department; Delirium and Dementia; Falls and Geriatric Trauma; Older Adults in the Emergency Department with Frailty; Communication Strategies to Better Care for Older Individuals in the Emergency Department; Systems-based Practice to Improve Care Within and Beyond the Emergency Department; Common Medication Management Approaches for Older Adults in the Emergency Department; Elder Abuse and Neglect; Care of those with end-of-life needs / Advanced illnesses in the Emergency Department; Behavioral Health Needs of Older Adults in the Emergency Department; and Pain Management Strategies for Older Adults.