Geriatric Emergency Medicine: Research Update - Tried and True to Somewhat new

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Geriatric Emergency Medicine Research Update -
Tried and True to Somewhat new
Jacques Lee MD, MSc, FRCPC
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Objectives

• To review existing research literature on
  Geriatric Emergency Medicine
• Tried and (probably) True
• Somewhat New!
• To finish before Christmas!

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GEM Literature Search Methods

• 1. Geriatric.m_titl.
• 2. elder.m_titl.
• 3. older.m_titl.
• 4. senior.m_titl.
• 5. 1 or 2 or 3 or 4

• 6. Emergency.m_titl.
• 7. (accidents and emergencies).m_titl.
• 8. ER.m_titl.
• 9. ED.m_titl.
• 10. 6 or 7 or 8 or 9

11.5 and 10 323 12.Limit English Human 299
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GEM Research Update Tried True

• Important reviews
• Grief et al. J Em Nurse 2003
• Aminzadeh et al. Ann Em Med 2002
• Samaras et al. Ann Em Med 2010

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GEM Research Update Epidemiology Descriptive
Studies

• Older patients
• Higher users of ED
• More Frequently arrive by Ambulance
• More likely to be admitted
• More likely to require Critical Care
• More likely to develop delirium
• More likely to die

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GEM Research Update Epidemiology Descriptive
Studies

• Older patients
• Receive More Tests / More resources
• Have longer ED lengths of stay
• Less likely to understand discharge instructions
• More likely to return for the same problem

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GEM Research Update Epidemiology Descriptive
Studies

• Emergency physicians with
• Less experience
• Less training
• Lower pay
• Higher perceived volume of older patients,
• Associated with higher perceived burden of
  care 6

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GEM Research Update Prediction and Screening

• Good data on clinical prediction tools for use in
  the ED
• ISAR
• TRST
• PERIL

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GEM Research Update Prediction and Screening

• Good data on clinical prediction tools for use in
  the ED
• ISAR
• TRST
• PERIL

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GEM Research Update Prediction and Screening

• Any studies comparing screening tool? 10
• Are screening tools being used? 11

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GEM Research Update Prediction and Screening

• Something New?
• Any studies comparing screening tool? 10
• Are screening tools being used? 11

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GEM Research Update Interventions

• McCusker J, Verdon J. Do geriatric interventions
  reduce emergency department visits? A systematic
  review..

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GEM Research Update Interventions

• Something New?
• Courtney et al.12
• 24 Weeks case management and customized exercise
  program
• Cost Effective ? 13

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GEM Research Update Delirium

• Tried True
• Delirium increases length of stay 14
• Prolonged ED stay increases Delirium
• Delirium is an independent risk factor for
  mortality
• Delirium can takes months to clear and can be
  permanent

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GEM Research Update Delirium

• Something New?
• Genetic markers for delirium predisposition?
• Computerized testing for delirium?

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References

1. Grief CL. Patterns of ED use and perceptions of
   the elderly regarding their emergency care a
   synthesis of recent research. J Emerg Nurs. Apr
   200329(2)122-126.
2. Aminzadeh F, Dalziel WB. Older adults in the
   emergency department a systematic review of
   patterns of use, adverse outcomes, and
   effectiveness of interventions. Ann Emerg Med Mar
   200239(3)238-247
3. Samaras N, Chevalley T, Samaras D, Gold G. Older
   patient in the Emergency Department. Ann Emerg
   Med Sept 21056(3)261-269.
4. Singal BM, Hedges JR, Rousseau E, et al.
   Geriatric patient emergency visits. Part I
   comparison of visits by geriatric and younger
   patients. Ann Emerg Med. 199221802-807.
5. Hedges J, Singal B, Rousseau E. Geriatric patient
   emergency visits. Part II Perceptions of visits
   by geriatric and younger patients. Ann Emerg Med.
   July 199221((7))808-813.

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References

1. Schumacher JG, Deimling GT, Meldon S, Woolard B.
   Older adults in the Emergency Department
   predicting physicians' burden levels. Journal
   of Emergency Medicine. 200630(4)455-60.
2. McCusker J, Bellavance F, Cardin S, Trepanier S,
   Verdon J, Ardman O. Detection of older people at
   increased risk of adverse health outcomes after
   an emergency visit the ISAR screening tool..
   Journal of the American Geriatrics Society.
   199947(10)1229-37.
3. Meldon SW, Mion LC, Palmer RM, Drew BL, Connor
   JT, Lewicki LJ, Bass DM, Emerman CL. A brief
   risk-stratification tool to predict repeat
   emergency department visits and hospitalizations
   in older patients discharged from the emergency
   department.. Acad Emerg Med. 200310(3)224-32.

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References

1. Lee JS, Schwindt G, Langevin M, Moghabghab R,
   Alibhai SM, Kiss A, Naglie G. Validation of the
   triage risk stratification tool to identify older
   persons at risk for hospital admission and
   returning to the emergency department.. JAGS.
   200856(11)2112-7.
2. McCusker J, Verdon J, Veillette N, Berg K, Emond
   T, Belzile E. Standardized screening and
   assessment of older patients in the emergency
   department a survey of implementation in
   Quebec.. Canadian Journal on Aging. 2007 cited
   200726(1)49-57.
3. McCusker J, Verdon J. Do geriatric interventions
   reduce emergency department visits? A systematic
   review. J Geront Series A. 200661(1)53-62.

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References

1. Courtney M, Edwards H, Chang A, Parker A,
   Finlayson K, Hamilton K. Fewer emergency
   readmissions and better quality of life for older
   adults at risk of hospital readmission a
   randomized controlled trial to determine the
   effectiveness of a 24-week exercise and telephone
   follow-up program.. Journal of the American
   Geriatrics Society. 2009 cited 2009
   Mar57(3)395-402.
2. Graves N, Courtney M, Edwards H, Chang A, Parker
   A, Finlayson K. Cost-effectiveness of an
   intervention to reduce emergency re-admissions to
   hospital among older patients.. PLoS ONE E-
   Resource. 20094(10)e7455.
3. McCusker J, Cole MG, Dendukuri N, Belzile E. Does
   Delirium increase hsopital stay? JAGS,
   200351(11)