Episode 208: Geriatric Emergency Medicin...

We explore the expanding field of Geriatric Emergency Medicine.

Hosts:
Ula Hwang, MD
Brian Gilberti, MD

Key Topics Discussed

• Importance and impact of geriatric emergency departments.
• Optimizing care strategies for geriatric patients in ED settings.
• Practical approaches for non-geriatric-specific EDs.

Challenges in Geriatric Emergency Care

• Geriatric patients often present with:
  • Multiple chronic conditions
  • Polypharmacy
  • Functional decline (mobility issues, cognitive impairments, social isolation)

Adapting Clinical Approach

• Core objective remains acute issue diagnosis and treatment.
• Additional considerations for geriatric patients:
  • Review and caution with medications to prevent adverse reactions.
  • Address functional limitations and cognitive impairments.
  • Emphasize safe discharge and care transitions to prevent unnecessary hospitalization.

Identifying High-Risk Geriatric Patients

• Screening tools:
  • Identification of Seniors at Risk (ISAR)
  • Frailty screens
• Alignment with the “Age-Friendly Health Systems” initiative focusing on:
  • Mentation
  • Mobility
  • Medications
  • Patient preferences (what matters most)
  • Mistreatment (elder abuse awareness)

Minimizing Hospital-Related Harms

• Involvement of multidisciplinary teams:
  • Social workers and care managers for care transitions
  • Geriatric-certified pharmacists for medication review
• Coordination with outpatient services post-discharge

Implementing Geriatric Care in All EDs

• Basic geriatric care achievable even in resource-limited or rural EDs.
• Level 3 Geriatric ED Accreditation can be achieved through:
  • Improved care transitions
  • Staff education enhancements
  • Age-friendly environments (comfort, nutrition, hydration)

Future of Geriatric Emergency Medicine

• Vision: Universal integration of geriatric-focused care.
• Goals:
  • Enhanced patient experience
  • Improved care transitions
  • Alignment of treatments with patient goals
  • Broader enhancement of emergency care quality for all patient populations