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Review article: Biomedical intelligence

Vol. 144 No. 4950 (2014)

Can geriatric approaches support the care of old patients in emergency departments? A review from a Swiss ED

  • Andreas W. Schoenenberger
  • Aristomenis K. Exadaktylos
DOI
https://doi.org/10.4414/smw.2014.14040
Cite this as:
Swiss Med Wkly. 2014;144:w14040
Published
30.11.2014

Summary

In the coming decades, old patients will account for an increasing proportion of emergency department (ED) visits. During or after their stay in the ED, they more frequently suffer adverse outcomes than younger patients. There is evidence that specific age-centred approaches improve the outcomes. We therefore reviewed specific conditions needing particular attention in older ED patients, such as cognitive disorders and delirium, impaired mobility and falls, as well as problems related to the activities of daily living, disability, poly-pharmacy, adverse drug effects, co-morbidity and atypical presentation. We also propose steps to further improve the quality of care in older ED patients by using appropriate age-centred management.

References

  1. 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. 2002;39(3):238–47.
  2. Coronado BE, Pope JH, Griffith JL, Beshansky JR, Selker HP. Clinical features, triage, and outcome of patients presenting to the ED with suspected acute coronary syndromes but without pain: a multicenter study. Am J Emerg Med. 2004;22(7):568–74.
  3. Schoenenberger AW, Radovanovic D, Stauffer JC, Windecker S, Urban P, Eberli FR, et al.; Acute Myocardial Infarction in Switzerland Plus Investigators. Age-related differences in the use of guideline-recommended medical and interventional therapies for acute coronary syndromes: a cohort study. J Am Geriatr Soc. 2008;56(3):510–6.
  4. Bingisser R, Nickel CH. The last century of symptom-oriented research in emergency presentations – have we made any progress? Swiss Med Wkly. 2013;143:w13829.
  5. Schoenenberger AW, Bieri C, Ozgüler O, Moser A, Haberkern M, Zimmermann H, et al. A novel multidimensional geriatric screening tool in the ED: evaluation of feasibility and clinical relevance. Am J Emerg Med. 2014;32(6):623–8.
  6. Ellis G, Whitehead MA, O’Neill D, Langhorne P, Robinson D. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2011;(7):CD006211.
  7. Hustey FM, Meldon SW. The prevalence and documentation of impaired mental status in elderly emergency department patients. Ann Emerg Med. 2002;39(3):248–53.
  8. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–22.
  9. Lewis LM, Miller DK, Morley JE, Nork MJ, Lasater LC. Unrecognized delirium in ED geriatric patients. Am J Emerg Med. 1995;13(2):142–5.
  10. Inouye SK, Rushing JT, Foreman MD, Palmer RM, Pompei P. Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. J Gen Intern Med. 1998;13(4):234–42.
  11. Maguire PA, Taylor IC, Stout RW. Elderly patients in acute medical wards: factors predicting length of stay in hospital. Br Med J (Clin Res Ed). 1986;292(6530):1251–3.
  12. Schoenenberger AW, Stortecky S, Neumann S, Moser A, Jüni P, Carrel T, et al. Predictors of functional decline in elderly patients undergoing transcatheter aortic valve implantation (TAVI). Eur Heart J. 2013;34(9):684–92.
  13. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185:914–9.
  14. Wilber ST, Blanda M, Gerson LW. Does functional decline prompt emergency department visits and admission in older patients? Acad Emerg Med. 2006;13(6):680–2.
  15. Caplan GA, Brown A, Croker WD, Doolan J. Risk of admission within 4 weeks of discharge of elderly patients from the emergency department – the DEED study. Discharge of elderly from emergency department. Age Ageing. 1998;27(6):697–702.
  16. Hohl CM, Dankoff J, Colacone A, Afilalo M. Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med. 2001;38(6):666–71.
  17. Chin MH, Wang LC, Jin L, Mulliken R, Walter J, Hayley DC, et al. Appropriateness of medication selection for older persons in an urban academic emergency department. Acad Emerg Med. 1999;6(12):1232–42.
  18. Platts-Mills TF, Travers D, Biese K, McCall B, Kizer S, LaMantia M, et al. Accuracy of the Emergency Severity Index triage instrument for identifying elder emergency department patients receiving an immediate life-saving intervention. Acad Emerg Med. 2010;17(3):238–43.
  19. Carpenter CR, Bassett ER, Fischer GM, Shirshekan J, Galvin JE, Morris JC. Four sensitive screening tools to detect cognitive dysfunction in geriatric emergency department patients: brief Alzheimer’s Screen, Short Blessed Test, Ottawa 3DY, and the caregiver-completed AD8. Acad Emerg Med. 2011;18(4):374–84.
  20. Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H. Validation of a short Orientation-Memory-Concentration Test of cognitive impairment. Am J Psychiatry. 1983;140(6):734–9.
  21. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113(12):941–8.
  22. Grossmann FF, Hasemann W, Graber A, Bingisser R, Kressig RW, Nickel CH. Screening, detection and management of delirium in the emergency department – a pilot study on the feasibility of a new algorithm for use in older emergency department patients: the modified Confusion Assessment Method for the Emergency Department (mCAM-ED). Scand J Trauma Resusc Emerg Med. 2014;22:19.
  23. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–8.
  24. Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J. A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med. 1995;332(20):1338–44.
  25. Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough-Gorr KM. Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ. 2010;340:c1718.
  26. Pfortmueller CA, Kunz M, Lindner G, Zisakis A, Puig S, Exadaktylos AK. Fall-related emergency department admission: fall environment and settings and related injury patterns in 6357 patients with special emphasis on the elderly. ScientificWorldJournal. 2014;2014:256519.
  27. Pfortmueller CA, Lindner G, Exadaktylos AK. Reducing fall risk in the elderly: risk factors and fall prevention, a systematic review. Minerva Med. 2014 May 27. [Epub ahead of print]
  28. Daniel H, Oesch P, Stuck AE, Born S, Bachmann S, Schoenenberger AW. Evaluation of a novel photography-based home assessment protocol for identification of environmental risk factors for falls in elderly persons. Swiss Med Wkly. 2013;143:w13884.
  29. Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46(2):72–83.
  30. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716–24.
  31. Terrell KM, Perkins AJ, Dexter PR, Hui SL, Callahan CM, Miller DK. Computerized decision support to reduce potentially inappropriate prescribing to older emergency department patients: a randomized, controlled trial. J Am Geriatr Soc. 2009;57(8):1388–94.
  32. Grossmann FF, Zumbrunn T, Frauchiger A, Delport K, Bingisser R, Nickel CH. At risk of undertriage? Testing the performance and accuracy of the emergency severity index in older emergency department patients. Ann Emerg Med. 2012;60(3):317–25.
  33. Rutschmann OT, Chevalley T, Zumwald C, Luthy C, Vermeulen B, Sarasin FP. Pitfalls in the emergency department triage of frail elderly patients without specific complaints. Swiss Med Wkly. 2005;135(9–10):145–50.
  34. Rubenstein LZ, Stuck AE. Multidimensional geriatric assessment. In: Principles and Practice of Geriatric Medicine, Fifth Edition. Edited by Sinclair AJ, Morley JE and Vellas B. 2012 John Wiley & Sons.
  35. McCusker J, Bellavance F, Cardin S, Trépanier S, Verdon J, Ardman O. Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc. 1999;47(10):1229–37.
  36. Graf CE, Giannelli SV, Herrmann FR, Sarasin FP, Michel JP, Zekry D, et al. Identification of older patients at risk of unplanned readmission after discharge from the emergency department – comparison of two screening tools. Swiss Med Wkly. 2012;141:w13327.
  37. Goldberg SE, Whittamore KH, Harwood RH, Bradshaw LE, Gladman JR, Jones RG; Medical Crises in Older People Study Group. The prevalence of mental health problems among older adults admitted as an emergency to a general hospital. Age Ageing. 2012;41(1):80–6.
  38. Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166(17):1822–8.
  39. Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc. 2004;52(5):675–84.

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