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Learning Objectives
Geriatric emergency medicine has emerged internationally as a subspecialty with fellowship training, resident core competencies, guidelines, and research priorities for patient-centered transdisciplinary care.
Resources such as the Geriatric Emergency Department Collaborative exist to share innovations around older adult-appropriate health care during times of emergency.
The components of age-friendly emergency care include infrastructural modifications and protocols focused on geriatric syndromes such as delirium, dementia, and falls.
While some geriatric screening such as vulnerability assessment currently lacks acceptable accuracy or obvious actionable next steps, a pragmatic approach emphasizes continued assessment for common older adult syndromes while concurrently ongoing research strives to improve prognostic accuracy and efficacy.
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Key Clinical Points
Delirium, predominantly hypoactive delirium, is frequently encountered in geriatric emergency care, and multiple screening instruments for this cognitive disorder have been validated in emergency department (ED) settings.
Possible dementia frequently coexists with delirium, but is also identified without delirium in up to one-third of older adults when evaluated in the ED using valid screening instruments.
Elder abuse is a hidden epidemic impacting up to 10% of older adults in the ED—but usually unrecognized without coordinated communication between social work, nursing, physicians, and law enforcement.
Falls and injurious falls are a threat to many older adults following an episode of emergency care, and effective fall prevention requires coordination between emergency medicine, physiotherapy, pharmacology, home health, and primary care.
Multiple measures exist to predict post-ED vulnerability to adverse outcomes, such as preventable returns or functional decline, but currently lack sufficient accuracy to identify either high-risk or low-risk subsets.
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As populations worldwide age, older adults seek emergency care with increasing frequency. Based on current population projections in the United States, the number of individuals over age 65 will more than double while those over age 85 will triple by 2060. Emergency departments (EDs) already functioning as society’s health care safety net will evaluate and disposition more complex older adults than in prior decades, often serving as the front porch of the hospital with expectations to cost-effectively manage admission rates and maintain patient flow. Unfortunately, the rapid evaluation model of emergency medicine that generally serves younger populations efficiently (Figure 15-1A), is an ineffective model for geriatric emergency care (Figure 15-1B). Recognizing this demographic shift, emergency medicine and geriatric professional societies responded over the past decade with core competencies for emergency medicine residency trainees, clinical practice guidelines, and pragmatic quality indicators.
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The aforementioned Geriatric Emergency Department Guidelines, endorsed by the American College of Emergency Physicians (ACEP), American Geriatrics Society, and Society for Academic Emergency Medicine in 2013, provided the requisite framework for ACEP’s Geriatric Emergency Department Accreditation ...