Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine.

Publisher: Springer International Publishing Country of Publication: Switzerland NLM ID: 101533694 Publication Model: Print-Electronic Cited Medium: Print ISSN: 1878-7649 (Print) Linking ISSN: 18787649 NLM ISO Abbreviation: Eur Geriatr Med Subsets: MEDLINE

Publication: 2018- : Cham : Springer International Publishing
Original Publication: Issy-les-Moulineaux, Paris : Elsevier Masson SAS

Emergency Medicine* ; Frailty* ; Geriatrics*; Aged ; Emergency Service, Hospital ; Geriatric Assessment ; Humans

Purpose: Despite the rapidly expanding knowledge in the field of Geriatric Emergency Medicine in Europe, widespread implementation of change is still lacking. Many opportunities in everyday clinical care are missed to improve care for this susceptible and growing patient group. The aim was to develop expert clinical recommendations on Geriatric Emergency Medicine to be disseminated across Europe.
Methods: A group of multi-disciplinary experts in the field of Geriatric Emergency Medicine in Europe was assembled. Using a modified Delphi procedure, a prioritized list of topics related to Geriatric Emergency Medicine was created. Next, a multi-disciplinary group of nurses, geriatricians and emergency physicians performed a review of recent guidelines and literature to create recommendations. These recommendations were voted upon by a group of experts and placed on visually attractive posters. The expert group identified the following eight subject areas to develop expert recommendations on: Comprehensive Geriatric Assessment in the Emergency Department (ED), age/frailty adjusted risk stratification, delirium and cognitive impairment, medication reviews in the ED for older adults, family involvement, ED environment, silver trauma, end of life care in the acute setting.
Results: Eight posters with expert clinical recommendations on the most important topics in Geriatric Emergency Medicine are now available through https://posters.geriemeurope.eu/ .
Conclusion: Expert clinical recommendations for Geriatric Emergency Medicine may help to improve care for older patients in the Emergency Department and are ready for dissemination across Europe.
(© 2021. The Author(s), under exclusive licence to European Geriatric Medicine Society.)

Aminzadeh F, Dalziel WB (2002) Older adults in the Emergency Department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med 39(3):238–247. (PMID: 10.1067/mem.2002.121523)
Gruneir A, Silver MJ, Rochon PA (2011) Emergency Department use by older adults: a literature review on trends, appropriateness, and consequences of unmet health care needs. Med Care Res Rev 68(2):131–155. (PMID: 10.1177/1077558710379422)
Schnitker L, Martin-Khan M, Beattie E, Gray L (2011) Negative health outcomes and adverse events in older people attending Emergency Departments: a systematic review. Australas Emerg Nurs 14(3):141–162. (PMID: 10.1016/j.aenj.2011.04.001)
Heeren P et al (2021) Structure and processes of emergency observation units with a geriatric focus: a scoping review. BMC Geriatr 21(1):95. (PMID: 10.1186/s12877-021-02029-9)
La Grouw Y, Bannink D, van Hout H (2020) Care professionals manage the future, frail older persons the past. Explaining why frailty management in primary care doesn’t always work. Front Med (Lausanne) 7:489. (PMID: 10.3389/fmed.2020.00489)
Dent E et al (2019) Management of frailty: opportunities, challenges, and future directions. Lancet 394(10206):1376–1386. (PMID: 10.1016/S0140-6736(19)31785-4)
Hesselink G et al (2020) Effects of a geriatric education program for emergency physicians: a mixed-methods study. Health Educ Res 35(3):216–227. (PMID: 10.1093/her/cyaa007)
Mooijaart SP et al (2019) Geriatric Emergency Medicine: time for a new approach on a European level. Eur J Emerg Med 26(2):75–76. (PMID: 10.1097/MEJ.0000000000000594)
Bellou A, Conroy SP, Graham CA (2016) The European curriculum for Geriatric Emergency Medicine. Eur J Emerg Med 23(4):239. (PMID: 10.1097/MEJ.0000000000000414)
Gladman JR et al (2016) New horizons in the implementation and research of comprehensive geriatric assessment: knowing, doing and the “know-do” gap. Age Ageing 45(2):194–200. (PMID: 10.1093/ageing/afw012)
Preston L et al (2020) Improving outcomes for older people in the Emergency Department: a review of reviews. Emerg Med J. https://doi.org/10.1136/emermed-2020-209514. (PMID: 10.1136/emermed-2020-209514)
McCusker J et al (2018) Elder-friendly Emergency Department: development and validation of a quality assessment tool. J Am Geriatr Soc 66:394–400. (PMID: 10.1111/jgs.15137)
Society BG (2012) Quality care for older people with urgent and emergency care needs—‘Silver Book’. BGS. https://www.bgs.org.uk/resources/resource-series/silver-book-ii.
Sinek S (2009) Start with why. Penguin Books Ltd, London.
American College of Emergency, P et al (2014) Geriatric Emergency Department guidelines. Ann Emerg Med 63(5):e7–e25. (PMID: 10.1016/j.annemergmed.2014.02.008)
Lo AX, Biese K, Carpenter CR (2017) Defining quality and outcome in geriatric emergency care. Ann Emerg Med 70(1):107–109. (PMID: 10.1016/j.annemergmed.2017.03.003)
Terrell KM et al (2009) Quality indicators for geriatric emergency care. Acad Emerg Med 16(5):441–449. (PMID: 10.1111/j.1553-2712.2009.00382.x)
Society BG (2021) Emergency care. Available from: https://www.bgs.org.uk/topics/emergency-care.
Schuster S et al (2020) Quality indicators for a geriatric emergency care (GeriQ-ED)—an evidence-based Delphi consensus approach to improve the care of geriatric patients in the Emergency Department. Scand J Trauma Resusc Emerg Med 28(1):68. (PMID: 10.1186/s13049-020-00756-3)
Carpenter CB, Conroy SJ (2021) Silver book II. British Geriatrics Society.
Nickel CB, Conroy A, S. (2018) Geriatric Emergency Medicine. Springer International Publishing. (PMID: 10.1007/978-3-319-19318-2)
(2019) In: Delirium: prevention, diagnosis and management. London; https://www.nice.org.uk/guidance/cg103.
Dawood M (2020) End of life care in the Emergency Department. Emerg Med J 37(5):273–278.
Carpenter CR et al (2019) Older adult falls in Emergency Medicine: 2019 update. Clin Geriatr Med 35(2):205–219. (PMID: 10.1016/j.cger.2019.01.009)
Hanning J et al (2019) Review article: goals-of-care discussions for adult patients nearing end of life in Emergency Departments: a systematic review. Emerg Med Australas 31(4):525–532. (PMID: 10.1111/1742-6723.13303)
Turner J et al (2015) In: What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review. Southampton (UK): NIHR Journals Library; 2015 Nov.
Crede SH et al (2017) What is the evidence for the management of patients along the pathway from the Emergency Department to acute admission to reduce unplanned attendance and admission? An evidence synthesis. BMC Health Serv Res 17(1):355. (PMID: 10.1186/s12913-017-2299-8)
Mooijaart SP et al (2020) A European Research Agenda for Geriatric Emergency Medicine: a modified Delphi study. Eur Geriatr Med 12:413–422. (PMID: 10.1007/s41999-020-00426-8)
Council ER (2021) ERC guidelines. Available from: https://cprguidelines.eu/#.
Ringer T et al (2018) White paper-Geriatric Emergency Medicine education: current state, challenges, and recommendations to enhance the emergency care of older adults. AEM Educ Train 2(Suppl 1):S5–S16. (PMID: 10.1002/aet2.10205)

Keywords: Acute care; Emergency Medicine; Frailty; Geriatric Emergency Medicine; Geriatrics; Guidelines

Date Created: 20211105 Date Completed: 20220421 Latest Revision: 20220609

20240628

PMC8568564

10.1007/s41999-021-00578-1

34738224