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Geriatric Emergency

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https://www.readbyqxmd.com/read/28422904/a-comparison-of-prognosis-calculators-for-geriatric-trauma-a-p-a-l-li-a-t-e-consortium-study
#1
Tarik D Madni, Akpofure Peter Ekeh, Scott C Brakenridge, Karen J Brasel, Bellal Joseph, Kenji Inaba, Brandon R Bruns, Jeffrey D Kerby, Joseph Cuschieri, M Jane Mohler, Paul A Nakonezny, Audra Clark, Jonathan Imran, Steven E Wolf, M Elizabeth Paulk, Ramona L Rhodes, Herb A Phelan
BACKGROUND: The nine-center PALLIATE consortium has validated the Geriatric Trauma Outcome Score (GTOS) as a prognosis calculator for injured elders. We compared GTOS' performance to that of the Trauma Injury Severity Score (TRISS) in a multicenter sample. METHODS: Three PALLIATE centers not submitting subjects to the GTOS validation study identified subjects aged 65 to 102 yrs admitted from 2000-2013. GTOS was specified using the formula [GTOS = age + (ISS x 2...
April 18, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28422415/impact-of-hospitalization-in-an-acute-geriatric-unit-on-polypharmacy-and-potentially-inappropriate-prescriptions-a-retrospective-study
#2
Marta Gutiérrez-Valencia, Mikel Izquierdo, Vincenzo Malafarina, Javier Alonso-Renedo, Belén González-Glaría, Beatriz Larrayoz-Sola, María Pilar Monforte-Gasque, Pello Latasa-Zamalloa, Nicolás Martínez-Velilla
AIM: Polypharmacy is a highly prevalent geriatric syndrome, and hospitalizations can worsen it. The aim of the present study was to analyze the influence of hospitalization on polypharmacy and indicators of quality of prescribing, and their possible association with health outcomes. METHODS: A retrospective study of 200 patients discharged from an acute geriatric unit was carried out. Indicators of quality of prescription were registered at admission and discharge: polypharmacy defined as ≥5 medications, hyperpolypharmacy (≥10), potentially inappropriate prescribing by Beers and Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria, potentially prescribing omissions by Screening Tool to Alert doctors to the Right Treatment (START) criteria, drug interactions and anticholinergic burden measured with the Anticholinergic Risk Scale...
April 19, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28399219/a-multidisciplinary-intervention-to-prevent-subsequent-falls-and-health-service-use-following-fall-related-paramedic-care-a-randomised-controlled-trial
#3
A Stefanie Mikolaizak, Stephen R Lord, Anne Tiedemann, Paul Simpson, Gideon A Caplan, Jason Bendall, Kirsten Howard, Lyndell Webster, Narelle Payne, Sarah Hamilton, Joanne Lo, Elisabeth Ramsay, Sandra O'Rourke, Linda Roylance, J C Close
Background: approximately 25% of older people who fall and receive paramedic care are not subsequently transported to an emergency department (ED). These people are at high risk of future falls, unplanned healthcare use and poor health outcomes. Objective: to evaluate the impact of a fall-risk assessment and tailored fall prevention interventions among older community-dwellers not transported to ED following a fall on subsequent falls and health service use. Design, setting, participants: Randomised controlled trial involving 221 non-transported older fallers from Sydney, Australia...
March 1, 2017: Age and Ageing
https://www.readbyqxmd.com/read/28398987/predicting-risk-and-outcomes-for-frail-older-adults-an-umbrella-review-of-frailty-screening-tools
#4
João Apóstolo, Richard Cooke, Elzbieta Bobrowicz-Campos, Silvina Santana, Maura Marcucci, Antonio Cano, Miriam Vollenbroek-Hutten, Federico Germini, Carol Holland
BACKGROUND: A scoping search identified systematic reviews on diagnostic accuracy and predictive ability of frailty measures in older adults. In most cases, research was confined to specific assessment measures related to a specific clinical model. OBJECTIVES: To summarize the best available evidence from systematic reviews in relation to reliability, validity, diagnostic accuracy and predictive ability of frailty measures in older adults. INCLUSION CRITERIA POPULATION: Older adults aged 60 years or older recruited from community, primary care, long-term residential care and hospitals...
April 2017: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/28390405/fam-face-sg-a-score-for-risk-stratification-of-frequent-hospital-admitters
#5
Lian Leng Low, Nan Liu, Kheng Hock Lee, Marcus Eng Hock Ong, Sijia Wang, Xuan Jing, Julian Thumboo
BACKGROUND: An accurate risk stratification tool is critical in identifying patients who are at high risk of frequent hospital readmissions. While 30-day hospital readmissions have been widely studied, there is increasing interest in identifying potential high-cost users or frequent hospital admitters. In this study, we aimed to derive and validate a risk stratification tool to predict frequent hospital admitters. METHODS: We conducted a retrospective cohort study using the readily available clinical and administrative data from the electronic health records of a tertiary hospital in Singapore...
April 8, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28388818/enhancing-quality-of-provider-practices-for-older-adults-in-the-emergency-department-equipped
#6
Melissa Stevens, Susan N Hastings, Alayne D Markland, Ula Hwang, William Hung, Ann E Vandenberg, William Bryan, Dewayne Cross, James Powers, Gerald McGwin, Noor Fattouh, William Ho, Carolyn Clevenger, Camille P Vaughan
EQUiPPED is a multicomponent quality improvement initiative combining education, electronic clinical decision support, and individual provider feedback to influence prescribing and improve medication safety for older adults. The objective here was to evaluate the effectiveness and sustainability of EQUiPPED to reduce the use of potentially inappropriate medications (PIMs), as defined by the American Geriatrics Society 2012 Beers Criteria, prescribed to older Veterans at the time of emergency department (ED) discharge...
April 7, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28367005/a-multidisciplinary-approach-to-improve-the-quality-of-care-for-patients-with-fragility-fractures
#7
Laura C Lamb, Stephanie C Montgomery, Brian Wong Won, Siobhan Harder, Jeffrey Meter, James M Feeney
BACKGROUND: Fragility fractures have become a worldwide epidemic associated with significant morbidity and mortality. As the world population ages, the number of patients that experience these fractures is also expected to rise. A multidisciplinary team was assembled that was coordinated by the Acute Inpatient Medical Service and included orthopedic surgeons, geriatricians, anesthesiologists, cardiologists, nurses, trauma surgeons, emergency medicine physicians, physiatrists, and physical therapists...
June 2017: Journal of Orthopaedics
https://www.readbyqxmd.com/read/28360515/a-review-of-general-pain-measurement-tools-and-instruments-for-consideration-of-use-in-copd-clinical-practice
#8
REVIEW
Alisha Maree Johnson, Sheree Ms Smith
BACKGROUND: The experience of pain can have a significant impact on the everyday life of individuals including those with COPD. Recently, pain has emerged as an area in COPD research. When considering pain measurement in COPD studies, it is important to consider the validity, reliability, responsiveness and interpretability of instruments and tools. This review sought to assess these domains of general pain instruments and tools using the consensus-based standards for the selection of health measurement instruments (COSMIN)...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28358972/nurse-patient-and-care-partner-perceptions-of-a-personalized-safety-plan-screensaver
#9
Megan Duckworth, Emily Leung, Theresa Fuller, Jenzel Espares, Brittany Couture, Frank Chang, Alexandra C Businger, Sarah Collins, Anuj Dalal, Anne Fladger, Jeffrey L Schnipper, Kumiko O Schnock, David W Bates, Patricia C Dykes
A patient safety plan dashboard was developed that captures disparate data from the electronic health record that is then displayed as a personalized bedside screensaver. The dashboard aligns all care team members, including patients and families, in the safety plan. The screensaver content includes icons that pertain to common geriatric syndromes. In two phases, interviews were conducted with nurses, nursing assistants, patients, and informal caregivers in a large, tertiary care center. End user perceptions of the content and interface of the personalized safety plan screensavers were identified and strategies to overcome the barriers to use for future iterations were defined...
April 1, 2017: Journal of Gerontological Nursing
https://www.readbyqxmd.com/read/28358232/medical-parole-and-aging-prisoners
#10
George Pro, Miesha Marzell
The population of geriatric prisoners in the United States will reach unprecedented levels in the coming decades. Geriatric prisoners are at increased risk for deteriorating health and experience the onset of disease earlier than the aging population at large. Medical parole is an underutilized program that allows aging prisoners to transition to community-based health care. This article presents original key informant interview data and analysis of the perceptions of medical parole. Three dominant themes emerged: (1) drugs and nonviolent crimes; (2) politics, costs, and consequences; and (3) quality of health care and sense of security in prison...
January 1, 2017: Journal of Correctional Health Care
https://www.readbyqxmd.com/read/28350254/career-dreams-among-health-care-students-i-want-to-make-a-difference
#11
Inge Øster, Karen Pallesgaard Munk, Jette Henriksen
There is a continuous increase in demand for health services in most countries, because older people are living longer. Older people's health care is not, generally, an attractive career option for undergraduate health professionals. This study investigated career dreams among undergraduates studying a variety of health care subjects in order to understand what motivates them. Eighteen focus groups were conducted with 90 students, and template analysis was performed within a sociological framework. Four themes emerged from the analysis: no plans to work with older people; dreaming of making a difference; seeking variety; and the impact of clinical placements on stimulating or reducing interest in working with older people...
March 28, 2017: Gerontology & Geriatrics Education
https://www.readbyqxmd.com/read/28340250/improving-safety-culture-in-hospitals-facilitators-and-barriers-to-implementation-of-systemic-falls-investigative-method-sfim
#12
Aleksandra A Zecevic, Alvin Ho-Ting Li, Charity Ngo, Michelle Halligan, Anita Kothari
Objective: The purpose of this study was to assess the facilitators and barriers to implementation of the Systemic Falls Investigative Method (SFIM) on selected hospital units. Design: A cross-sectional explanatory mixed methods design was used to converge results from a standardized safety culture survey with themes that emerged from interviews and focus groups. Findings were organized by six elements of the Ottawa Model of Research Use framework. Setting: A geriatric rehabilitation unit of an acute care hospital and a neurological unit of a rehabilitation hospital were selected purposefully due to the high frequency of falls...
March 17, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/28338866/the-growing-challenge-of-major-trauma-in-older-people-a-role-for-comprehensive-geriatric-assessment
#13
James Michael Fisher, Charlotte Bates, Jay Banerjee
In this commentary article, we describe the impact that an ageing population is having on the nature of major trauma seen in emergency departments. The proportion of major trauma victims who are older people is rapidly increasing and a fall from standing is now the most common mechanism of injury in major trauma. Potential barriers to effective care of this patient group are highlighted, including: a lack of consensus regarding triage criteria; potentially misleading physiological parameters within triage criteria; non-linear patient presentations and diagnostic nihilism...
March 10, 2017: Age and Ageing
https://www.readbyqxmd.com/read/28331248/prevalence-and-predictors-of-depression-in-community-dwelling-elderly-in-rural-haryana-india
#14
Manju Pilania, Mohan Bairwa, Hitesh Khurana, Neelam Kumar
BACKGROUND: Depression in the elderly has been emerged as a serious public health challenge in the developing countries. Elderly population with depression is on rise in India, but is not adequately addressed. This study was planned to ascertain the prevalence of depression among elderly in a rural population of Haryana and assess its socio-demographic correlates. METHODS: This study was a community based, cross sectional study, which was conducted in Community Health Centre (CHC), Chiri of Rohtak district (Haryana, India)...
January 2017: Indian Journal of Community Medicine
https://www.readbyqxmd.com/read/28330452/a-structure-process-and-outcome-evaluation-of-the-geriatric-emergency-department-intervention-model-of-care-a-study-protocol
#15
Elizabeth Marsden, Andrea Taylor, Marianne Wallis, Alison Craswell, Marc Broadbent, Adrian Barnett, Kim-Huong Nguyen, Julia Crilly, Colleen Johnston, Amanda Glenwright
BACKGROUND: Emergency departments are chaotic environments in which complex, frail older persons living in the community and residential aged care facilities are sometimes subjected to prolonged emergency department lengths of stay, excessive tests and iatrogenic complications. Given the ageing population, the importance of providing appropriate, quality health care in the emergency department for this cohort is paramount. One possible solution, a nurse-led, physician-championed, emergency department gerontological intervention team, which provides frontload assessment, early collateral communication and appropriate discharge planning, has been developed...
March 23, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28325586/-prognostic-indices-for-older-adults-during-the-year-following-hospitalization-in-an-acute-medical-ward-an-update
#16
Josephine Thomazeau, Samantha Huo Yung Kai, Yves Rolland, Sandrine Sourdet, Nicolas Saffon, Fati Nourhashemi
CONTEXT: As population grow older, chronic diseases are more prevalent. It leads to an increase of hospitalization for acute decompensation, sometimes iterative. Management of these patients is not always clear, and care provided is not always proportional to life expectancy. Making decisions in acute situations is not easy. OBJECTIVE: This review aims to list and describe mortality scores within a year following hospitalization of patients of 65 years or older...
March 18, 2017: La Presse Médicale
https://www.readbyqxmd.com/read/28302750/the-clinical-frailty-scale-upgrade-your-eyeball-test
#17
Jonathan Afilalo
With the emergence of transcatheter aortic valve replacement (TAVR) as a therapeutic option to treat high-risk older adults suffering from aortic stenosis, the geriatric concept of frailty has assumed mainstream relevance for cardiovascular practitioners. We have eagerly adopted tools to objectify the definition of frailty and accordingly discern good and bad candidates among a pool of complex octogenarians with multiple chronic conditions - a daunting yet mission-critical task. Initial studies published during the first half of this decade revealed that frailty status was one of the top predictors of mid-term mortality and incident disability after TAVR1, leading to its integration in clinical care pathways and predictive risk models...
March 16, 2017: Circulation
https://www.readbyqxmd.com/read/28302066/geriatric-support-in-the-emergency-department-a-national-survey-in-belgium
#18
Els Devriendt, Isabelle De Brauwer, Lies Vandersaenen, Pieter Heeren, Simon Conroy, Benoit Boland, Johan Flamaing, Marc Sabbe, Koen Milisen
BACKGROUND: Older people in the emergency department (ED) represent a growing population and increasing proportion of the workload in the ED. This study investigated the support for frail older people in the ED, by exploring the collaboration between the geriatric services (GS) and the EDs in Belgian hospitals. METHODS: An electronic cross-sectional survey in all Belgian hospitals with an ED (n = 100) about care aspects, collaboration, education and infrastructure for older patients in the ED was collected...
March 16, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28279073/end-of-life-care-and-discussions-in-japanese-geriatric-health-service-facilities
#19
Asako Kanoh, Yoshiyuki Kizawa, Satoru Tsuneto, Shoji Yokoya
BACKGROUND: Geriatric health service facilities (GHSFs) play important roles as intermediate care facilities for elderly individuals temporarily when they need rehabilitation before returning home. However, the number of residents spending their end-of-life (EOL) period in such facilities is increasing. To improve the quality of EOL care, end-of-life discussions (EOLDs) are recommended by some guidelines and studies. AIM: This study aimed to clarify the current practice of EOL care and EOLDs in GHSFs in Japan...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28266338/vocally-disruptive-behaviors-management-in-older-people-with-dementia
#20
Caroline Berastegui, Emmanuel Monfort, Bertrand Boudin
Although shouting is a common psycho-behavioral symptom in geriatric institutions, the question of its assessment and treatment remains seldom studied and has rarely been the subject of specific recommendations. The combination of the focus group method and brainstorming has emerged as a methodology both relevant and feasible in geriatric facility to identify the coping strategies used by professionals and generalize guidelines for clinical observation and vocally disruptive behaviors management (shouting)...
March 1, 2017: Gériatrie et Psychologie Neuropsychiatrie du Vieillissement
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