Principles of Geriatric EM Care

With Paul Dekoning and Lauren Bailey

Christina Shenvi

The Greatest Generation. There’s a reason the oldest patients in our Emergency Departments have earned this title. They’re resilient, stoic, and sometimes even sneaky. They’re our absolute favorite patients to care for. And if your ED is anything like ours, there are days where it seems like the average age in the department is over 75. In this episode, Paul Dekoning, MD, and Lauren Bailey, MD, PhD discuss some of the unique aspects of geriatric emergency care, how they present (and how they don’t), as well as some tips and tricks we’ve learned along the way. While some of these tips may seem tongue-and-cheek, we’ve found them to be reliable and easy to remember. Listen for ideas, wit, and wisdom you can use on your next shift.

References

  • Shenvi, Christina L.; Platts-Mills, Timothy F. Managing the Elderly Emergency Department Patient. Ann Emerg Med 2019. 3:73;302-307.
  • Kizer, Kenneth W; Vassar, Mary J. Emergency department diagnosis of abdominal disorders in the elderly. Am J Emerg Med 1998. 4:16; 357-362.
  • Martinez, Joseph P.; Mattu, Amal. Abdominal Pain in the Elderly. Emergency Medicine Clinics of North America 2006. 2:24; 371-388.
  • Lewis, L. M.; Banet, G. A.; Blanda, M, et al. Etiology and Clinical Course of Abdominal Pain in Senior Patients: A Prospective, Multicenter Study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2005. 8:60; 1071-1076.
  • Potts, F. E.; Vukov, L. F.  Utility of Fever and Leukocytosis in Acute Surgical Abdomens in Octogenarians and Beyond. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 1999. 2:54; M55-M58.
  • Heffernan, Daithi S.; Thakkar, Rajan K.; Monaghan, Sean F, et al. Normal Presenting Vital Signs Are Unreliable in Geriatric Blunt Trauma Victims. The Journal of Trauma: Injury, Infection, and Critical Care 2010. 4:69;813-820.
  • Carpenter, Christopher R.; Bromley, Marilyn; Caterino, Jeffrey M., et al. Optimal Older Adult Emergency Care: Introducing Multidisciplinary Geriatric Emergency Department Guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine. Journal of the American Geriatrics Society 2014. 7:62;1360-1363.
  • Brieger, David; Eagle, Kim A.; Goodman, Shaun G., et al. Acute Coronary Syndromes Without Chest Pain, An Underdiagnosed and Undertreated High-Risk Group.       Chest 2004. 2:126; 461-469.
  • Ichwan, Brian; Darbha, Subrahmanyam; Shah, Manish N., et al. Geriatric-Specific Triage Criteria Are More Sensitive Than Standard Adult Criteria in Identifying Need for Trauma Center Care in Injured Older Adults. Ann Emerg Med 2015. 1:65; 92-100.
  • Platts-Mills, Timothy F.; Evans, Christopher S.; Brice, Jane H. Prehospital Triage of Injured Older Adults: Thinking Slow Inside the Golden Hour. Journal of the American Geriatrics Society 2016. 10:64;1941-1943.
  • Cannon, Austin R.; Lin, Li; Lytle, Barbara; et al. Use of Prehospital 12-Lead Electrocardiography and Treatment Times Among ST-Elevation Myocardial Infarction Patients With Atypical Symptoms. Acad Emerg Med 2014. 8:21;892-898.
  • Salottolo, Kristin M; Mains, Charles W; Offner, Patrick J; et al. A retrospective analysis of geriatric trauma patients: venous lactate is a better predictor of mortality than traditional vital signs. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013. 1:21;7.
  • Perdue, P. W.; Watts, D. D.; Kaufmann, C. R.; Trask, A. L. Differences in mortality between elderly and younger adult trauma patients: geriatric status increases risk of delayed death. The Journal of Trauma 1998. 4:45;805-810.
  • Acierno, Ron; Hernandez, Melba A.; Amstadter, Ananda B.; et al. Prevalence and Correlates of Emotional, Physical, Sexual, and Financial Abuse and Potential Neglect in the United States: The National Elder Mistreatment Study. Am J Pub Health 2010. 2:100; 292-297.
  • Platts-Mills, Timothy F.; Dayaa, Joseph A.; Reeve, Bryce B.; et al. Development of the Emergency Department Senior Abuse Identification (ED Senior AID) tool; Journal of Elder Abuse & Neglect 2018. 4:30;247-270.
  • Stevens, Tarshona B.; Richmond, Natalie L.; Pereira, Gregory F.; Shenvi, Christina L.; Platts-Mills, Timothy F. Prevalence of Nonmedical Problems Among Older Adults Presenting to the Emergency Department. Acad Emerg Med 2014. 6:21; 651-658.

Image credit: Adobe licensed stock photo

This podcast uses sounds from freesound.org by HerbertBoland 

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Hosted by

Christina Shenvi

MD, PhD, FACEP
Bio

Dr. Christina Shenvi is an associate professor of Emergency Medicine at the University of North Carolina. She is fellowship-trained in Geriatric Emergency Medicine and is the founder of GEMCast. She is the director of the UNC Office of Academic Excellence, president of the Association of Professional Women in Medical Sciences, co-directs the ACEP/CORD Teaching Fellowship, is on the Annals of EM editorial board, is on the Geriatric ED Accreditation board of governors, and she teaches and writes about time management at timeforyourlife.org.

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