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      Care of the Older Adult in the Emergency Department: Nurses Views of the Pressing Issues

      , , , ,
      The Gerontologist
      Oxford University Press (OUP)

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          Abstract

          The purpose of the study was to describe nurses' views of the issues to be addressed to improve care of the older adult in the emergency department (ED).

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          Most cited references37

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          Older patients in the emergency department: a review.

          Older patients account for up to a quarter of all emergency department (ED) visits. Atypical clinical presentation of illness, a high prevalence of cognitive disorders, and the presence of multiple comorbidities complicate their evaluation and management. Increased frailty, delayed diagnosis, and greater illness severity contribute to a higher risk of adverse outcomes. This article will review the most common conditions encountered in older patients, including delirium, dementia, falls, and polypharmacy, and suggest simple and efficient strategies for their evaluation and management. It will discuss age-related changes in the signs and symptoms of acute coronary events, abdominal pain, and infection, examine the yield of different diagnostic approaches in this population, and list the underlying medical problems present in half of all "social" admission cases. Complete geriatric assessments are time consuming and beyond the scope of most EDs. We propose a strategy based on the targeting of high-risk patients and provide examples of simple and efficient tools that are appropriate for ED use. Copyright (c) 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
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            MODELS OF GERIATRICS PRACTICE; The Hospital Elder Life Program: A Model of Care to Prevent Cognitive and Functional Decline in Older Hospitalized Patients

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              A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: 'interface geriatrics'.

              many frail older people who attend acute hospital settings and who are discharged home within short periods (up to 72 h) have poor outcomes. This review assessed the role of comprehensive geriatric assessment (CGA) for such people. standard bibliographic databases were searched for high-quality randomised controlled trials (RCTs) of CGA in this setting. When appropriate, intervention effects were presented as rate ratios with 95% confidence intervals. five trials of sufficient quality were included. There was no clear evidence of benefit for CGA interventions in this population in terms of mortality [RR 0.92 (95% CI 0.55-1.52)] or readmissions [RR 0.95 (95% CI 0.83-1.08)] or for subsequent institutionalisation, functional ability, quality-of-life or cognition. there is no clear evidence of benefit for CGA interventions in frail older people being discharged from emergency departments or acute medical units. However, few such trials have been carried out and their overall quality was poor. Further well designed trials are justified.
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                Author and article information

                Journal
                The Gerontologist
                The Gerontologist
                Oxford University Press (OUP)
                0016-9013
                1758-5341
                April 25 2013
                June 01 2013
                February 26 2013
                June 01 2013
                : 53
                : 3
                : 441-453
                Article
                10.1093/geront/gnt004
                3635857
                23442380
                9bdb563e-c3c1-4697-98fb-79c6132f1278
                © 2013
                History

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