E4. Geriatric ED

Question 1

What are negative effects OA may experience in the ED?

Answer 1

Busy, crowded emer- gency departments (ED). While in the ED, they may experience prolonged lengths of stay, iatrogenic infections, misdiagnosis, delirium, bedsores and other adverse consequences.

Question 2

What are 4 differences from younger peresons that may make the ED a different experience for OA?

Answer 2

more likely to receive a greater number of diagnostic tests and treatment regimens, have longer lengths of stay, and often have multiple hospital admissions

Question 3

Name 4 geriatric education guideline contents

Answer 3

Atypical presentations of disease
Trauma, including falls and hip fracture
Cognitive and behavioral disorders
Modifications of emergent interventions for older patients Medication management
Transitions of care and referrals to services
Pain management and palliative care
Effects of comorbid conditions
Functional impairments and disorders

Management of diseases peculiar to the geriatric adult:
Abdominal pain
Weakness and dizziness
Iatrogenic injuries
Cross-cultural issues involving older patients in the emergency setting Elder abuse and neglect
Ethical issues, including advance directives

Question 4

What are 3 recommended physical space and equipment pieces for geri ED?

Answer 4

development of a GED should adapt the physical space with struc- tural modifications and introduce and utilize equipment and supplies designed for the safe, comfortable, and effective evaluation and man- agement of geriatric patients while decreasing iatrogenic complica- tions. Enhancements that address issues of mobility, comfort, safety, and behavioral needs (including memory cues and sensory perception of vision and hearing) are desirable.

reclining examination chairs that facilitate safe transferring, thick and soft gurney mattresses (or if feasible, pressure-redistributing foam mattresses) designed to decrease the risk of pressure ulcers

Upholstery choices would preferably be soft, moisture-proof, easy to clean, and designed to protect fragile skin while retaining the ability to reduce contamination by hospital-associated pathogens.

Special equip- ment for GEDs should include blanket warmers, nonslip fall mats, bedside commodes, walking aids and devices, hearing aids, and con- dom catheters to reduce the risk of catheter-associated urinary tract infections.

Visual orientation improvements include soft lighting, with a com- bination of ambient and indirect lighting, designed to increase over- all lighting while reducing glare. Patients should have control of the lighting in their respective rooms.

Acoustic orientation improvements will provide better commu- nication and decreased levels of anxiety and delirium.

Question 5

What are 4 key components of improved geri ED care?

Answer 5

equipment and supplies
f/u and trnasition of care
policies procedures and protocols
education
QI measures
staffing and admin - omprised of a multidisciplinary team of care providers who have specific geriatric training and education to focus on high-quality geriatric care. These include a GED medical director, GED nurse manager, staff physicians and nurses, and medical staff specialists (including a geriatric consul- tation service) who can provide accessibility to ancillary services (e.g., social workers, geriatric case managers, pharmacists, physical and occupational therapists)

Question 6

For which of the following outcomes are hospitalized elders at increased risk?
a. Infections
b. Delirium
c. Functional decline d. Iatrogenic injuries e. All of the above

Answer 6

e

Question 7

The Geriatric ED (GED) Guidelines developed by ACEP, SAEM, AGS, and ENA make recommendations in all of the following areas except:
a. Education and patient care protocols
b. Proper technique for central line placement c. Quality improvement measures
d. Staffing, supplies, and administration
e. Follow-up and transitions of care

Answer 7

b

Question 8

The GED guidelines recommend elder-specific educational content in all of the following areas except:
a. Atypical presentations of disease
b. Cognitive and behavioral disorders
c. Psychotherapy for adjustment disorders

Answer 8

c

Question 9

ED consultation from which of the following interdisciplinary ser- vices has been shown to decrease the likelihood of an elder return- ing to the ED with a fall within 30 days?
a. Pharmacy
b. Social work
c. Casemanagement
d. Physical therapy
e. Occupationaltherapy

Answer 9

d

Question 10

Which of the following core content areas is not a component of
geriatric emergency medicine education?
a. Elderly trauma, including falls and hip fracture b. Myocardial infarction
c. Cognitive and behavioral disorders
d. Medication management
e. Transitions of careb

Answer 10

b