Sep 12, 2016
Sue Mason gives you her take on Geriatric Emergency Medicine. Sue’s bread and butter is managing the elderly in the Emergency Department. It is not a sexy topic and there are few gizmos and gadgets. Nevertheless, it is very important. How big is the problem? Patients over 65 years represent about a quarter of the patients that attend Sue’s Emergency Department. However, most of these patients arrive by ambulance and the vast majority of visits in this age group are deemed necessary. This culminates with 50% of these patients being admitted. Attendance and admissions in the elderly age group are both going up. What are we doing about it? Advances have been made in prehospital care. In Sue’s region, paramedics have been trained in assessing and managing elderly falls. This found a reduction in ED attendance by 25% and decreased admissions by 6%. Approaching the management of the elderly with a multidisciplinary team has proved to be effective in a ward setting. This has not been replicated in the Emergency Department. Within the ED there is potential for the inclusion of a pharmacist to improve admission rates. However there has not been any other “in department” interventions involving a broader team. The initiation of interventions from the ED to continue in the community has been looked at, although the evidence is mixed. How can we do it better? Sue explores the question of whether all Emergency physicians should be trained in Geriatric Medicine. Or whether there should be sub-specialists in Geriatric Emergency Medicine. She also explores other strategies. Simple things such as not putting elderly patients on beds/trolleys unless clinically indicated and ensuring they have fluids on board. Overriding all decisions should be the question – does this patient need this investigation, treatment, and admission.
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