Geriatric Emergency Medicine by Sue Mason
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, but 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.
Moreover, 50% of these patients are admitted.
Attendance and admissions in the elderly age group are both going up. What are we doing about it?
Prehospital care has led the way with significant advances. For example, paramedics have been trained to assess and manage 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. However, this needs to be 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.
How can we do it better? Should we be training emergency physicians in Geriatric Medicine? Should there 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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