Geriatric Emergency Medicine

Summary

More older people in Ireland, than ever before, are attending our emergency departments and healthcare services. Irish Central Statistics Office data shows that the population aged 65 years and is increasing. Nowadays, it is not uncommon for hospitals catering for unscheduled care to have over 50% of their bed days accounted for by patients over the age of 65. These trends are in line with international figures. The British Geriatric Society has acknowledged the pressing need to address how older people are cared for over the first 72 hours of an emergency admission.

Attending hospital is associated with risk for older patients. Admission rates are higher for older people: whereas for patients attending an ED aged 50 or less there is an approximately 20% observed admission rate, for patients over 75 in some areas this increases to over 50%.

Older patients also stay in hospital longer than other patient groups. Many of these older patients suffer from complex comorbidities, frailty and are at high risk of adverse outcomes (including sepsis and pharmacological adverse events, but also delirium, falls as well as general deconditioning).

Working with frail older patients can be difficult for those working in emergency medicine; however, as our demographics change, it is becoming a more and more important part of our everyday work.

This course introduces participants to the key concepts involved in delivering high-quality emergency care for the older adult. The course is delivered as a series of small group interactive workshops delivered by a combination of consultants in geriatric medicine and geriatric emergency medicine.

Course overview

Topics covered in this course include:

  • Confusion – a pragmatic approach in the ED
  • Older persons trauma care
  • What is frailty?
  • Communicating with patients and families
  • Managing aggression and agitation in the ED
  • Changes in physiology and pharmacology in older age
  • What can my patient do? Simple functional assessment
  • Wound management and pressure sores in fragile older skin
  • Falls in the ED
  • Managing challenging behaviour
  • Getting care right at the end of life

Learning outcomes

  • Understand and recognise frailty and its significance in prognosis and clinical decision making.
  • Identify triggers for delirium in older patients.
  • Develop a knowledge of the key physiological and pharmacological changes for the older patient.
  • Enhance safe discharge decision making by learning simple functional assessment strategies.
  • Develop an approach to recognise and manage end of life care.

Suitable for: SHOs and registrars in emergency medicine, general medicine, general surgery, orthopaedics and trauma