II. Epidemiology

  1. Adverse events occur in 6% of patients over age 65
    1. Twice the rate of all patients
    2. Brennan (2004) Qual Saf Health Care 13:145 [PubMed]
  2. Adverse events in the elderly
    1. Drug event (15%)
    2. Pressure Ulcer (13-23%)
    3. Functional loss (33%)
    4. Delirium (9-56%)
    5. Malnutrition (75%)
    6. Rothschild (2000) Arch Intern Med 160:2717 [PubMed]

III. Evaluation: Factors that affect poor outcome

  1. Cognitive Function
    1. Clock Drawing Test with 3 item recall
  2. Mobility
    1. Get Up and Go Test
  3. Activities of Daily Living
    1. See Activities of Daily Living
  4. Nutrition (involve dietician early)
    1. BMI <20
    2. Weight loss >10 pounds in 6 months
    3. Cachexia
    4. Albumin <3.0 mg/dl

IV. Disposition: Safety for Discharge Home from Emergency Department or Hospital

  1. Functional
    1. Activities of Daily Living (ADLs)
    2. Fall Risk
    3. Medication Compliance
  2. Social
    1. Community support
    2. Chain of emergency contacts and support
  3. Cognitive
    1. Dementia or Delirium
    2. Confusion Assessment Method
  4. Medical
    1. Seriousness of acute complaint
    2. Risk of short-term decompensation of chronic comorbidity
  5. References
    1. http://boringem.org/2015/01/12/approach-to-geriatric-patients/

V. Prevention: Five steps to improve safety and quality

  1. Address Advance Directives
  2. Careful drug prescribing
    1. See Medications to Avoid in Older Adults: Beer's List
    2. See Polypharmacy
  3. Reconcile medications
    1. Verify admission list for accuracy
    2. Assess medication doses, indications, stop dates
    3. Discharge summary clearly reconcile medications
      1. Admitting medications listed in PMH
      2. Discharge medication list should be clear
        1. Was the drug new, continued, stopped, changed?
        2. Date for re-evaluation or stopping
        3. Medication indication
  4. Address for Delirium
    1. See Delirium
  5. Minimize functional loss
    1. Reduce use of restraints and catheters
    2. Keep patients moving
      1. Consult occupational and physical therapy early
      2. Muscle Strength loss is 5% per day with non-use
    3. Reduce use of psychoactive drugs
      1. See Medications to Avoid in Older Adults

VI. References

  1. AA Borrud (Fall, 2005) Mayo Geriatric Update Lecture

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