Tuesday, October 20, 2015

Paciente geriátrico

emDocs - October 20, 2015 - Authors: Lo A, Booth K, Hwang U
Edited by: Koyfman A & Bright J.
  • Look for atypical presentations of common medical conditions
  • Avoid admitting to hospital simply because of their age, as unwarranted hospitalization CAN be harmful to the patient’s subsequent function, mobility, and quality of life
  • Know your own biases: older adults are a source of stress in EPs; >75% recognize the need to improve quality of care
    • 22% of ED admits are potentially avoidable
    • 50% of ED admits are for non-clinical reasons
  • Address unmet social needs as these are highly responsible for ED returns – ask ED social worker or case manager for help
  • Screen for geriatric syndromes to identify older adults at high risk for adverse events
    • Delirium (abnormal RASS score) predicts increased mortality at 6 months
    • Dementia is unrecognized in the ED up to 70% of the time
    • Elder abuse and neglect may have subtle signs/symptoms
    • Two mechanical falls in a given year indicates an increased risk of adverse events
    • Declines in mobility (e.g. walking speed) is associated with increased hospitalization or mortality
  • Potentially Inappropriate Medications (PIMs)"