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Pinardi E, Ornago AM, Bianchetti A, Morandi A, Mantovani S, Marengoni A, Colombo M, Arosio B, Okoye C, Cortellaro F, Bellelli G. Optimizing older patient care in emergency departments: a comprehensive survey of current practices and challenges in Northern Italy. BMC Emerg Med 2024; 24:86. [PMID: 38764046 PMCID: PMC11103964 DOI: 10.1186/s12873-024-01004-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/10/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND The progressive aging of the population and the increasing complexity of health issues contribute to a growing number of older individuals seeking emergency care. This study aims to assess the state of the art of care provided to older people in the Emergency Departments of Lombardy, the most populous region in Italy, counting over 2 million people aged 65 years and older. METHODS An online cross-sectional survey was developed and disseminated among emergency medicine physicians and physicians affiliated to the Lombardy section of the Italian Society of Geriatrics and Gerontology (SIGG), during June and July 2023. The questionnaire covered hospital profiles, geriatric consultation practices, risk assessment tools, discharge processes and perspectives on geriatric emergency care. RESULTS In this mixed method research, 219 structured interviews were collected. The majority of physicians were employed in hospitals, with 54.7% being geriatricians. Critical gaps in older patient's care were identified, including the absence of dedicated care pathways, insufficient awareness of screening tools, and a need for enhanced professional training. CONCLUSIONS Tailored protocols and geriatric educational programs are crucial for improving the quality of emergency care provided to older individuals. These measures might also help relieve the burden on the Emergency Departments, thereby potentially enhancing overall efficiency and ensuring better outcomes.
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Affiliation(s)
- Elena Pinardi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy.
| | - Alice Margherita Ornago
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
| | - Angelo Bianchetti
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Medicine and Rehabilitation Department, Istituto Clinico S.Anna Hospital, Gruppo San Donato, Brescia, Italy
| | - Alessandro Morandi
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Intermediate Care and Rehabilitation, Azienda Speciale "Cremona Solidale", Cremona, Italy
- Parc Sanitari Pere Virgili, Vall d'Hebrón Institute of Research, Barcelona, Spain
| | - Stefano Mantovani
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- RSA Don Giuseppe Cuni, Magenta, Italy
| | - Alessandra Marengoni
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Department of Clinical and Experimental Sciences, Geriatric Unit, University of Brescia, Brescia, Italy
| | - Mauro Colombo
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Golgi Cenci Foundation, Abbiategrasso, Italy
| | - Beatrice Arosio
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Chukwuma Okoye
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Acute Geriatrics Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Francesca Cortellaro
- Integrazione Percorsi di Cura Ospedale Territorio, Urgency Emergency Regional Agency (Agenzia Regionale Emergenza Urgenza - AREU), Milan, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Acute Geriatrics Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Southerland LT, Willoughby LR, Lyou J, Goett RR, Markwalter DW, Gorgas DL. Integration of Geriatric Education Within the American Board of Emergency Medicine Model. West J Emerg Med 2024; 25:51-60. [PMID: 38205985 PMCID: PMC10777174 DOI: 10.5811/westjem.60842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/30/2023] [Accepted: 11/03/2023] [Indexed: 01/12/2024] Open
Abstract
Background Emergency medicine (EM) resident training is guided by the American Board of Emergency Medicine Model of the Clinical Practice of Emergency Medicine (EM Model) and the EM Milestones as developed based on the knowledge, skills, and abilities (KSA) list. These are consensus documents developed by a collaborative working group of seven national EM organizations. External experts in geriatric EM also developed competency recommendations for EM residency education in geriatrics, but these are not being taught in many residency programs. Our objective was to evaluate how the geriatric EM competencies integrate/overlap with the EM Model and KSAs to help residency programs include them in their educational curricula. Methods Trained emergency physicians independently mapped the geriatric resident competencies onto the 2019 EM Model items and the 2021 KSAs using Excel spreadsheets. Discrepancies were resolved by an independent reviewer with experience with the EM Model development and resident education, and the final mapping was reviewed by all team members. Results The EM Model included 77% (20/26) of the geriatric competencies. The KSAs included most of the geriatric competencies (81%, 21/26). All but one of the geriatric competencies mapped onto either the EM Model or the KSAs. Within the KSAs, most of the geriatric competencies mapped onto necessary level skills (ranked B, C, D, or E) with only five (8%) also mapping onto advanced skills (ranked A). Conclusion All but one of the geriatric EM competencies mapped to the current EM Model and KSAs. The geriatric competencies correspond to knowledge at all levels of training within the KSAs, from beginner to expert in EM. Educators in EM can use this mapping to integrate the geriatric competencies within their curriculums.
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Affiliation(s)
- Lauren T. Southerland
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| | - Lauren R. Willoughby
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| | - Jason Lyou
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| | - Rebecca R. Goett
- Rutgers New Jersey Medical School, Department of Emergency Medicine, Newark, New Jersey
| | - Daniel W. Markwalter
- University of North Carolina School of Medicine, Department of Emergency Medicine, Chapel Hill, North Carolina
- University of North Carolina School of Medicine, UNC Palliative Care Program, Chapel Hill, North Carolina
| | - Diane L. Gorgas
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
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Warren N, Gordon E, Pearson E, Siskind D, Hilmer SN, Etherton-Beer C, Hanjani LS, Young AM, Reid N, Hubbard RE. A systematic review of frailty education programs for health care professionals. Australas J Ageing 2022; 41:e310-e319. [PMID: 35801297 PMCID: PMC10084012 DOI: 10.1111/ajag.13096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/27/2022] [Accepted: 05/01/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To identify and examine the reported effectiveness of education programs for health professionals on frailty. METHODS A systematic review was conducted of articles published up to June 2021, examining the evaluation of frailty training or education programs targeting health professionals/students. The participant demographics, program content and structure, effectiveness assessment methodology and outcomes, as well as participant feedback, were recorded with narrative synthesis of results. RESULTS There were nine programs that have evaluated training of health professionals in frailty. These programs varied with respect to intensity, duration, and delivery modality, and targeted a range of health professionals and students. The programs were well-received and found to be effective in increasing frailty knowledge and self-perceived competence in frailty assessment. Common features of successful programs included having multidisciplinary participants, delivering a clinically tailored program and using flexible teaching modalities. Of note, many programs assessed self-perceived efficacy rather than objective changes in patient outcomes. CONCLUSIONS Despite increasing attention on frailty in clinical practice, this systematic review found that there continues to be limited reporting of frailty training programs.
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Affiliation(s)
- Nicola Warren
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Metro South Health, Mental Health, Woolloongabba, Queensland, Australia
| | - Emily Gordon
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Geriatrics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Ella Pearson
- School of Biomedical Science, University of Queensland, Brisbane, Queensland, Australia
| | - Dan Siskind
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Metro South Health, Mental Health, Woolloongabba, Queensland, Australia
| | - Sarah N Hilmer
- Kolling Institute, Faculty of Medicine and Health, University of Sydney and Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Christopher Etherton-Beer
- Centre for Health and Ageing, University of Western Australia, Crawley, Western Australia, Australia
| | | | - Adrienne M Young
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Natasha Reid
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ruth E Hubbard
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Geriatrics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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Sir Ö, Hesselink G, Schoon Y, Olde Rikkert MGM. Dutch emergency physicians insufficiently educated in geriatric emergency medicine: results of a nationwide survey. Age Ageing 2021; 50:1997-2003. [PMID: 34673884 PMCID: PMC8581378 DOI: 10.1093/ageing/afab175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Indexed: 11/16/2022] Open
Abstract
Background Emergency physicians (EPs) provide care to older adults with complex health problems. Treating these patients is challenging for many EPs, which might originate from modest geriatric education. Objective Our aim was to assess EPs’ self-perceived needs regarding geriatric emergency medicine (GEM) education, factors determining these needs and the utilization of this education. Our secondary aim was to assess emergency department (ED) managers’ view and support for GEM education. Methods All EPs and ED managers in the Netherlands received a survey by e-mail. The questionnaires focused on EPs’ needs in GEM education, EPs’ utilization of GEM education and managerial support for GEM education. We used descriptive statistics to analyse needs, utilization of- and support for GEM education. Regression analyses were used to identify factors associated with EPs’ need for GEM education. Results EPs reported to need better training in diagnosing, treating and communicating with older adults. Seventy percent of EPs reported no GEM education program in their hospital, and 83% reported no utilization of GEM education outside their hospital. EPs working in EDs with a possibility for geriatric consultation, and EPs aware of actual GEM education programs, had lower educational needs. Of responding managers, 86.2% reported the care for older adults as an important topic; lack of finances and time were obstacles to provide GEM education for EPs. Conclusion EPs in the Netherlands feel insufficiently educated to treat older adults. ED managers largely recognize this educational challenge. This nationwide survey underlines the need to prioritize GEM education for EPs.
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Affiliation(s)
- Özcan Sir
- Radboud University Medical Center, Department of Emergency Medicine, Nijmegen, The Netherlands
| | - Gijs Hesselink
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Health Care, Nijmegen, The Netherlands
| | - Yvonne Schoon
- Radboud University Medical Center, Department of Geriatrics, Nijmegen, The Netherlands
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Lucke JA, Mooijaart SP, Heeren P, Singler K, McNamara R, Gilbert T, Nickel CH, Castejon S, Mitchell A, Mezera V, Van der Linden L, Lim SE, Thaur A, Karamercan MA, Blomaard LC, Dundar ZD, Chueng KY, Islam F, de Groot B, Conroy S. Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine. Eur Geriatr Med 2021; 13:309-317. [PMID: 34738224 PMCID: PMC8568564 DOI: 10.1007/s41999-021-00578-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/20/2021] [Indexed: 01/08/2023]
Abstract
Aim The aim was to develop expert clinical recommendations on Geriatric Emergency Medicine to be disseminated across Europe. Findings Eight posters with expert clinical guidelines on the most important topics in Geriatric Emergency Medicine are now available through https://posters.geriemeurope.eu/. Message Expert clinical recommendations for Geriatric Emergency Medicine in Europe were created and are ready for dissemination across Europe. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00578-1. Purpose Despite the rapidly expanding knowledge in the field of Geriatric Emergency Medicine in Europe, widespread implementation of change is still lacking. Many opportunities in everyday clinical care are missed to improve care for this susceptible and growing patient group. The aim was to develop expert clinical recommendations on Geriatric Emergency Medicine to be disseminated across Europe. Methods A group of multi-disciplinary experts in the field of Geriatric Emergency Medicine in Europe was assembled. Using a modified Delphi procedure, a prioritized list of topics related to Geriatric Emergency Medicine was created. Next, a multi-disciplinary group of nurses, geriatricians and emergency physicians performed a review of recent guidelines and literature to create recommendations. These recommendations were voted upon by a group of experts and placed on visually attractive posters. The expert group identified the following eight subject areas to develop expert recommendations on: Comprehensive Geriatric Assessment in the Emergency Department (ED), age/frailty adjusted risk stratification, delirium and cognitive impairment, medication reviews in the ED for older adults, family involvement, ED environment, silver trauma, end of life care in the acute setting. Results Eight posters with expert clinical recommendations on the most important topics in Geriatric Emergency Medicine are now available through https://posters.geriemeurope.eu/. Conclusion Expert clinical recommendations for Geriatric Emergency Medicine may help to improve care for older patients in the Emergency Department and are ready for dissemination across Europe. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00578-1.
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Affiliation(s)
- J A Lucke
- Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, The Netherlands.
| | - S P Mooijaart
- Department of Internal Medicine, Section on Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - P Heeren
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | - K Singler
- Department of Geriatrics, Klinikum Nürnberg, Paracelsus Private, Medical University, Nuremberg, Germany.,Institute for Biomedicine of Ageing, Friedrich-Alexander-University, Erlangen-Nuremberg, Erlangen, Germany
| | - R McNamara
- Department of Emergency Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - T Gilbert
- Department of Geriatric Medicine, Lyon-Sud University Hospital, Lyon, France
| | - C H Nickel
- Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - S Castejon
- Department of Geriatrics and Palliative Care, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - A Mitchell
- Department of Emergency Medicine, Sligo University Hospital, Sligo, Ireland
| | - V Mezera
- Geriatric Center, Pardubice Hospital, Pardubice, Czech Republic
| | - L Van der Linden
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - S E Lim
- Academic Geriatric Medicine, University of Southampton, Southampton, UK
| | - A Thaur
- Department of Emergency Medicine, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - M A Karamercan
- Department of Emergency Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - L C Blomaard
- Department of Internal Medicine, Section on Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Z D Dundar
- Department of Emergency Medicine, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - K Y Chueng
- Accident and Emergency Department, United Christian Hospital, Kwun Tong, Hong Kong
| | - F Islam
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - B de Groot
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - S Conroy
- Geriatric Medicine, MRC Unit for Lifelong Health and Ageing at UCL, 5th Floor, 1-19 Torrington Place, London, WC1E 7HB, UK
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