Journal of the American Geriatrics Society
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In the United States and around the world, effective, efficient, and reliable strategies to provide emergency care to aging adults is challenging crowded emergency departments (EDs) and strained healthcare systems. In response, geriatric emergency medicine clinicians, educators, and researchers collaborated with the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine to develop guidelines intended to improve ED geriatric care by enhancing expertise, educational, and quality improvement expectations, equipment, policies, and protocols. These Geriatric Emergency Department Guidelines represent the first formal society-led attempt to characterize the essential attributes of the geriatric ED and received formal approval from the boards of directors of each of the four societies in 2013 and 2014. This article is intended to introduce emergency medicine and geriatric healthcare providers to the guidelines while providing recommendations for continued refinement of these proposals through educational dissemination, formal effectiveness evaluations, cost-effectiveness studies, and eventually institutional credentialing.
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Randomized Controlled Trial Multicenter Study
Structured pharmaceutical analysis of the Systematic Tool to Reduce Inappropriate Prescribing is an effective method for final-year medical students to improve polypharmacy skills: a randomized controlled trial.
Medical students may not be adequately trained to prescribe appropriately to older adults with polypharmacy. This study addressed how to teach students to minimize inappropriate polypharmacy. Final-year medical students (N = 106) from two Dutch schools of medicine participated in this randomized controlled trial with a pre/posttest design. ⋯ E-learning did not have a different effect from that of non-E-learning methods. Students were satisfied with the method. The STRIP method is effective in helping final-year medical students improve their prescribing skills.
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Randomized Controlled Trial
Randomized controlled trial of a prehospital decision system by emergency medical services to ensure optimal treatment for older adults in Sweden.
To evaluate the feasibility and appropriateness of a prehospital system allowing ambulance nurses to transport older adults directly to geriatric care at a community-based hospital (CH) or to an emergency department (ED). ⋯ Ambulance nurses are able to send older adults to an alternative healthcare facility with the help of a prehospital decision support system. In this geographical setting, this appears to be a promising method to optimize resources and improve emergency care of elderly adults.
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Comparative Study
Veterans Affairs Saint Louis University Mental Status examination compared with the Montreal Cognitive Assessment and the Short Test of Mental Status.
To compare the ability of the Veterans Affairs Saint Louis University Mental Status (SLUMS) examination to detect mild cognitive impairment (MCI) and dementia according to the Clinical Dementia Rating Scale (CDR) with that of two other well-known screening instruments, the Montreal Cognitive Assessment (MoCA) and the Short Test of Mental Status (STMS). ⋯ The SLUMS examination has validity similar to that of the MoCA and STMS for the detection of MCI, dementia, and MCI or dementia according to the CDR.
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Observational Study
Duration of postoperative delirium is an independent predictor of 6-month mortality in older adults after hip fracture.
To evaluate the association between number of days with delirium and 6-month mortality in elderly adults after hip fracture surgery. ⋯ In older adults undergoing hip fracture surgery, duration of POD is an important prognostic factor for 6-month mortality. Efforts to reduce duration of POD are therefore crucial for these individuals.