Emergency medicine clinics of North America
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Chronic brain failure, also known as dementia or major neurocognitive disorder, is a syndrome of progressive functional decline characterized by both cognitive and neuropsychiatric symptoms. It can be conceptualized like other organ failure syndromes and its impact on quality of life can be mitigated with proper treatment. ⋯ Logic and reason are rarely successful when attempting to redirect someone with advanced dementia. Interactions that offer a sense of choice are more likely to succeed.
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Increasing prescription drug use trends in the United States affects patients across all ages, but especially the geriatric patient. As patients age, they are at increased risk for adverse events owing to natural changes in body composition and organ function, increased sensitivity to medications, and a higher chance of adverse events from drug-drug interactions and polypharmacy. Falls are common and can increase morbidity and mortality. To mitigate falls, it is imperative to have a comprehensive approach to screening home medication lists, be aware of and avoid high-risk medications, and deprescribe agents that are potentially inappropriate for this patient population.
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Older adults are frequently seen in the emergency department for genitourinary complaints, necessitating that emergency physicians are adept at managing a myriad of genitourinary emergencies. Geriatric patients may present with acute kidney injury, hematuria, or a urinary infection and aspects of how managing these presentations differs from their younger counterparts is emphasized. Older adults may also present with acute urinary retention or urinary incontinence as a result of genitourinary pathology or other systemic etiologies. Finally, genital complaints as they pertain to older adults are briefly highlighted with emphasis on emergent management and appropriate referrals.
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Emerg. Med. Clin. North Am. · May 2021
ReviewRapid Fire: Acute Brain Failure in Older Emergency Department Patients.
Delirium is common in older emergency department (ED) patients. Although associated with significant morbidity and mortality, it often goes unrecognized. ⋯ Management is aimed at identifying and treating the underlying cause. Meaningful improvements in delirium care can be achieved when prevention, identification, and management of older delirious ED patients is integrated by physicians and corresponding frameworks implemented at the health system level.
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Emerg. Med. Clin. North Am. · May 2021
ReviewPhysical Therapy, Occupational Therapy, and Speech Language Pathology in the Emergency Department: Specialty Consult Services to Enhance the Care of Older Adults.
The rehab services of Physical Therapy, Occupational Therapy, and Speech Language Pathology (PT/OT/SLP) are areas of emerging practice in the emergency department (ED). These specialty consult services can provide ED physicians with valuable, nuanced assessments for the older adults that will assist in determining a safe discharge plan. PT and OT interventions in the ED have been shown to decrease hospital admissions and readmissions, increase patient satisfaction, and decrease cost. Rehab specialists provide physicians with an expanded scope of management options that can greatly enhance the care of patients in the ED.