Background: The emergency department plays an important role in improving elderly care. As an ever-increasing access point for medical care, the emergency department sits at a crossroads between inpatients and outpatient care.
Aim and objective: To evaluate the management strategies to make the emergency OPD elderly friendly through quality assurance of geriatric syndrome.
Materials and methods: Four hundred elderly patients admitted to the emergency department of a tertiary care hospital were enrolled consecutively. Information regarding baseline characteristics was recorded. A 34-point observation checklist was used to assess the management strategies being practiced for the elderly population. The checklist comprised of observation pertaining to the geriatric-friendly environment; the practice of using geriatric assessment scales; and training of nursing personnel regarding care of elderly patients.
Results: Though the engineering aspects of the study setting had adequate-elderly friendly features, there was a scope of ensuring the provision of assistive and enabling devices like walkers, canes, etc., availability of low-heightened beds and trolleys, bedside commode, raised toilet, etc. There was also a definite scope of initiating a system of formal SOPs/protocols/policies/for various syndromes like cognitive decline, urinary incontinence, falls, polypharmacy, pain management, etc. A need was also observed to organize on-the-job training for the nursing personnel because well-informed professionals will be better able to provide quality and customized care to the elderly.
Conclusion: Though elderly patients were being managed adequately in the emergency, there was a definite scope of initiating a system of formal SOPs/protocols/policies/for various domains pertaining to geriatric syndromes and training of nurses regarding the care of the elderly.
Introduction To Geriatrics - Geriatrics [Internet]. MSD Manual Professional Edition. [Cited 2019Feb 2]. Available From: Https://Www.Msdmanuals.Com/Professional/Geriatrics/Approach-To-The-Geriatric-Patient/Introduction-To-Geriatrics.
Dey S, Nambiar D, Lakshmi JK, et al., Health of the Elderly in India. National Academy of Sciences. 2012 [Internet] [Cited on 2019 April 20] http:www.ncbi.nlm.nib.gov/book/NBR.
Sanon M, Hwang U, Abraham G, et al. ACE model for adults in ED. Geriatrics (Basel) 2019;4(1):24.
Qingyu D, Wang W, Wang H, et al. Prognostic value of frailty in elderly patients with acute coronary syndrome a systematic review and meta-analysis. BMC Geriatric 2019;1(19):1–10.
Gunnarsdottir OS, Rafinsson V. Mortality of the users of a hospital emergency department. Emerg Med J 2006;23(4):269–273. DOI: 10.1136/emj.2005.026690.
Carpenter C, Mills T. Evolving prehospital, emergency department and inpatient management models for geriatric emergencies. Clin Geriatr Med 2013;1(1):31–47. DOI: 10.1016/j.cger.2012.09.003.
Kennelly P, Mccabe J. Acute care of older patients in the emergency department: strategies to improve patient outcome. J Emerg Med 2015;7:45–54.
Sharma D, Kaur M, Chaudhary R, et al. Admission of elderly in emergency units: causes and problems. J Adv Pract Nurs 2016;2(3):2–3.
Basic D, Conforti DA. A prospective, randomized, controlled trial of an aged care nurse intervention within the emergency department. Aust Health Rev 2005;29(1):51–59. DOI: 10.1071/ah050051.
Guttam A, Afilalo M, Guttman R, et al. An emergency department-based discharge coordinator for elder patients: does it make a difference? Acad Emerg Med 2014;11:1318–1327.
Boltz M, Parke B, Shuluk J, et al. Care of the older adult in the emergency department: nurses views of the pressing issues. Gerontologist 2013;53(3):441–453. DOI: 10.1093/geront/gnt004.
Samaras N, Chevalley T, Samaras D, et al. Older patients in the emergency department: a review. Ann Emerg Med 2010;56(3):261–269. DOI: 10.1016/j.annemergmed.2010.04.015.
Sinha S, Bessman E, Flomenbaum N, et al. A systematic review and qualitative analysis to inform the development of a new emergency department-based geriatric case management model. Ann Emerg Med 2011;6(6):672–682. DOI: 10.1016/j.annemergmed.2011.01.021.
Conroy SP, Ansari K, Williams M, et al. Controlled evaluation of comprehensive geriatric assessment in emergency department: the ‘Emergency Frailty Unit’. Age Aging 2014;43(1):109–114. DOI: 10.1093/ageing/aft087.
Wadman M, Lyons W, Hoffman L, et al. Assessment of chief complaints-based curriculum for resident education in geriatric emergency medicine. West J Emerg Med 2011;12(4):484–488. DOI: 10.5811/westjem.2010.10.1722.
Cusker J, Verdon J, Vadeboncoeur A, et al. The elder friendly emergency department assessment tool: development of a quality assessment tool for emergency department based geriatric care. J Am Geriatr Soc 2012;60(8):1534–1539. DOI: 10.1111/j.1532-5415.2012.04058.x.
Kelley LM, Parke B, Jokinen N, et al. Senior friendly emergency department care: an environmental assessment. J Health Serv 2011;16(1):6–12. DOI: 10.1258/jhsrp.2010.009132.
Kaur S, Singh A, Kumari S, et al. Assessment of functional status and daily life problems faced by elderly in a North Indian city. Psychogeriatrics 2019(5). DOI: 10.1111/psyg.12406.
Kumar A, Anand N, Poverty Target Programs for the Elderly in India with Special Reference to National Old Age Pension Scheme, 1995. Chronic Poverty Res Cent Work Pap. (2008-09) 2006. [Available from: http://www.papers.ssrn.com/sol3/papers.cfm?abstract_id=1755099.
Kaur S, Gill A, Sharma U, et al. Quality care audit of old age homes in a North Indian City. J Indian Acad Geriatr 2015;11:3–9.
Adhikari P. Geriatric health care in India - Unmet needs and the way forward. Arch Med Health Sci 2017;5:112–114.
