Clinics in geriatric medicine
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In the emergency department (ED), frailty represents the vulnerability of an individual because of their underlying health status. An older patient can be identified as frail by using a frailty index, the Clinical Frailty Scale, a frailty phenotype, or a screening measure such as the Identification of Seniors at Risk (ISAR). In the ED, the frail older person should have an interdisciplinary assessment, a thoughtful review of their medications, a screen for other geriatric syndromes, and a care plan that addresses the individual's needs, includes the patient's goals and preferences, and follows the patient beyond the ED.
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Older patients with advanced illness are presenting more frequently to emergency departments (EDs). These patients have complex needs, which challenge busy EDs tuned to provide emergent, life-sustaining interventions, and rapid dispositions. This article outlines communication skills to assess patient goals so that the ED provider can create a care plan that matches level of medical intervention with patient wishes. Furthermore, this article outlines symptom-based care for the actively dying geriatric patient in the ED, specifically, acute pain, dyspnea, terminal delirium, secretions, dry mouth, fever, and bereavement.
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Pulmonary hypertension is a pathologic hemodynamic condition defined by a mean pulmonary arterial pressure of 25 mm Hg or greater at rest. Because of age-associated stiffening of the heart and the pulmonary vasculature and the higher prevalence in the elderly of comorbidities associated with the development of pulmonary hypertension, it is an increasingly common finding in this patient population. ⋯ The general management is to treat the underlying conditions responsible for the development of the disorder. Pulmonary vasodilators are indicated in patients with pulmonary arterial hypertension.
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The Rapid Geriatric Assessment (RGA) measures frailty, sarcopenia, anorexia, cognition, and advanced directives. The RGA is a screen for primary care physicians to be able to detect geriatric syndromes. Early intervention when geriatric syndromes are recognized can decrease disability, hospitalization, and mortality.
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There is no single definition of polypharmacy. Use of 5 or more medications commonly is used. ⋯ The American Geriatrics Society (AGS) Beers Criteria and Screening Tool of Older People's Prescriptions (STOPP) explicit criteria reflect elements that are common across protocols and algorithms. Concepts in AGS Beers and STOPP can be incorporated into polypharmacy reduction strategies to improve outcomes of care for older adults.