Clinics in geriatric medicine
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Clin. Geriatr. Med. · Feb 2013
ReviewEvolving prehospital, emergency department, and "inpatient" management models for geriatric emergencies.
Alternative management methods are essential to ensure high-quality and efficient emergency care for the growing number of geriatric adults worldwide. Protocols to support early condition-specific treatment of older adults with acute severe illness and injury are needed. Improved emergency department care for older adults will require providers to address the influence of other factors on the patient's health. This article describes recent and ongoing efforts to enhance the quality of emergency care for older adults using alternative management approaches spanning the spectrum from prehospital care, through the emergency department, and into evolving inpatient or outpatient processes of care.
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An increasing number of emergency departments (EDs) are providing extended care and monitoring of patients in ED observation units (EDOUs). EDOUs can be useful for older adults as an alternative to hospitalization and as a means of risk stratification for older adults with unclear presentations. They can also provide a period of therapeutic intervention and reassessment for older patients in whom the appropriateness and safety of immediate outpatient care are unclear. This article discusses the general characteristics of EDOUs, reviews appropriate entry and exclusion criteria for older adults in EDOUs, and discusses regulatory implications of observation status for patients with Medicare.
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Clin. Geriatr. Med. · Feb 2013
ReviewGeriatric dizziness: evolving diagnostic and therapeutic approaches for the emergency department.
Dizziness affects one in five people over the age of 65 years and is associated with substantial healthcare costs. Serious causes of dizziness are found in 20% of patients over 50 years. ⋯ The risk of vascular events is higher in the first 30 days than after, suggesting some missed diagnoses. Medications and vestibular rehabilitation may serve as treatment options for dizziness, but data on their efficacy in older patients is lacking.
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Clin. Geriatr. Med. · Feb 2013
ReviewAltered mental status in older patients in the emergency department.
Altered mental status is a common chief compliant among older patients in the emergency department (ED). Acute changes in mental status are more concerning and are usually secondary to delirium, stupor, and coma. ⋯ For patients with acute changes in mental status the ED evaluation should focus on searching for the underlying etiology. Infection is one of the most common precipitants of delirium, but multiple causes may exist concurrently.
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Clin. Geriatr. Med. · Feb 2013
ReviewTreating the elderly stroke patient: complications, controversies, and best care metrics.
Acute stroke is a devastating disease that affects almost 800,000 Americans annually. Worldwide, the incidence of stroke is rapidly increasing. ⋯ Despite this, there are disparities in thrombolytic treatment rates, and as well as outcomes, between elderly stroke patients and their younger counterparts. This article discusses what is currently known about the elderly stroke patient for a greater understanding of the disease burden, research limitations and potential treatment options.