Episode 208: Geriatric Emergency Medicine

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Apr 15, 2025

Ula Hwang, a full professor at NYU and a trailblazer in geriatric emergency medicine, discusses the growing importance of specialized emergency care for older adults. She highlights the unique challenges faced by these patients, such as polypharmacy and functional decline. The conversation delves into essential screening tools to identify at-risk seniors and emphasizes customized care strategies. Ula also covers the need for multidisciplinary teams in emergency settings to ensure safe transitions and optimal outcomes for geriatric patients.

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ADVICE

Adapting Care for Geriatrics

Address the acute problem while considering multiple chronic conditions and functional limitations in geriatric patients.
Take extra time to ensure safe discharge and meet patient goals to potentially avoid hospitalizations.

ADVICE

Screening High-Risk Geriatrics

Screen geriatric patients for risk using tools like ISAR and frailty scores.
Assess mentation, medications, mobility, patient goals, and elder mistreatment as part of age-friendly care.

ADVICE

Ensure Safe Geriatric Discharge

Focus on safe care transitions by coordinating with outpatient services and care managers.
Involve geriatric pharmacists to review medications and reduce hospital-related harms.

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We explore the expanding field of Geriatric Emergency Medicine.

Hosts:
Ula Hwang, MD
Brian Gilberti, MD

Download Leave a Comment Tags: Geriatric

Show Notes

Key Topics Discussed

Importance and impact of geriatric emergency departments.
Optimizing care strategies for geriatric patients in ED settings.
Practical approaches for non-geriatric-specific EDs.

Challenges in Geriatric Emergency Care

Geriatric patients often present with:
- Multiple chronic conditions
- Polypharmacy
- Functional decline (mobility issues, cognitive impairments, social isolation)

Adapting Clinical Approach

Core objective remains acute issue diagnosis and treatment.
Additional considerations for geriatric patients:
- Review and caution with medications to prevent adverse reactions.
- Address functional limitations and cognitive impairments.
- Emphasize safe discharge and care transitions to prevent unnecessary hospitalization.

Identifying High-Risk Geriatric Patients

Screening tools:
- Identification of Seniors at Risk (ISAR)
- Frailty screens
Alignment with the “Age-Friendly Health Systems” initiative focusing on:
- Mentation
- Mobility
- Medications
- Patient preferences (what matters most)
- Mistreatment (elder abuse awareness)

Minimizing Hospital-Related Harms

Involvement of multidisciplinary teams:
- Social workers and care managers for care transitions
- Geriatric-certified pharmacists for medication review
Coordination with outpatient services post-discharge

Implementing Geriatric Care in All EDs

Basic geriatric care achievable even in resource-limited or rural EDs.
Level 3 Geriatric ED Accreditation can be achieved through:
- Improved care transitions
- Staff education enhancements
- Age-friendly environments (comfort, nutrition, hydration)

Future of Geriatric Emergency Medicine

Vision: Universal integration of geriatric-focused care.
Goals:
- Enhanced patient experience
- Improved care transitions
- Alignment of treatments with patient goals
- Broader enhancement of emergency care quality for all patient populations