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A Novel Emergency Medical Services–Based Program to Identify and Assist Older Adults in a Rural Community

Authors

  • Manish N. Shah MD, MPH,

    1. From the Departments of *Emergency Medicine, Community and Preventive Medicine, Medicine, Division of Geriatrics and Aging, University of Rochester Medical Center, Rochester, New York; §Livingston County Department of Health, Livingston County, New York; Livingston County Office for the Aging, Livingston County, New York; #Tri-County Family Medicine, Cohocton, New York; and **Genesee Valley Health Partnership, Nunda, New York.
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  • Thomas V. Caprio MD,

    1. From the Departments of *Emergency Medicine, Community and Preventive Medicine, Medicine, Division of Geriatrics and Aging, University of Rochester Medical Center, Rochester, New York; §Livingston County Department of Health, Livingston County, New York; Livingston County Office for the Aging, Livingston County, New York; #Tri-County Family Medicine, Cohocton, New York; and **Genesee Valley Health Partnership, Nunda, New York.
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  • Peter Swanson BA,

    1. From the Departments of *Emergency Medicine, Community and Preventive Medicine, Medicine, Division of Geriatrics and Aging, University of Rochester Medical Center, Rochester, New York; §Livingston County Department of Health, Livingston County, New York; Livingston County Office for the Aging, Livingston County, New York; #Tri-County Family Medicine, Cohocton, New York; and **Genesee Valley Health Partnership, Nunda, New York.
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  • Karthik Rajasekaran BA,

    1. From the Departments of *Emergency Medicine, Community and Preventive Medicine, Medicine, Division of Geriatrics and Aging, University of Rochester Medical Center, Rochester, New York; §Livingston County Department of Health, Livingston County, New York; Livingston County Office for the Aging, Livingston County, New York; #Tri-County Family Medicine, Cohocton, New York; and **Genesee Valley Health Partnership, Nunda, New York.
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  • Joan H. Ellison RN, MPH,

    1. From the Departments of *Emergency Medicine, Community and Preventive Medicine, Medicine, Division of Geriatrics and Aging, University of Rochester Medical Center, Rochester, New York; §Livingston County Department of Health, Livingston County, New York; Livingston County Office for the Aging, Livingston County, New York; #Tri-County Family Medicine, Cohocton, New York; and **Genesee Valley Health Partnership, Nunda, New York.
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  • Kaaren Smith RD,

    1. From the Departments of *Emergency Medicine, Community and Preventive Medicine, Medicine, Division of Geriatrics and Aging, University of Rochester Medical Center, Rochester, New York; §Livingston County Department of Health, Livingston County, New York; Livingston County Office for the Aging, Livingston County, New York; #Tri-County Family Medicine, Cohocton, New York; and **Genesee Valley Health Partnership, Nunda, New York.
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  • Paul Frame MD,

    1. From the Departments of *Emergency Medicine, Community and Preventive Medicine, Medicine, Division of Geriatrics and Aging, University of Rochester Medical Center, Rochester, New York; §Livingston County Department of Health, Livingston County, New York; Livingston County Office for the Aging, Livingston County, New York; #Tri-County Family Medicine, Cohocton, New York; and **Genesee Valley Health Partnership, Nunda, New York.
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  • Paul Cypher BS, MA,

    1. From the Departments of *Emergency Medicine, Community and Preventive Medicine, Medicine, Division of Geriatrics and Aging, University of Rochester Medical Center, Rochester, New York; §Livingston County Department of Health, Livingston County, New York; Livingston County Office for the Aging, Livingston County, New York; #Tri-County Family Medicine, Cohocton, New York; and **Genesee Valley Health Partnership, Nunda, New York.
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  • Jurgis Karuza PhD,

    1. From the Departments of *Emergency Medicine, Community and Preventive Medicine, Medicine, Division of Geriatrics and Aging, University of Rochester Medical Center, Rochester, New York; §Livingston County Department of Health, Livingston County, New York; Livingston County Office for the Aging, Livingston County, New York; #Tri-County Family Medicine, Cohocton, New York; and **Genesee Valley Health Partnership, Nunda, New York.
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  • Paul Katz MD

    1. From the Departments of *Emergency Medicine, Community and Preventive Medicine, Medicine, Division of Geriatrics and Aging, University of Rochester Medical Center, Rochester, New York; §Livingston County Department of Health, Livingston County, New York; Livingston County Office for the Aging, Livingston County, New York; #Tri-County Family Medicine, Cohocton, New York; and **Genesee Valley Health Partnership, Nunda, New York.
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Address correspondence to Manish N. Shah, Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655, Rochester, NY 14642. E-mail: manish.shah@rochester.edu

Abstract

Rural-dwelling older adults experience unique challenges related to accessing medical and social services. This article describes the development, implementation, and experience of a novel, community-based program to identify rural-dwelling older adults with unmet medical and social needs that leveraged the existing emergency medical services (EMS) system. The program specifically included geriatrics training for EMS providers; screening of older adult EMS patients for falls, depression, and medication management strategies by EMS providers; communication of EMS findings to community-based case managers; in-home evaluation by case managers; and referral to community resources for medical and social interventions. Measures used to evaluate the program included patient needs identified by EMS or the in-home assessment, referrals provided to patients, and patient satisfaction. EMS screened 1,231 of 1,444 visits to older patients (85%). Of those receiving specific screens, 45% had fall-related, 69% medication management–related, and 20% depression-related needs identified. One hundred and seventy-one eligible EMS patients who could be contacted accepted the in-home assessment. Of the 153 individuals completing the assessment, 91% had identified needs and received referrals or interventions. This project demonstrated that screening by EMS during emergency care for common geriatric syndromes and linkage to case managers is feasible in this rural community, although many will refuse the services. Further patient evaluations by case managers, with subsequent interventions by existing service providers as required, can facilitate the needed linkages between vulnerable rural-dwelling older adults and needed community-based social and medical services.

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