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Keywords:

  • elders;
  • geriatrics;
  • Domain Management Model;
  • communication

Abstract

  1. Top of page
  2. Abstract
  3. References

Older adults in emergency departments (EDs) can have complicated health problems that defy straightforward diagnosis and management. Implementation of the 11 core principles in the geriatric emergency care model requires changes in care processes. The Domain Management Model (DMM) is one solution to organize care efficiently using a standard language. Its use is consistent with the geriatric model. Patients' problems are organized into one of four domains: I. Medical/Surgical Issues; II. Mental Status/Emotions/Coping; III. Physical Function; and IV. Living Environment (A. Physical, B. Social, and C. Financial). Specific geriatric cases illustrate improved communication using these standard domains. This model can educate health care staff, facilitate team care, improve flow of relevant information, improve decision making, and facilitate more meaningful interactions with patients.

References

  1. Top of page
  2. Abstract
  3. References
  • Wilber ST, Gerson L. A research agenda for geriatric emergency medicine. Acad Emerg Med. 2003; 10:25160.
  • Strange GR, Chen E, Sanders AB. Use of emergency departments by elderly patients: projections from a multicenter data base. Ann Emerg Med. 1992; 21:81924.
  • McNamara RM, Rousseau E, Sanders AB. Geriatric emergency medicine: a survey of practicing emergency physicians. Ann Emerg Med. 1992; 21:796801.
  • Sanders, AB, Witzke, D, Jones, JS, Richmond, K, Kidd, P. Principles of care and application of the geriatric emergency care model. In: SandersAB (ed). Emergency Care of the Elder Person. St Louis , MO : Beverly Cracom Publications, 1996, pp 5993.
  • Siebens H. Applying the Domain Management Model in treating patients with chronic disease. Jt Comm J Qual Improvement. 2001; 27:30214.
  • Bernstein E. Functional assessment, mental status and case finding. In: SandersAB (ed). Emergency Care of the Elder Person. St Louis , MO : Beverly Cracom Publications, 1996, pp 97116.
  • Engel G. The need for a new medical model: a challenge for biomedicine. Science. 1977; 196:12936.
  • Stedman's Medical Dictionary., 23rd Edition Baltimore : Williams & Wilkins, 1976, pp 317, 1379.
  • Gerson, LW, Counsell, SR, Fontanarosa, PB, Smucker, WD. Case finding for cognitive impairment in elderly emergency department patients. Ann Emerg Med. 1994; 23:8137.
  • Hustey FM, Meldon S. The prevalence and documentation of impaired mental status in elderly emergency department patients. Ann Emerg Med. 2002; 39:24853.
  • Meldon SW, Emerman C, Schubert DSP. Recognition of depression in geriatric ED patients by emergency physicians. Ann Emerg Med. 1997; 30:4427.
  • Gerson, LW, Rousseau, E, Hogan, TM, Bernstein, E, Kalbfleisch, N. Multicenter study of case finding in elderly emergency department patients. Acad Emerg Med. 1995; 2:72934.
  • Likourezos A, Burack O, Lantz MS. The therapeutic use of companion animals. Clin Geriatrics. 2002; 10:313.
  • Reuben, DB, Herr, KA, Pacala, JT, Pollock, BG, Potter, JF, Semla, TP. Geriatrics at Your Fingertips. Belle Mead , NJ : Excerpta Medica, 2001, pp 1215.
  • Reuben, DB, Herr, KA, Pacala, JT, Pollock, BG, Potter, JF, Semla, TP. Geriatrics at Your Fingertips. Malden , MA : Blackwell Science, 2002, pp 1229.
  • Siebens H. The Domain Management Model: Organizing Care for Stroke Survivors and Other Persons with Chronic Diseases. Top Stroke Rehabil. 2002; 9:125.
  • Hesse K, Siebens H. Clinical information systems for primary care: more than just an electronic medical record. Top Stroke Rehabil. 2002; 9:3959.
  • Weed L. Medical Records, Medical Education, and Patient Care; The Problem-oriented Record as a Basic Tool The Press of Case Western Reserve University. Chicago : Year Book Medical Publishers, 1969.
  • Society for Academic Emergency Medicine. Emergency Care of the Elder Person: Instructor's Manual. Available at: http:www.saem.orgservicesgerintro.htm. Accessed Sept 1, 2003.
  • Siebens H, Kelly N, Pu C. The Domain Management Model: a tool to help organize care of stroke survivors in skilled nursing facilities. Top Stroke Rehabil. 2002; 9:6074.
  • Adams JG, Gerson LW. A new model for emergency care of geriatric patients. Acad Emerg Med. 2003; 10:2714.
  • Gerson LW, Schelble D, Wilson JE. Using paramedics to identify at-risk elderly. Ann Emerg Med. 1992; 21:68891.
  • Bisognomo M. Plenary talk. Orlando , FL : Institute for Healthcare Improvement Annual Forum, 2002.
  • McCusker, J, Bellavance, F, Cardin, S, Trepanier, S, Verdon, J, Ardman, O. Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc. 1999; 47:122937.
  • McCusker, J, Cardin, S, Bellavance, F, Belzile, E. Return to the emergency department among elders: patterns and predictors. Acad Emerg Med. 2000; 7:24959.
  • Meldon SW, Mion L, Palmer RM et al. A brief risk-stratification tool to predict repeat emergency department visits and hospitalizations in older patients discharged from the emergency department. Acad Emerg Med. 2003; 10:22432.
  • Senge P. The Fifth Discipline. New York , NY : Doubleday, 1990.
  • Miller G. The magical number seven, plus or minus two: some limits on our capacity for processing information. Psychol Rev. 1956; 63(2):8197.