Palliative Care Needs of Seriously Ill, Older Adults Presenting to the Emergency Department

Authors

  • Corita R. Grudzen MD, MSHS,

    1. From the Department of Emergency Medicine (CRG, LDR, MM, EC) and the Brookdale Department of Geriatrics and Palliative Medicine (CRG, RSM), Mount Sinai School of Medicine, New York, NY; and the James J. Peters VA Hospital (RSM), Bronx, NY.
    Search for more papers by this author
  • Lynne D. Richardson MD,

    1. From the Department of Emergency Medicine (CRG, LDR, MM, EC) and the Brookdale Department of Geriatrics and Palliative Medicine (CRG, RSM), Mount Sinai School of Medicine, New York, NY; and the James J. Peters VA Hospital (RSM), Bronx, NY.
    Search for more papers by this author
  • Matthew Morrison,

    1. From the Department of Emergency Medicine (CRG, LDR, MM, EC) and the Brookdale Department of Geriatrics and Palliative Medicine (CRG, RSM), Mount Sinai School of Medicine, New York, NY; and the James J. Peters VA Hospital (RSM), Bronx, NY.
    Search for more papers by this author
  • Elizabeth Cho MD,

    1. From the Department of Emergency Medicine (CRG, LDR, MM, EC) and the Brookdale Department of Geriatrics and Palliative Medicine (CRG, RSM), Mount Sinai School of Medicine, New York, NY; and the James J. Peters VA Hospital (RSM), Bronx, NY.
    Search for more papers by this author
  • R. Sean Morrison MD

    1. From the Department of Emergency Medicine (CRG, LDR, MM, EC) and the Brookdale Department of Geriatrics and Palliative Medicine (CRG, RSM), Mount Sinai School of Medicine, New York, NY; and the James J. Peters VA Hospital (RSM), Bronx, NY.
    Search for more papers by this author

  • Presented at the American Geriatric Society annual meeting, Orlando, FL, May 2010; and the Society for Academic Emergency Medicine annual meeting, Phoenix, AZ, June 2010.

  • This study was funded by a Brookdale Foundation Leadership in Aging Fellowship (Dr. Grudzen) and by a Mid-Career Investigator Award in Patient Oriented Research (K24 AG022345) from the National Institute on Aging (Dr. Morrison).

  • Supervising Editor: Manish Shah, MD, MPH.

Address for correspondence and reprints: Corita R. Grudzen, MD, MSHS; e-mail: corita.grudzen@mssm.edu.

Abstract

Objectives:  The objective was to identify the palliative care needs of seriously ill, older adults in the emergency department (ED).

Methods:  The authors conducted a cross-sectional structured survey. A convenience sample of 50 functionally impaired adults 65 years or older with coexisting cancer, congestive heart failure, end-stage liver or renal disease, stroke, oxygen-dependent pulmonary disease, or dementia was recruited from an urban academic tertiary care ED. Face-to-face interviews were conducted using the Needs Near the End-of-Life Screening Tool (NEST), McGill Quality of Life Index (MQOL), and Edmonton Symptom Assessment Survey (ESAS) to assess 1) range and severity of symptoms, 2) goals of care, 3) psychological well-being, 4) health care utilization, 5) spirituality, 6) social connectedness, 7) financial burden, 8) the patient–clinician relationship, and 9) overall quality of life (QOL).

Results:  Mean (±SD) age was 74.3 (±6.5) years and cancer was the most common diagnosis. Mean (±SD) QOL on the MQOL was 3.6 (±2.9). Over half of the patients exceeded intratest severity-of-needs cutoffs in four categories of the NEST: physical symptoms (47/50, 94%), finances (36/50, 72%), mental health (31/50, 62%), and access to care (29/50, 58%). The majority of patients reported moderate to severe fatigue, pain, dyspnea, and depression on the ESAS.

Conclusions:  Seriously ill, older adults in an urban ED have substantial palliative care needs. Future work should focus on the role of emergency medicine and the new specialty of palliative care in addressing these needs.

ACADEMIC EMERGENCY MEDICINE 2010; 17:1253–1257 © 2010 by the Society for Academic Emergency Medicine

Ancillary