Research Priorities for High-quality Geriatric Emergency Care: Medication Management, Screening, and Prevention and Functional Assessment

Authors

  • Christopher R. Carpenter MD, MS,

    1. From the Division of Emergency Medicine, Washington University in St. Louis (CRC), St. Louis MO; Rocky Mountain Poison and Drug Center, Denver, CO, and the University of Colorado Department of Emergency Medicine (KH), Aurora, CO; the Department of Emergency Medicine, Summa Akron City Hospital, Northeastern Ohio Universities College of Medicine (SW, KS, LWG), Akron, OH; the Department of Emergency Medicine, University of Colorado (AAG), Aurora, CO; the Department of Medicine, University of California at Los Angeles (NSW), Los Angeles, CA; and the Center for Aging Research, Indiana University and Regenstrief Institute Inc. (DKM), Indianapolis, IN.
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  • Kennon Heard MD,

    1. From the Division of Emergency Medicine, Washington University in St. Louis (CRC), St. Louis MO; Rocky Mountain Poison and Drug Center, Denver, CO, and the University of Colorado Department of Emergency Medicine (KH), Aurora, CO; the Department of Emergency Medicine, Summa Akron City Hospital, Northeastern Ohio Universities College of Medicine (SW, KS, LWG), Akron, OH; the Department of Emergency Medicine, University of Colorado (AAG), Aurora, CO; the Department of Medicine, University of California at Los Angeles (NSW), Los Angeles, CA; and the Center for Aging Research, Indiana University and Regenstrief Institute Inc. (DKM), Indianapolis, IN.
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  • Scott Wilber MD, MPH,

    1. From the Division of Emergency Medicine, Washington University in St. Louis (CRC), St. Louis MO; Rocky Mountain Poison and Drug Center, Denver, CO, and the University of Colorado Department of Emergency Medicine (KH), Aurora, CO; the Department of Emergency Medicine, Summa Akron City Hospital, Northeastern Ohio Universities College of Medicine (SW, KS, LWG), Akron, OH; the Department of Emergency Medicine, University of Colorado (AAG), Aurora, CO; the Department of Medicine, University of California at Los Angeles (NSW), Los Angeles, CA; and the Center for Aging Research, Indiana University and Regenstrief Institute Inc. (DKM), Indianapolis, IN.
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  • Adit A. Ginde MD, MPH,

    1. From the Division of Emergency Medicine, Washington University in St. Louis (CRC), St. Louis MO; Rocky Mountain Poison and Drug Center, Denver, CO, and the University of Colorado Department of Emergency Medicine (KH), Aurora, CO; the Department of Emergency Medicine, Summa Akron City Hospital, Northeastern Ohio Universities College of Medicine (SW, KS, LWG), Akron, OH; the Department of Emergency Medicine, University of Colorado (AAG), Aurora, CO; the Department of Medicine, University of California at Los Angeles (NSW), Los Angeles, CA; and the Center for Aging Research, Indiana University and Regenstrief Institute Inc. (DKM), Indianapolis, IN.
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  • Kirk Stiffler MD,

    1. From the Division of Emergency Medicine, Washington University in St. Louis (CRC), St. Louis MO; Rocky Mountain Poison and Drug Center, Denver, CO, and the University of Colorado Department of Emergency Medicine (KH), Aurora, CO; the Department of Emergency Medicine, Summa Akron City Hospital, Northeastern Ohio Universities College of Medicine (SW, KS, LWG), Akron, OH; the Department of Emergency Medicine, University of Colorado (AAG), Aurora, CO; the Department of Medicine, University of California at Los Angeles (NSW), Los Angeles, CA; and the Center for Aging Research, Indiana University and Regenstrief Institute Inc. (DKM), Indianapolis, IN.
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  • Lowell W. Gerson PhD,

    1. From the Division of Emergency Medicine, Washington University in St. Louis (CRC), St. Louis MO; Rocky Mountain Poison and Drug Center, Denver, CO, and the University of Colorado Department of Emergency Medicine (KH), Aurora, CO; the Department of Emergency Medicine, Summa Akron City Hospital, Northeastern Ohio Universities College of Medicine (SW, KS, LWG), Akron, OH; the Department of Emergency Medicine, University of Colorado (AAG), Aurora, CO; the Department of Medicine, University of California at Los Angeles (NSW), Los Angeles, CA; and the Center for Aging Research, Indiana University and Regenstrief Institute Inc. (DKM), Indianapolis, IN.
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  • Neal S. Wenger MD, MPH,

    1. From the Division of Emergency Medicine, Washington University in St. Louis (CRC), St. Louis MO; Rocky Mountain Poison and Drug Center, Denver, CO, and the University of Colorado Department of Emergency Medicine (KH), Aurora, CO; the Department of Emergency Medicine, Summa Akron City Hospital, Northeastern Ohio Universities College of Medicine (SW, KS, LWG), Akron, OH; the Department of Emergency Medicine, University of Colorado (AAG), Aurora, CO; the Department of Medicine, University of California at Los Angeles (NSW), Los Angeles, CA; and the Center for Aging Research, Indiana University and Regenstrief Institute Inc. (DKM), Indianapolis, IN.
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  • Douglas K. Miller MD,

    1. From the Division of Emergency Medicine, Washington University in St. Louis (CRC), St. Louis MO; Rocky Mountain Poison and Drug Center, Denver, CO, and the University of Colorado Department of Emergency Medicine (KH), Aurora, CO; the Department of Emergency Medicine, Summa Akron City Hospital, Northeastern Ohio Universities College of Medicine (SW, KS, LWG), Akron, OH; the Department of Emergency Medicine, University of Colorado (AAG), Aurora, CO; the Department of Medicine, University of California at Los Angeles (NSW), Los Angeles, CA; and the Center for Aging Research, Indiana University and Regenstrief Institute Inc. (DKM), Indianapolis, IN.
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  • on behalf of the Society for Academic Emergency Medicine (SAEM) Geriatric Task Force


  • This project was funded by an award from the American Geriatrics Society as part of the Geriatrics for Specialists Initiative, which is supported by the John A. Hartford Foundation.

  • CRC, AAG, KH, and SW were supported by Dennis W. Jahnigen Career Development Awards, which are funded by the American Geriatrics Society, the John A. Hartford Foundation, and Atlantic Philanthropies. CRR was supported by the Washington University Goldfarb Patient Safety award. KH was supported by Award Number K08DA020573 from the National Institute on Drug Abuse. The content is solely the responsibility of the authors and does not necessarily represent the official views of the supporting societies and foundations or the funding agencies.

  • Supervising Editor: Mark Hauswald, MD.

Address for correspondence and reprints: Christopher R. Carpenter, MD, MS; e-mail: carpenterc@wustl.edu.

Abstract

ACADEMIC EMERGENCY MEDICINE 2011; 18:644–654 © 2011 by the Society for Academic Emergency Medicine

Abstract

Background:  Geriatric adults represent an increasing proportion of emergency department (ED) users and can be particularly vulnerable to acute illnesses. Health care providers have recently begun to focus on the development of quality indicators (QIs) to define a minimal standard of care.

Objectives:  The original objective of this project was to develop additional ED-specific QIs for older patients within the domains of medication management, screening and prevention, and functional assessment, but the quantity and quality of evidence were insufficient to justify unequivocal minimal standards of care for these three domains. Accordingly, the authors modified the project objectives to identify key research opportunities within these three domains that can be used to develop QIs in the future.

Methods:  Each domain was assigned one or two content experts who created potential QIs based on a systematic review of the literature, supplemented by expert opinion. Candidate QIs were then reviewed by four groups: the Society for Academic Emergency Medicine (SAEM) Geriatric Task Force, the SAEM Geriatric Interest Group, and audiences at the 2008 SAEM Annual Meeting and the 2009 American Geriatrics Society Annual Meeting, using anonymous audience response system technology as well as verbal and written feedback.

Results:  High-quality evidence based on patient-oriented outcomes was insufficient or nonexistent for all three domains. The participatory audiences did not reach a consensus on any of the proposed QIs. Key research questions for medication management (three), screening and prevention (two), and functional assessment (three) are presented based on proposed QIs that the majority of participants accepted.

Conclusions:  In assessing a minimal standard of care by which to systematically derive geriatric QIs for medication management, screening and prevention, and functional assessment, compelling clinical research evidence is lacking. Patient-oriented research questions that are essential to justify and characterize future QIs within these domains are described.

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