scholarly journals Collaborative care when older adults fall: The benefits of geriatric consultation for trauma patients aged 75 years and older

2022 ◽  
Author(s):  
Amanda R. A. Roberts ◽  
Carolyne R. Falank ◽  
Julianne B. Ontengco ◽  
Emily L. Carter ◽  
Sarah A. M. Hallen
Keyword(s):  
Older Adults ◽  
Collaborative Care ◽  
Trauma Patients ◽  
Geriatric Consultation

Geriatric Trauma Screening Tool: Preinjury Functional Status Dictates Intensive Care Unit Discharge Disposition

2019 ◽  
Vol 85 (8) ◽  
pp. 800-805
Author(s):  
Lindsey C. Bridges ◽  
Amy B. Christie ◽  
Hamza H. Awad ◽  
Erika J. Sigman ◽  
D. Benjamin Christie ◽  
...  
Keyword(s):  
Older Adults ◽  
Functional Status ◽  
Screening Tool ◽  
Intensive Care Unit Discharge ◽  
Hospital Length ◽  
Transitions Of Care ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Discharge Disposition ◽  
Hospital Resources

Older adults account for an increasing percentage of trauma patients and have worse outcomes when compared with younger populations. Simple prediction tools are needed to designate risk categories among these patients. The Geriatric Trauma Screening Tool (GTST) was developed to risk stratify older adults admitted to the ICU at a Level 1 trauma center. One hundred fifty patients aged ≥ 65 years were prospectively screened for high-risk (HR) injuries, comorbidities, and pre-hospital function using the GTST. Patients who screened for HR were more likely to have an unfavorable disposition than non-HR patients. HR patients had significantly longer ICU and hospital length of stays when compared with non-HR patients. In addition, patients with prior functional impairment were at higher risk for an unfavorable discharge disposition than their counterparts. Implementation of the GTST predicted discharge disposition in geriatric trauma patients admitted to the ICU. Pre-injury functional status was a better predictor of discharge disposition than either the types of HR injuries or the presence of comorbidities. Risk stratification of geriatric trauma patients allows for early engagement of patients and caregivers regarding transitions of care as well as more efficient utilization of hospital resources.

A systematic review and meta-analysis evaluating geriatric consultation on older trauma patients

2020 ◽  
Vol 88 (3) ◽  
pp. 446-453
Author(s):  
Debra Eagles ◽  
Bradley Godwin ◽  
Wei Cheng ◽  
Joy Moors ◽  
Sonshire Figueira ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Trauma Patients ◽  
Geriatric Consultation

The Triage of Older Adults with Physiologic Markers of Serious Injury Using a State-Wide Prehospital Plan

2019 ◽  
Vol 34 (05) ◽  
pp. 497-505
Author(s):  
Matthew H. Meyers ◽  
Trent L. Wei ◽  
Julianne M. Cyr ◽  
Thomas M. Hunold ◽  
Frances S. Shofer ◽  
...  
Keyword(s):  
Older Adults ◽  
Trauma Center ◽  
Medical Information ◽  
Geriatric Trauma ◽  
Medical Information System ◽  
Trauma Patients ◽  
Glascow Coma Scale ◽  
Serious Injury ◽  
Gcs Score ◽  
The Impact

AbstractIntroduction:In January of 2010, North Carolina (NC) USA implemented state-wide Trauma Triage Destination Plans (TTDPs) to provide standardized guidelines for Emergency Medical Services (EMS) decision making. No study exists to evaluate whether triage behavior has changed for geriatric trauma patients.Hypothesis/Problem:The impact of the NC TTDPs was investigated on EMS triage of geriatric trauma patients meeting physiologic criteria of serious injury, primarily based on whether these patients were transported to a trauma center.Methods:This is a retrospective cohort study of geriatric trauma patients transported by EMS from March 1, 2009 through September 30, 2009 (pre-TTDP) and March 1, 2010 through September 30, 2010 (post-TTDP) meeting the following inclusion criteria: (1) age 50 years or older; (2) transported to a hospital by NC EMS; (3) experienced an injury; and (4) meeting one or more of the NC TTDP’s physiologic criteria for trauma (n = 5,345). Data were obtained from the Prehospital Medical Information System (PreMIS). Data collected included proportions of patients transported to a trauma center categorized by specific physiologic criteria, age category, and distance from a trauma center.Results:The proportion of patients transported to a trauma center pre-TTDP (24.4% [95% CI 22.7%-26.1%]; n = 604) was similar to the proportion post-TTDP (24.4% [95% CI 22.9%-26.0%]; n = 700). For patients meeting specific physiologic triage criteria, the proportions of patients transported to a trauma center were also similar pre- and post-TTDP: systolic blood pressure <90 mmHg (22.5% versus 23.5%); respiratory rate <10 or >29 (23.2% versus 22.6%); and Glascow Coma Scale (GCS) score <13 (26.0% versus 26.4%). Patients aged 80 years or older were less likely to be transported to a trauma center than younger patients in both the pre- and post-TTDP periods.Conclusions:State-wide implementation of a TTDP had no discernible effect on the proportion of patients 50 years and older transported to a trauma center. Under-triage remained common and became increasingly prevalent among the oldest adults. Research to understand the uptake of guidelines and protocols into EMS practice is critical to improving care for older adults in the prehospital environment.

Comparison of in-person and telegeriatric follow-up consultations

2020 ◽  
pp. 1357633X2096541
Author(s):  
Georgia Betkus ◽  
Shannon Freeman ◽  
Melinda Martin-Khan ◽  
Shell Lau ◽  
Frank Flood ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Care ◽  
Fiscal Year ◽  
Care Provision ◽  
Geriatric Consultation ◽  
Day Clinic ◽  
Predominately Female ◽  
Improve Access ◽  
Medication Changes

Introduction Telehealth has the potential to support the care of older adults and their desire to age at home by providing a videoconferencing connection to specialist geriatric care. However, more information is needed to determine how telehealth services affect the care of older adults, and how telehealth services for older adults compare to traditional in-person methods of care provision. The aim of this study was to compare telegeriatric and in-person geriatric consultation methods with respect to outcomes and costs. Methods This was a retrospective chart analysis of consultation letters from patients’ first follow-up appointment with a geriatric specialist during the 2017/2018 fiscal year ( N = 95) in a health jurisdiction of a Western Canadian province. Results Patients seen through telehealth and in person were similar in mean age ( M = 79.1 and 78.1 years, respectively) and were predominately female. Telegeriatric consultations resulted in more requests for further testing and screening ( p = 0.003), new diagnoses ( p = 0.002), medication changes ( p = 0.009) and requests for follow-up ( p = 0.03) compared to in-person consultations. An average one-day clinic with one geriatric specialist providing consultations through telehealth cost Can$1684–$1859 less than an equivalent in-person clinic. Discussion Although additional research is needed to explain the differences in outcomes further between telehealth and in-person consultations found in this work, telehealth consultations cost substantially less than in-person consultations and are a promising way to improve access to geriatric care for older adults in underserved areas.

Geriatric Consultation for Older Trauma Patients Improves Adherence to Geriatric Trauma Management Guidelines

2016 ◽  
Vol 223 (4) ◽  
pp. e92-e93
Author(s):  
Daniel Ruter ◽  
Lauren T. Southerland ◽  
Tanya R. Gure ◽  
Michael M. Li ◽  
David C. Evans
Keyword(s):  
Geriatric Trauma ◽  
Trauma Patients ◽  
Trauma Management ◽  
Management Guidelines ◽  
Geriatric Consultation

scholarly journals Randomized controlled trial of geriatric consultation versus standard care in older adults with hematologic malignancies

Haematologica ◽  
2021 ◽  
Author(s):  
Clark DuMontier ◽  
Hajime Uno ◽  
Tammy Hshieh ◽  
Guohai Zhou ◽  
Richard Chen ◽  
...  
Keyword(s):  
Older Adults ◽  
Randomized Controlled Trial ◽  
Standard Care ◽  
Controlled Trial ◽  
Hematologic Malignancies ◽  
Care Utilization ◽  
Goals Of Care ◽  
Randomized Controlled ◽  
Geriatric Consultation ◽  
The Impact

We conducted a randomized controlled trial in older adults with hematologic malignancies to determine the impact of geriatrician consultation embedded in our oncology clinic alongside standard care. From February 2015 to May 2018, transplant-ineligible patients age ii75 years who presented for initial consultation for lymphoma, leukemia, or multiple myeloma at Dana-Farber Cancer Institute (Boston, MA) were eligible. Pre-frail and frail patients, classified based on phenotypic and deficitaccumulation approaches, were randomized to receive either standard oncologic care with or without consultation with a geriatrician. The primary outcome was 1-year overall survival. Secondary outcomes included unplanned care utilization within 6 months of follow-up and documented end of life (EOL) goals of care discussions. Clinicians were surveyed as to their impressions of geriatric consultation. One hundred sixty patients were randomized to either geriatric consultation plus standard care (n = 60) or standard care alone (n = 100). Median age was 80.4 years (SD = 4.2). Of those randomized to geriatric consultation, 48 (80%) completed at least one visit with a geriatrician. Consultation did not improve survival at one year compared to standard care (difference: 2.9%, 95% CI = -9.5% to 15.2%, p = 0.65), and did not significantly reduce the incidence of ED visits, hospitalizations, or days in hospital. Consultation did improve the odds of having EOL goals of care discussions (odds ratio = 3.12, 95% CI = 1.03 to 9.41) and was valued by surveyed hematologiconcology clinicians, with 62.9%-88.2% rating consultation as useful in the management of several geriatric domains.

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