Advertisement

Secondary Assessment of Life-Threatening Conditions of Older Patients

  • Hubert Blain
  • Abdelouahab Bellou
  • Mehmet Akif Karamercan
  • Jacques Boddaert
Chapter

Abstract

People aged 65 years and older have higher rate of emergency department (ED) use than other age groups. Critically ill older ED people have specific characteristics. Older patients with life-threatening conditions often present with atypical signs and symptoms unspecific of the altered organ or tissue, and often usual severity criteria are missing. Some symptoms such as delirium, faintness, general malaise, digestive problems, fatigue, balance impairments, or falls can be incorrectly regarded as mild, whereas they are the only sign of a life-threatening condition. Even small initial insults in patients with multisystem deterioration and loss of physiological reserve (frailty) can induce a disabling cascade of adverse effects, called the “domino” effect, which can threaten the life of older patients. Determining whether the older patient is frail, i.e., his (her) medical, psychological, and functional ability to cope with the acute condition, is therefore crucial in older ED patients for optimizing therapeutic options and anticipating treatment adverse effects. Ethical consideration and whether the patient has an advanced directive, health-care power of attorney, or living will on admission are also crucial parts of the assessment of older ED patients. The present chapter displays a model of geriatric secondary assessment adapted to critically ill older ED patients that takes into account the above specificities and particular needs of these patients.

References

  1. 1.
    McCusker J, Cardin S, Bellavance F, Belzile E (2000) Return to the emergency department among elders: patterns and predictors. Acad Emerg Med 7:249–259PubMedGoogle Scholar
  2. 2.
    Rosted E, Wagner L, Hendriksen C, Poulsen I (2012) Geriatric nursing assessment and intervention in an emergency department: a pilot study. Int J Older People Nursing 7:141–151Google Scholar
  3. 3.
    Adams JG, Gerson LW (2003) A new model for emergency care of geriatric patients. Acad Emerg Med 10:271–274PubMedGoogle Scholar
  4. 4.
    Gruneir A, Silver MJ, Rochon PA (2011) Emergency department use by older adults: a literature review on trends, appropriateness, and consequences of unmet health care needs. Med Care Res Rev 68:131–155PubMedGoogle Scholar
  5. 5.
    Schumacher JG (2005) Emergency medicine and older adults: continuing challenges and opportunities. Am J Emerg Med 23:556–560PubMedCentralPubMedGoogle Scholar
  6. 6.
    Aminzadeh F, Dalziel WB (2002) Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med 39:238–247PubMedCentralPubMedGoogle Scholar
  7. 7.
    Foo CL, Siu VW, Tan TL, Ding YY, Seow E (2012) Geriatric assessment and intervention in an emergency department observation unit reduced re-attendance and hospitalisation rates. Australas J Ageing 31:40–46PubMedGoogle Scholar
  8. 8.
    Hwang U, Morrison RS (2007) The geriatric emergency department. J Am Geriatr Soc 55:1873–1876PubMedGoogle Scholar
  9. 9.
    Lowenstein SR, Crescenzi CA, Kern DC, Steel K (1986) Care of the elderly in the emergency department. Ann Emerg Med 15:528–535PubMedGoogle Scholar
  10. 10.
    Basic D, Conforti DA (2005) A prospective, randomised controlled trial of an aged care nurse intervention within the emergency department. Aust Health Rev 29:51–59PubMedGoogle Scholar
  11. 11.
    McCoy HV, Kipp CW, Ahern M (1992) Reducing older patients’ reliance on the emergency department. Soc Work Health Care 17:23–37PubMedGoogle Scholar
  12. 12.
    McCusker J, Dendukuri N, Tousignant P, Verdon J, Poulin de Courval L, Belzile E (2003) Rapid two-stage emergency department intervention for seniors: impact on continuity of care. Acad Emerg Med 10:233–243PubMedGoogle Scholar
  13. 13.
    Besdine RW (1983) The educational utility of comprehensive functional assessment in the elderly. J Am Geriatr Soc 31:651–656PubMedGoogle Scholar
  14. 14.
    Heppenstall CP, Wilkinson TJ, Hanger HC, Keeling S (2009) Frailty: dominos or deliberation? N Z Med J 122:42–53PubMedGoogle Scholar
  15. 15.
    Rubenstein LZ, Stuck AE, Siu AL, Wieland D (1991) Impacts of geriatric evaluation and management programs on defined outcomes: overview of the evidence. J Am Geriatr Soc 39:8S–16SPubMedGoogle Scholar
  16. 16.
    Han JH, Zimmerman EE, Cutler N et al (2009) Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes. Acad Emerg Med 16:193–200PubMedCentralPubMedGoogle Scholar
  17. 17.
    Kennedy M, Enander RA, Wolfe RE, Marcantonio ER, Shapiro NI (2012) Identification of delirium in elderly emergency department patients. Acad Emerg Med 19:S147Google Scholar
  18. 18.
    Han JH, Eden S, Shintani A, Morandi A, Schnelle J, Dittus RS, Storrow AB, Ely EW (2011) Delirium in older emergency department patients is an independent predictor of hospital length of stay. Acad Emerg Med 18:451–457PubMedCentralPubMedGoogle Scholar
  19. 19.
    Han JH, Wilber ST (2013) Altered mental status in older patients in the emergency department. Clin Geriatr Med 29:101–136PubMedCentralPubMedGoogle Scholar
  20. 20.
    Kennedy M, Enander RA, Tadiri SP, Wolfe RE, Shapiro NI, Marcantonio ER (2014) Delirium risk prediction, healthcare use and mortality of elderly adults in the emergency department. J Am Geriatr Soc 62:462–469PubMedCentralPubMedGoogle Scholar
  21. 21.
    Gillis NK, Arslanian-Engoren C, Struble LM (2014) Acute coronary syndromes in older adults: a review of literature. J Emerg Nurs 40:270–275PubMedGoogle Scholar
  22. 22.
    Grosmaitre P, Le Vavasseur O, Yachouh E, Courtial Y, Jacob X, Meyran S, Lantelme P (2013) Significance of atypical symptoms for the diagnosis and management of myocardial infarction in elderly patients admitted to emergency departments. Arch Cardiovasc Dis 106:586–592PubMedCentralPubMedGoogle Scholar
  23. 23.
    Hendriksen JM, Geersing GJ, Lucassen WA, Erkens PM, Stoffers HE, van Weert HC, Büller HR, Hoes AW, Moons KG (2015) Diagnostic prediction models for suspected pulmonary embolism: systematic review and independent external validation in primary care. BMJ 351:h4438PubMedCentralPubMedGoogle Scholar
  24. 24.
    Righini M, Le Gal G, Bounameaux H (2015) Venous thromboembolism diagnosis: unresolved issues. Thromb Haemost 113:1184–1192PubMedGoogle Scholar
  25. 25.
    Spangler R, Van Pham T, Khoujah D, Martinez JP (2014) Abdominal emergencies in the geriatric patient. Int J Emerg Med 7:43PubMedCentralPubMedGoogle Scholar
  26. 26.
    Asplund R (2005) Nocturia in relation to sleep, health, and medical treatment in the elderly. BJU Int 96(Suppl 1):15–21PubMedGoogle Scholar
  27. 27.
    Rockwood K, Rockwood MR, Andrew MK, Mitnitski A (2008) Reliability of the hierarchical assessment of balance and mobility in frail older adults. J Am Geriatr Soc 56:1213–1217PubMedGoogle Scholar
  28. 28.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156PubMedCentralPubMedGoogle Scholar
  29. 29.
    Arch AE, Weisman DC, Coca S, Nystrom KV, Wira CR, Schindler JL (2016) Missed ischemic stroke diagnosis in the emergency department by emergency medicine and neurology services. Stroke 47:668–673PubMedGoogle Scholar
  30. 30.
    Coventry LL, Bremner AP, Jacobs IG, Finn J (2013) Myocardial infarction: sex differences in symptoms reported to emergency dispatch. Prehosp Emerg Care 17:193–202PubMedGoogle Scholar
  31. 31.
    Leuthauser A, McVane B (2016) Abdominal pain in the geriatric patient. Emerg Med Clin North Am 34:363–375PubMedGoogle Scholar
  32. 32.
    Canto JG, Shlipak MG, Rogers WJ, Malmgren J, Frederick P, Lambrew CT, Ornato JP, Kiefe CI (2000) Prevalence, clinical characteristics and mortality among patients with myocardial infarction presenting without chest pain. JAMA 283:3223–3229PubMedGoogle Scholar
  33. 33.
    Mussa FF, Horton JD, Moridzadeh R, Nicholson J, Trimarchi S, Eagle KA (2016) Acute aortic dissection and intramural hematoma: a systematic review. JAMA 316:754V763Google Scholar
  34. 34.
    Halawi HM, Maasri KA, Mourad FH, Barada KA (2012) Faecal impaction: in-hospital complications and their predictors in a retrospective study on 130 patients. Color Dis 14:231–236Google Scholar
  35. 35.
    Dickinson M, Leo MM (2014) Geriatric emergency medicine: principles and practice. In: Kahn JH, Maguaran BG Jr, Olshaker JS (eds) Gastrointestinal emergencies in the elderly. Cambridge University Press, New York, pp 207–218Google Scholar
  36. 36.
    Ellis G, Marshall T, Ritchie C (2014) Comprehensive geriatric assessment in the emergency department. Clin Interv Aging 9:2033–2043PubMedCentralPubMedGoogle Scholar
  37. 37.
    Fan JS, Kao WF, Yen DH, Wang LM, Huang CI, Lee CH (2007) Risk factors and prognostic predictors of unexpected intensive care unit admission within 3 days after ED discharge. Am J Emerg Med 25:1009–1014PubMedGoogle Scholar
  38. 38.
    Somes J, Donatelli NS (2013) Pain assessment in the cognitively impaired or demented older adult. J Emerg Nurs 39:164–167PubMedGoogle Scholar
  39. 39.
    Musso CG, Alvarez-Gregori J, Jauregui J, Núñez JF (2015) Are currently GFR estimating equations and standard Kt/V value adequate for advanced chronic kidney disease (CKD) frail elderly patients? Int Urol Nephrol 47:1231–1232PubMedGoogle Scholar
  40. 40.
    Rosner MH (2013) Acute kidney injury in the elderly. Clin Geriatr Med 29:565–578PubMedGoogle Scholar
  41. 41.
    Meyers HP, Limkakeng AT Jr, Jaffa EJ, Patel A, Theiling BJ, Rezaie SR, Stewart T, Zhuang C, Pera VK, Smith SW (2015) Validation of the modified Sgarbossa criteria for acute coronary occlusion in the setting of left bundle branch block: a retrospective case-control study. Am Heart J 170:1255–1264PubMedGoogle Scholar
  42. 42.
    Ayer A, Terkelsen CJ (2014) Difficult ECGs in STEMI: lessons learned from serial sampling of pre- and in-hospital ECGs. J Electrocardiol 47:448–458PubMedGoogle Scholar
  43. 43.
    Menacer S, Claessens YE, Meune C et al (2013) Reference range values of troponin measured by sensitive assays in elderly patients without any cardiac signs/symptoms. Clin Chim Acta 417:45–47PubMedGoogle Scholar
  44. 44.
    Slattery A, Liebelt E, Gaines LA. Common ocular effects reported to a poison control center after systemic absorption of drugs in therapeutic and toxic doses. Curr Opin Ophthalmol. 2014;25(6):519–23.PubMedGoogle Scholar
  45. 45.
    Hanlon JT, Fillenbaum GG, Ruby CM, Gray S, Bohannon A (2001) Epidemiology of over-the-counter drug use in community dwelling elderly: United States perspective. Drugs Aging 18:123–131PubMedGoogle Scholar
  46. 46.
    Hustey FM, Mion LC, Connor JT, Emerman CL, Campbell J, Palmer RM (2007) A brief risk stratification tool to predict functional decline in older adults discharged from emergency departments. J Am Geriatrics Soc 55:1269–1274Google Scholar
  47. 47.
    Zed PJ, Abu-Laban RB, Balen RM, Loewen PS, Hohl CM, Brubacher JR, Wilbur K, Wiens MO, Samoy LJ, Lacaria K, Purssell RA (2008) Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. CMAJ 178:1563–1569PubMedCentralPubMedGoogle Scholar
  48. 48.
    Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA et al (1997) The costs of adverse drug events in hospitalized patients. Adverse drug events prevention study group. JAMA 277:307PubMedGoogle Scholar
  49. 49.
    Johnson JA, Bootman JL (1995) Drug-related morbidity and mortality. A cost-of-illness model. Arch Int Med 155:1949–1956Google Scholar
  50. 50.
    Budnitz DS, Lovegrove MC, Shehab N, Richards CL (2011) Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 365:2002–2012PubMedGoogle Scholar
  51. 51.
    Geller AI, Shehab N, Weidle NJ, Lovegrove MC, Wolpert BJ, Timbo BB, Mozersky RP, Budnitz DS (2015) Emergency department visits for adverse events related to dietary supplements. N Engl J Med 373:1531–1540PubMedGoogle Scholar
  52. 52.
    Sardar GK, Eilbert WP (2015) Severe hyponatremia associated with thiazide diuretic use. J Emerg Med 48(3):305–309PubMedGoogle Scholar
  53. 53.
    Brown JD, Hutchison LC, Li C, Painter JT, Martin BC (2016) Predictive validity of the beers and screening tool of older persons’ potentially inappropriate prescriptions (STOPP) criteria to detect adverse drug events, hospitalizations, and emergency department visits in the United States. J Am Geriatr Soc 64:22–30PubMedCentralPubMedGoogle Scholar
  54. 54.
    American Geriatrics Society 2012 Beers Criteria Update Expert Panel (2012) American Geriatrics Society updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 60:616–631Google Scholar
  55. 55.
    Gallagher P, O’Mahony D (2008) STOPP (screening tool of older persons’ potentially inappropriate prescriptions): application to acutely ill elderly patients and comparison with beers’ criteria. Age Ageing 37:673–679PubMedGoogle Scholar
  56. 56.
    Hill-Taylor B, Walsh KA, Stewart S, Hayden J, Byrne S, Sketris IS (2016) Effectiveness of the STOPP/START (screening tool of older persons’ potentially inappropriate prescriptions/screening tool to alert doctors to the right treatment) criteria: systematic review and meta-analysis of randomized controlled studies. J Clin Pharm Ther 41:158–169PubMedGoogle Scholar
  57. 57.
    Becerra-Camargo J, Martínez-Martínez F, García-Jiménez E (2015) The effect on potential adverse drug events of a pharmacist-acquired medication history in an emergency department: a multicentre, double-blind, randomised, controlled, parallel-group study. BMC Health Serv Res 15:337PubMedCentralPubMedGoogle Scholar
  58. 58.
    Polverino E, Torres A, Menendez R, Cilloniz C, Valles JM, Capelastegui A et al (2013) Microbial aetiology of healthcare associated pneumonia in Spain: a prospective, multicentre, case-control study. Thorax 68:1007–1014PubMedGoogle Scholar
  59. 59.
    Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of Adl: a standardized measure of biological and psychosocial function. JAMA 185:914–919Google Scholar
  60. 60.
    Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186Google Scholar
  61. 61.
    Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65Google Scholar
  62. 62.
    McCusker J, Bellavance F, Cardin S, Trépanier S, Verdon J, Ardman O (1999) Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc 47:1229–1237PubMedGoogle Scholar
  63. 63.
    Nydegger UE, Luginbühl M, Risch M (2015) The aging human recipient of transfusion products. Transfus Apher Sci 52:290–294PubMedGoogle Scholar
  64. 64.
    Overdyk F, Dahan A, Roozekrans M, van der Schrier R, Aarts L, Niesters M (2014) Opioid-induced respiratory depression in the acute care setting: a compendium of case reports. Pain Manag 4:317–325PubMedGoogle Scholar
  65. 65.
    Rockwood K (2005) Frailty and its definition: a worthy challenge. J Am Geriatr Soc 53:1069–1070PubMedGoogle Scholar
  66. 66.
    Wallis SJ, Wall J, Biram RW, Romero-Ortuno R (2015) Association of the clinical frailty scale with hospital outcomes. QJM 108:943–949PubMedGoogle Scholar
  67. 67.
    Calvani R, Marini F, Cesari M, Tosato M, Anker SD, von Haehling S, Miller RR, Bernabei R, Landi F, Marzetti E, SPRINTT consortium (2015) Biomarkers for physical frailty and sarcopenia: state of the science and future developments. J Cachexia Sarcopenia Muscle 6:278–286PubMedCentralPubMedGoogle Scholar
  68. 68.
    Du Y, Karvellas CJ, Baracos V, Williams DC, Khadaroo RG, Acute Care and Emergency Surgery (ACES) Group (2014) Sarcopenia is a predictor of outcomes in very elderly patients undergoing emergency surgery. Surgery 156:521–527PubMedGoogle Scholar
  69. 69.
    Avila-Funes JA, Amieva H, Barberger-Gateau P, Le Goff M, Raoux N, Ritchie K et al (2009) Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: the three-city study. J Am Geriatr Soc 57:453–461PubMedGoogle Scholar
  70. 70.
    Eeles EM, White SV, O'Mahony SM, Bayer AJ, Hubbard RE (2012) The impact of frailty and delirium on mortality in older inpatients. Age Ageing 41:412–416PubMedGoogle Scholar
  71. 71.
    Cartagena LJ, Kang A, Munnangi S, Jordan A, Nweze IC, Sasthakonar V, Boutin A, George Angus LD (2016) Risk factors associated with in-hospital mortality in elderly patients admitted to a regional trauma center after sustaining a fall. Aging Clin Exp Res 29(3):427–433. doi:10.1007/s40520-016-0579-5 CrossRefPubMedGoogle Scholar
  72. 72.
    Röhrig G (2016) Anemia in the frail, elderly patient. Clin Interv Aging 11:319–326PubMedCentralPubMedGoogle Scholar
  73. 73.
    Guyonnet S, Secher M, Vellas B (2015) Nutrition, frailty, cognitive frailty and prevention of disabilities with aging. Nestle Nutr Inst Workshop Ser 82:143–152PubMedGoogle Scholar
  74. 74.
    Gómez C, Vega-Quiroga S, Bermejo-Pareja F, Medrano MJ, Louis ED, Benito-León J (2015) Polypharmacy in the elderly: a marker of increased risk of mortality in a population-based prospective study (NEDICES). Gerontology 61:301–309PubMedGoogle Scholar
  75. 75.
    Dramé M, Lang PO, Jolly D, Narbey D, Mahmoudi R, Lanièce I, Somme D, Gauvain JB, Heitz D, Voisin T, de Wazières B, Gonthier R, Ankri J, Saint-Jean O, Jeandel C, Couturier P, Blanchard F, Novella JL (2012) Nursing home admission in elderly subjects with dementia: predictive factors and future challenges. J Am Med Dir Assoc 13:83PubMedGoogle Scholar
  76. 76.
    Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. Lancet 381:752–762Google Scholar
  77. 77.
    Ellis G, Whitehead MA, Robinson D, O’Neill D, Langhorne P (2011) Comprehensive geriatric assessment for older adults admitted to hospital: metaanalysis of randomised controlled trials. BMJ 343:d6553PubMedCentralPubMedGoogle Scholar
  78. 78.
    Ellis G, Whitehead MA, O’Neill D, Langhorne P, Robinson D (2011) Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev 7:CD006211Google Scholar
  79. 79.
    Kline JA, Courtney DM, Kabrhel C, Moore CL, Smithline HA, Plewa MC, Richman PB, O’Neil BJ, Nordenholz K (2008) Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost 6:772–780PubMedGoogle Scholar
  80. 80.
    Limpawattana P, Phungoen P, Mitsungnern T, Laosuangkoon W, Tansangworn N (2016) Atypical presentations of older adults at the emergency department and associated factors. Arch Gerontol Geriatr 62:97–102PubMedCentralPubMedGoogle Scholar
  81. 81.
    Hofman SE, Lucke JA, Heim N, de Gelder J, Fogteloo AJ, Heringhaus C, de Groot B, de Craen AJ, Blauw GJ, Mooijaart SP (2016) Prediction of 90-day mortality in older patients after discharge from an emergency department: a retrospective follow-up study. BMC Emerg Med 16:26PubMedCentralPubMedGoogle Scholar
  82. 82.
    Kim SY, Jeong TD, Lee W, Chun S, Min WK (2015) Procalcitonin in the assessment of bacteraemia in emergency department patients: results of a large retrospective study. Ann Clin Biochem 52:654–659PubMedGoogle Scholar
  83. 83.
    Guo F, Xu T, Wang H (2009) Early recognition of myxedematous respiratory failure in the elderly. Am J Emerg Med 27:212–215PubMedGoogle Scholar
  84. 84.
    Lesperance ME, Bell SE, Ervin NE (2005) Heart failure and weight gain monitoring. Lippincotts Case Manage 10:287–293Google Scholar
  85. 85.
    Miro J, Huguet A, Nieto R, Paredes S, Baos J (2005) Evaluation of reliability, validity, and preference for a pain intensity scale for use with the elderly. J Pain 6:727–735PubMedGoogle Scholar
  86. 86.
    Platts-Mills TF, Flannigan SA, Bortsov AV, Smith S, Domeier RM, Swor RA, Hendry PL, Peak DA, Rathlev NK, Jones JS, Lee DC, Keefe FJ, Sloane PD, SA ML (2016) Persistent pain among older adults discharged home from the emergency department after motor vehicle crash: a prospective cohort study. Ann Emerg Med 67:166–176.e1PubMedGoogle Scholar
  87. 87.
    Mosele M, Inelmen EM, Toffanello ED, Girardi A, Coin A, Sergi G, Manzato E (2012) Psychometric properties of the pain assessment in advanced dementia scale compared to self assessment of pain in elderly patients. Dement Geriatr Cogn Disord 34:38–43PubMedGoogle Scholar
  88. 88.
    Platts-Mills TF, Esserman DA, Brown DL, Bortsov AV, Sloane PD, McLean SA (2014) Older US emergency department patients are less likely to receive pain medication than younger patients: results from a national survey. Ann Emerg Med 60:199–206Google Scholar
  89. 89.
    van der Steen JT, Sampson EL, Van den Block L, Lord K, Vankova H, Pautex S, Vandervoort A, Radbruch L, Shvartzman P, Sacchi V, de Vet HC, Van Den Noortgate NJ, EU-COST Action TD1005 Collaborators (2015) Tools to assess pain or lack of comfort in dementia: a content analysis. J Pain Symptom Manag 50:65975.e3Google Scholar
  90. 90.
    Cooper L, Vellodi C, Stansby G, Avital L (2015) The prevention and management of pressure ulcers: summary of updated NICE guidance. J Wound Care 24:179–181PubMedGoogle Scholar
  91. 91.
    Cohen RR, Lagoo-Deenadayalan SA, Heflin MT, Sloane R, Eisen I, Thacker JM, Whitson HE (2012) Exploring predictors of complication in older surgical patients: a deficit accumulation index and the Braden Scale. J Am Geriatr Soc 60(9):1609–1615PubMedCentralPubMedGoogle Scholar
  92. 92.
    Ely EW, Truman B, Shintani A et al (2003) Monitoring sedation status over time in ICU patients: reliability and validity of the richmond agitation-sedation scale (RASS). JAMA 289:2983–2991Google Scholar
  93. 93.
    Han JH, Wilson A, Graves AJ, Shintani A, Schnelle JF, Dittus RS, Powers JS, Vernon J, Storrow AB, Ely EW (2014) Validation of the confusion assessment method for the intensive care unit in older emergency department patients. Acad Emerg Med 21:180–187PubMedCentralPubMedGoogle Scholar
  94. 94.
    Han JH, Vasilevskis EE, Schnelle JF, Shintani A, Dittus RS, Wilson A, Ely EW (2015) The diagnostic performance of the richmond agitation sedation scale for detecting delirium in older emergency department patients. Acad Emerg Med 22:878–882PubMedCentralPubMedGoogle Scholar
  95. 95.
    Morandi A, Han JH, Meagher D, Vasilevskis E, Cerejeira J, Hasemann W, MacLullich AM, Annoni G, Trabucchi M, Bellelli G (2016) Detecting delirium superimposed on dementia: evaluation of the diagnostic performance of the richmond agitation and sedation scale. J Am Med Dir Assoc 17(9):828–833PubMedCentralPubMedGoogle Scholar
  96. 96.
    Van de Meeberg EK, Festen S, Kwant M, Georg RR, Izaks GJ, Ter Maaten JC (2016) Improved detection of delirium, implementation and validation of the CAM-ICU in elderly emergency department patients. Eur J Emerg Med. doi:10.1097/MEJ.0000000000000380 PubMedGoogle Scholar
  97. 97.
    Hustey FM, Meldon SW, Smith MD, Lex CK (2003) The effect of mental status screening on the care of elderly emergency department patients. Ann Emerg Med 41:678–684PubMedGoogle Scholar
  98. 98.
    Davis KK, Allen JK (2013) Identifying cognitive impairment in heart failure: a review of screening measures. Heart Lung 42:92–97PubMedGoogle Scholar
  99. 99.
    Kirby M, Denihan A, Bruce I, Coakley D, Lawlor BA (2001) The clock drawing test in primary care: sensitivity in dementia detection and specificity against normal and depressed elderly. Int J Geriatr Psychiatry 16:935–940PubMedGoogle Scholar
  100. 100.
    Callahan CM, Unverzagt FW, Hui SL, Perkins AJ, Hendrie HC (2002) Six-item screener to identify cognitive impairment among potential subjects for clinical research. Med Care 40:771–781PubMedGoogle Scholar
  101. 101.
    Wilber ST, Lofgren SD, Mager TG, Blanda M, Gerson LW (2005) An evaluation of two screening tools for cognitive impairment in older emergency department patients. Acad Emerg Med 12:612–616PubMedGoogle Scholar
  102. 102.
    Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A (2000) The mini-cog: a cognitive “vital signs” measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry 15:1021–1027PubMedGoogle Scholar
  103. 103.
    Scanlan J, Borson S (2001) The mini-cog: receiver operating characteristics with expert and naive raters. Int J Geriatr Psychiatry 16:216–222PubMedGoogle Scholar
  104. 104.
    Lin JS, O’Connor E, Rossom RC, Perdue LA, Eckstrom E (2013) Screening for cognitive impairment in older adults: a systematic review for the U.S. preventive services task force. Ann Intern Med 159:601–612PubMedGoogle Scholar
  105. 105.
    McCabe JJ, Kennelly SP (2015) Acute care of older patients in the emergency department: strategies to improve patient outcomes. Open Access Emerg Med 7:45–54PubMedCentralPubMedGoogle Scholar
  106. 106.
    Choi NG, Marti CN, Bruce ML, Kunik ME (2012) Relationship between depressive symptom severity and emergency department use among low-income, depressed homebound older adults aged 50 years and older. BMC Psychiatry 12:233PubMedCentralPubMedGoogle Scholar
  107. 107.
    Lutwak N, Dill C (2012) A depressed post-menopausal woman. J Emerg Med 43:815–819PubMedGoogle Scholar
  108. 108.
    Arroll B, Goodyear-Smith F, Kerse N, Fishman T, Gunn J (2005) Effect of the addition of a “help” question to two screening questions on specificity for diagnosis of depression in general practice: diagnostic validity study. BMJ 331:884PubMedCentralPubMedGoogle Scholar
  109. 109.
    Sheth TN, Choudhry NK, Bowes M, Detsky AS (1997) The relation of conjunctival pallor to the presence of anemia. J Gen Intern Med 12:102–106PubMedCentralPubMedGoogle Scholar
  110. 110.
    Porath-Waller AJ, Beirness DJ (2010) Simplifying the process for identifying drug combinations by drug recognition experts. Traffic Inj Prev 11(5):453–459. doi:10.1080/15389588.2010.489199 PubMedGoogle Scholar
  111. 111.
    Scheffer AC, van Hensbroek PB, van Dijk N, Luitse JS, Goslings JC, Luigies RH, de Rooij SE (2013) Risk factors associated with visiting or not visiting the accident & emergency department after a fall. BMC Health Serv Res 13:286PubMedCentralPubMedGoogle Scholar
  112. 112.
    Chou R, Dana T, Bougatsos C (2009) Screening older adults for impaired visual acuity: a review of the evidence for the U.S. preventive services task force. Ann Int Med 151:44–58PubMedGoogle Scholar
  113. 113.
    Demers K (2013) Hearing screening in older adults: a brief hearing loss screener. In: Try this: best practices in nursing care to older adults. Hartford Institute for Geriatric Nursing, College of Nursing, New York University, New York:issue 12Google Scholar
  114. 114.
    Suzuki T, Lyon A, Saggar R, Heaney LM, Aizawa K, Cittadini A, Mauro C, Citro R, Limongelli G, Ferrara F, Vriz O, Morley-Smith A, Calabrò P, Bossone E (2016) Editor’s Choice-Biomarkers of acute cardiovascular and pulmonary diseases. Eur Heart J Acute Cardiovasc Care 5(5):416–433Google Scholar
  115. 115.
    Collamati A, Martone AM, Poscia A, Brandi V, Celi M, Marzetti E, Cherubini A, Landi F (2016) Anticholinergic drugs and negative outcomes in the older population: from biological plausibility to clinical evidence. Aging Clin Exp Res 28:25–35PubMedGoogle Scholar
  116. 116.
    Roulet L, Ballereau F, Hardouin JB, Chiffoleau A, Potel G, Asseray N (2014) Adverse drug event nonrecognition in emergency departments: an exploratory study on factors related to patients and drugs. J Emerg Med 46:857–864PubMedGoogle Scholar
  117. 117.
    Salvi F, Miller MD, Grilli A, Giorgi R, Towers AL, Morichi V, Spazzafumo L, Mancinelli L, Espinosa E, Rappelli A, Dessì-Fulgheri P (2008) A manual of guidelines to score the modified cumulative illness rating scale and its validation in acute hospitalized elderly patients. J Am Geriatr Soc 56:1926–1931Google Scholar
  118. 118.
    de Venecia TA, Lu MY, Nwakile CC, Figueredo VM (2015) Utility of the QT interval in predicting outcomes in patients presenting to the emergency department with chest pain. Coron Artery Dis 26:422–424PubMedGoogle Scholar
  119. 119.
    Huang HH, Chang YC, Yen DH, Kao WF, Chen JD, Wang LM, Huang CI, Lee CH (2005) Clinical factors and outcomes in patients with acute mesenteric ischemia in the emergency department. J Chin Med Assoc 68:299–306PubMedGoogle Scholar
  120. 120.
    Chen YC, Fan JS, Chen MH, Hsu TF, Huang HH, Cheng KW, Yen DH, Huang CI, Chen LK, Yang CC (2014) Risk factors associated with adverse drug events among older adults in emergency department. Eur J Int Med 25:49–55Google Scholar
  121. 121.
    Bafadhel M, Clark TW, Reid C, Medina MJ, Batham S, Barer MR, Nicholson KG, Brightling CE (2011) Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or COPD. Chest 139:1410–1418PubMedGoogle Scholar
  122. 122.
    Albazzaz MK, Pal C, Berman P, Shale DJ. Inflammatory markers of lower respiratory tract infection in elderly people. Age Ageing. 1994;23(4):299–302.PubMedGoogle Scholar
  123. 123.
    Haran JP, Beaudoin FL, Suner S, Lu S. C-reactive protein as predictor of bacterial infection among patients with an influenza-like illness. Am J Emerg Med. 2013 Jan;31(1):137–44.PubMedGoogle Scholar
  124. 124.
    Hortmann M, Singler K, Geier F, Christ M (2015) Recognition of infections in elderly emergency patients. Z Gerontol Geriatr 48:601–607PubMedGoogle Scholar
  125. 125.
    Schuetz P, Daniels LB, Kulkarni P, Anker SD, Mueller B (2016) Procalcitonin: a new biomarker for the cardiologist. Int J Cardiol 223:390–397PubMedGoogle Scholar
  126. 126.
    Zarnescu NO, Costea R, Zarnescu Vasiliu EC, Neagu S (2015) Clinico-biochemical factors to early predict biliary etiology of acute pancreatitis: age, female gender, and ALT. J Med Life 8:523–526PubMedCentralPubMedGoogle Scholar
  127. 127.
    Moon J, Kang W, Oh PC, Seo SY, Lee K, Han SH, Ahn T, Shin E (2014) Serum transaminase determined in the emergency room predicts outcomes in patients with acute ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention. Int J Cardiol 177:442–447PubMedGoogle Scholar
  128. 128.
    Moreira-Silva S, Urbano J, Moura MC, Ferreira-Coimbra J, Bettencourt P, Pimenta J (2016) Liver cytolysis in acute heart failure: what does it mean? Clinical profile and outcomes of a prospective hospital cohort. Int J Cardiol 221:422–427PubMedGoogle Scholar
  129. 129.
    Weibrecht K, Dayno M, Darling C, Bird SB (2010) Liver aminotransferases are elevated with rhabdomyolysis in the absence of significant liver injury. J Med Toxicol 6(3):294–300PubMedCentralPubMedGoogle Scholar
  130. 130.
    Burra P (2013) Liver abnormalities and endocrine diseases. Best Pract Res Clin Gastroenterol 27:553–563PubMedGoogle Scholar
  131. 131.
    Fontana RJ, Hayashi PH, Barnhart H, Kleiner DE, Reddy KR, Chalasani N, Lee WM, Stolz A, Phillips T, Serrano J, Watkins PB (2015) DILIN investigators. Persistent liver biochemistry abnormalities are more common in older patients and those with cholestatic drug induced liver injury. Am J Gastroenterol 110:1450–1459PubMedCentralPubMedGoogle Scholar
  132. 132.
    McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, McDonagh T, Sechtem U, Bonet LA, Avraamides P, Ben Lamin HA, Brignole M, Coca A, Cowburn P, Dargie H, Elliott P, Flachskampf FA, Guida GF, Hardman S, Iung B, Merkely B, Mueller C, Nanas JN, Nielsen OW, Orn S, Parissis JT, Ponikowski P, ESC Committee for Practice Guidelines (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the heart failure association (HFA) of the ESC. Eur J Heart Fail 14:803–869PubMedGoogle Scholar
  133. 133.
    Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ, ESC Committee for Practice Guidelines (2014) 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European society of cardiology (ESC). Eur Heart J 35:2873–2926Google Scholar
  134. 134.
    Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, Gibbs JS, Huisman MV, Humbert M, Kucher N, Lang I, Lankeit M, Lekakis J, Maack C, Mayer E, Meneveau N, Perrier A, Pruszczyk P, Rasmussen LH, Schindler TH, Svitil P, Vonk Noordegraaf A, Zamorano JL, Zompatori M, Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) (2014) 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35:3033–3069PubMedGoogle Scholar
  135. 135.
    Righini M, Van Es J, Den Exter PL, Roy PM, Verschuren F, Ghuysen A, Rutschmann OT, Sanchez O, Jaffrelot M, Trinh-Duc A, Le Gall C, Moustafa F, Principe A, Van Houten AA, Ten Wolde M, Douma RA, Hazelaar G, Erkens PM, Van Kralingen KW, Grootenboers MJ, Durian MF, Cheung YW, Meyer G, Bounameaux H, Huisman MV, Kamphuisen PW, Le Gal G (2014) Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA 311:1117–1124PubMedGoogle Scholar
  136. 136.
    Schouten HJ, Geersing GJ, Koek HL, Zuithoff NP, Janssen KJ, Douma RA, van Delden JJ, Moons KG, Reitsma JB (2013) Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis. BMJ 346:f2492PubMedCentralPubMedGoogle Scholar
  137. 137.
    van der Does Y, Rood PP, Haagsma JA, Patka P, van Gorp EC, Limper M (2016) Procalcitonin-guided therapy for the initiation of antibiotics in the ED: a systematic review. Am J Emerg Med 34:1286–1293PubMedGoogle Scholar
  138. 138.
    Park JH, Wee JH, Choi SP, Oh SH (2012) The value of procalcitonin level in community-acquired pneumonia in the ED. Am J Emerg Med 30:1248–1254PubMedGoogle Scholar
  139. 139.
    Ko BS, Ryoo SM, Ahn S, Sohn CH, Seo DW, Kim WY (2016) Usefulness of procalcitonin level as an outcome predictor of adult bacterial meningitis. Intern Emerg Med. doi:10.1007/s11739-016-1509-4 PubMedGoogle Scholar
  140. 140.
    Arora S, Singh P, Singh PM, Trikha A (2015) Procalcitonin levels in survivors and nonsurvivors of sepsis: systematic review and meta-analysis. Shock 43:212–221PubMedGoogle Scholar
  141. 141.
    de Azevedo JR, Torres OJ, Beraldi RA, Ribas CA, Malafaia O (2015) Prognostic evaluation of severe sepsis and septic shock: procalcitonin clearance vs Δ sequential organ failure assessment. J Crit Care 30:219.e9–219.12Google Scholar
  142. 142.
    Metersky ML, Williams A, Rafanan AL (1997) Retrospective analysis: are fever and altered mental status indications for lumbar puncture in a hospitalized patient who has not undergone neurosurgery? Clin Infect Dis 25:285–288PubMedGoogle Scholar
  143. 143.
    DeGrauw X, Annest JL, Stevens JA, Xu L, Coronado V (2016) Unintentional injuries treated in hospital emergency departments among persons aged 65 years and older, United States, 2006–2011. J Saf Res 56:105–109Google Scholar
  144. 144.
    Bonne S, Schuerer DJ (2013) Trauma in the older adult: epidemiology and evolving geriatric trauma principles. Clin Geriatr Med 29:137–150PubMedGoogle Scholar
  145. 145.
    Keller JM, Sciadini MF, Sinclair E, O’Toole RV (2012) Geriatric trauma: demographics, injuries, and mortality. J Orthop Trauma 26:e161–e165PubMedGoogle Scholar
  146. 146.
    Pfortmueller CA, Kunz M, Lindner G, Zisakis A, Puig S, Exadaktylos AK (2014) Fall-related emergency department admission: fall environment and settings and related injurypatterns in 6357 patients with special emphasis on the elderly. Sci World J 2014:256519Google Scholar
  147. 147.
    Southerland LT, Stephens JA, Robinson S, Falk J, Phieffer L, Rosenthal JA, Caterino JM (2016) Head trauma from falling increases subsequent emergency department visits more than other fall-related injuries in older adults. J Am Geriatr Soc 64:870–874PubMedCentralPubMedGoogle Scholar
  148. 148.
    Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI (2000) Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National emergency X-radiography utilization study group. N Engl J Med 343:94–99Google Scholar
  149. 149.
    Kavalci C, Aksel G, Salt O, Yilmaz MS, Demir A, Kavalci G, Akbuga Ozel B, Altinbilek E, Durdu T, Yel C, Durukan P, Isik B (2014) Comparison of the Canadian CT head rule and the new orleans criteria in patients with minorhead injury. World J Emerg Surg 9:31PubMedCentralPubMedGoogle Scholar
  150. 150.
    Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A (2001) The Canadian CT head rule for patients with minor head injury. Lancet 357:1391–1396PubMedGoogle Scholar
  151. 151.
    Tran J, Jeanmonod D, Agresti D, Hamden K, Jeanmonod RK (2016) Prospective validation of modified NEXUS cervical spine injury criteria in low-risk elderly fall patients. West J Emerg Med 17:252–257PubMedCentralPubMedGoogle Scholar
  152. 152.
    Ariza-Vega P, Jiménez-Moleón JJ, Kristensen MT (2014) Non-weight-bearing status compromises the functional level up to 1 yr after hip fracturesurgery. Am J Phys Med Rehabil 93:641–648PubMedGoogle Scholar
  153. 153.
    Di Monaco M, Castiglioni C, De Toma E, Gardin L, Giordano S, Tappero R (2015) Handgrip strength is an independent predictor of functional outcome in hip-fracture women: a prospective study with 6-month follow-up. Medicine (Baltimore) 94:e542Google Scholar
  154. 154.
    He D, Xue Y, Li Z, Tang Y, Ding H, Yang Z, Zhang C, Zhou H, Zhao Y, Zong Y (2014) Effect of depression on femoral head avascular necrosis from femoral neck fracture in patients younger than 60 years. Orthopedics 37:e244–e251PubMedGoogle Scholar
  155. 155.
    Blain H, Masud T, Dargent-Molina P, Martin FC, Rosendahl E, van der Velde N, Bousquet J, Benetos A, Cooper C, Kanis JA, Reginster JY, Rizzoli R, Cortet B, Barbagallo M, Dreinhöfer KE, Vellas B, Maggi S, Strandberg T, EUGMS Falls and Fracture Interest Group, European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO), Osteoporosis Research and Information Group (GRIO), International osteoporosis Foundation (IOF) (2016) A comprehensive fracture prevention strategy in older adults: the European Union geriatric medicine society (EUGMS) statement. J Nutr Health Aging 20:647–652PubMedCentralPubMedGoogle Scholar
  156. 156.
    American Geriatrics Society, British Geriatrics Society (2011) Panel on prevention of falls in older persons. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 59:148–157Google Scholar
  157. 157.
    Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 9:CD007146Google Scholar
  158. 158.
    Ageron FX, Ricard C, Perrin-Besson S, Picot F, Dumont O, Cabillic S, Haesevoet M, Dalmon P, Gaillard C, Cezard O, Belle L, Couturier P (2016) Effectiveness of a multimodal intervention program for older individuals presenting to the emergency department after a fall in the northern French alps emergency network. Acad Emerg Med 23(9):1031–1039. doi:10.1111/acem.12989 CrossRefPubMedGoogle Scholar
  159. 159.
    Lewis LM, Banet GA, Blanda M, Hustey FM, Meldon SW, Gerson LW (2005) Etiology and clinical course of abdominal pain in senior patients: a prospective, multicenter study. J Gerontol A Biol Sci Med Sci 60:1071–1076PubMedGoogle Scholar
  160. 160.
    Laurell H, Hansson LE, Gunnarsson U (2006) Acute abdominal pain among elderly patients. Gerontology 52:339–444PubMedGoogle Scholar
  161. 161.
    Millet I et al. (2017) Systematic unenhanced CT for acute abdominal symptoms in the elderly patients improves both emergency department diagnosis and prompt clinical management. Eur Radiol 27(2):868–877PubMedGoogle Scholar
  162. 162.
    Segev L, Keidar A, Schrier I, Rayman S, Wasserberg N, Sadot E (2015) Acute appendicitis in the elderly in the twenty-first century. J Gastrointest Surg 19:730–735PubMedGoogle Scholar
  163. 163.
    Schnitker LM, Martin-Khan M, Burkett E, Brand CA, Beattie ER, Jones RN, Gray LC (2015) Research collaboration for quality care of older persons: emergency care panel. Structural quality indicators to support quality of care for older people with cognitive impairment in emergency departments. Acad Emerg Med 22:273–284PubMedGoogle Scholar
  164. 164.
    Guttman A, Afilalo M, Guttman R et al (2004) An emergency department-based nurse discharge coordinator for elder patients: does it make a difference? Acad Emerg Med 11:1318–1327PubMedGoogle Scholar
  165. 165.
    Hegney D, Buikstra E, Chamberlain C et al (2006) Nurse discharge planning in the emergency department: a Toowoomba, Australia, study. J Clin Nurs 15:1033–1044PubMedGoogle Scholar
  166. 166.
    Miller DK, Lewis LM, Nork MJ, Morley JE (1996) Controlled trial of a geriatric case-finding and liaison service in an emergency department. J Am Geriatr Soc 44:513–520PubMedGoogle Scholar
  167. 167.
    Mion LC, Palmer RM, Meldon SW et al (2003) Case finding and referral model for emergency department elders: a randomized clinical trial. Ann Emerg Med 41:57–68PubMedGoogle Scholar
  168. 168.
    Moss JE, Flower CL, Houghton LM, Moss DL, Nielsen DA, Taylor DM (2002) A multidisciplinary care coordination team improves emergency department discharge planning practice. Med J Aust 177:435–439PubMedGoogle Scholar
  169. 169.
    Ballabio C, Bergamaschini L, Mauri S, Baroni E, Ferretti M, Bilotta C, Vergani C (2008) A comprehensive evaluation of elderly people discharged from an emergency department. Intern Emerg Med 3:245–249PubMedGoogle Scholar
  170. 170.
    Bird SR, Kurowski W, Dickman GK, Kronborg I (2007) Integrated care facilitation for older patients with complex health care needs reduces hospital demand. Aust Health Rev 31:451–461. discussion 449–450PubMedGoogle Scholar
  171. 171.
    Caplan GA, Williams AJ, Daly B, Abraham K (2004) A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department – the DEED II study. J Am Geriatr Soc 52:1417–1423PubMedGoogle Scholar
  172. 172.
    Lee JS, Hurley MJ, Carew D, Fisher R, Kiss A, Drummond N (2007) A randomized clinical trial to assess the impact on an emergency response system on anxiety and health care use among older emergency patients after a fall. Acad Emerg Med 14:301–308PubMedGoogle Scholar
  173. 173.
    McCusker J, Verdon J, Tousignant P, de Courval LP, Dendukuri N, Belzile E (2001) Rapid emergency department intervention for older people reduces risk of functional decline: results of a multicenter randomized trial. J Am Geriatr Soc 49:1272–1281PubMedGoogle Scholar
  174. 174.
    Mion LC, Palmer RM, Anetzberger GJ, Meldon SW (2001) Establishing a case-finding and referral system for at-risk older individuals in the emergency department setting: the SIGNET model. J Am Geriatr Soc 49:1379–1386PubMedGoogle Scholar
  175. 175.
    Salvi F, Morichi V, Lorenzetti B, Rossi L, Spazzafumo L, Luzi R, De Tommaso G, Lattanzio F (2012) Risk stratification of older patients in the emergency department: comparison between the identification of seniors at risk and triage risk screening tool. Rejuvenation Res 15:288–294PubMedGoogle Scholar
  176. 176.
    Sirois MJ, Griffith L, Perry J, Daoust R, Veillette N, Lee J, Pelletier M, Wilding L, Émond M (2017) Measuring frailty can help emergency departments identify independent seniors at risk of functional decline after minor injuries. J Gerontol A Biol Sci Med Sci 72(1):68–74Google Scholar
  177. 177.
    Yao JL, Fang J, Lou QQ, Anderson RM (2015) A systematic review of the identification of seniors at risk (ISAR) tool for the prediction of adverse outcome in elderly patients seen in the emergency department. Int J Clin Exp Med 8:4778–4786PubMedCentralPubMedGoogle Scholar
  178. 178.
    Beland F, Bergman H, Lebel P, Dallaire L (2006) Integrated services for frail elders (SIPA): a trial of a model for Canada. Can J Aging 25:5–42PubMedGoogle Scholar
  179. 179.
    Kodner DL (2006) Whole-system approaches to health and social care partnerships for the frail elderly: an exploration of north American models and lessons. Health Soc Care Community 14:384–390PubMedGoogle Scholar
  180. 180.
    Lowthian JA, McGinnes RA, Brand CA, Barker AL, Cameron PA (2015) Discharging older patients from the emergency department effectively: a systematic review and meta-analysis. Age Ageing 44:761–770PubMedGoogle Scholar
  181. 181.
    Tirrell G, Sri-on J, Lipsitz LA, Camargo CA Jr, Kabrhel C, Liu SW (2015) Evaluation of older adult patients with falls in the emergency department: discordance with national guidelines. Acad Emerg Med 22:461–467PubMedGoogle Scholar
  182. 182.
    Glendinning C (2003) Breaking down barriers: integrating health and care services for older people in England. Health Policy (New York) 65:139–151Google Scholar
  183. 183.
    Sanders AB (1992) Care of the elderly in emergency departments: conclusions and recommendations. Ann Emerg Med 21:830–834PubMedGoogle Scholar
  184. 184.
    Carpenter CR, Bromley M, Caterino JM, Chun A, Gerson LW, Greenspan J, Hwang U, John DP, Lyons WL, Platts-Mills TF, Mortensen B, Ragsdale L, Rosenberg M, Wilber S (2014) Optimal older adult emergency care: introducing multidisciplinary geriatric emergency department guidelines from the American College of Emergency Physicians, American Geriatrics Society, emergency nurses association, and Society for Academic Emergency Medicine. Acad Emerg Med 21:806–809PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  • Hubert Blain
    • 1
  • Abdelouahab Bellou
    • 2
  • Mehmet Akif Karamercan
    • 3
  • Jacques Boddaert
    • 4
  1. 1.Department of Internal Medicine and Geriatrics, Faculty of MedicineUniversity Hospital of Montpelier, Montpellier University, MacVia-LRMontpelierFrance
  2. 2.Department of Emergency MedicineBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonUSA
  3. 3.Emergency Medicine DepartmentGazi University School of MedicineAnkaraTurkey
  4. 4.Unit of Peri-Operative Geriatric Care (UPOG), Geriatric Department Pitié-Salpêtrière Hospital47-83 Bd de l’Hôpital (APHP) DHU Fighting Aging and Stress (FAST) CNRS UMR 8256 Pierre et Marie Curie University (UPMC Paris 6)ParisFrance

Personalised recommendations