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Background: Persons living with dementia (PLWD) experience frequent and costly emergency department (ED) visits, with poor outcomes attributed to suboptimal care and postdischarge care transitions. Yet, patient‐centered data on ED care experiences and postdischarge needs are lacking. The objective of this study was to examine the facilitators and barriers to successful ED care and care transitions after discharge, according to PLWD and their caregivers. Methods: We conducted a qualitative study involving ED patients ages 65 and older with confirmed or suspected dementia and their caregivers. The semistructured interview protocol followed the National Quality Forum's ED Transitions of Care Framework and addressed ED care, care transitions, and outpatient follow‐up care. Interviews were conducted during an ED visit at an urban, academic ED. Traditional thematic analysis was used to identify themes. Results: We interviewed 11 patients and 19 caregivers. Caregivers were more forthcoming than patients about facilitators and challenges experienced. Characteristics of the patients' condition (e.g., resistance to care, forgetfulness), the availability of family resources (e.g., caregiver availability, primary care access), and system‐level factors (e.g., availability of timely appointments, hospital policies tailored to persons with dementia) served as facilitators and barriers to successful care. Some resources that would ameliorate care transition barriers could be easily provided in the ED, for example, offering clear discharge instructions and care coordination services and improving patient communication regarding disposition timeline. Other interventions would require investment from other parts of the health care system (e.g., respite for caregivers, broader insurance coverage). Conclusions: ED care and care transitions for PLWD are suboptimal, and patient‐level factors may exacerbate existing system‐level deficiencies. Insight from patients and their caregivers may inform the development of ED interventions to design specialized care for this patient population. This qualitative study also demonstrated the feasibility of conducting ED‐based studies on PLWD during their ED visit. [ABSTRACT FROM AUTHOR]

Background: Delirium, altered mental status (AMS), or confusion among older adults are common presentations to the emergency department (ED). We aimed to report the proportion of older ED patients presenting with delirium who have acute abnormal findings on head imaging. We also assessed whether anticoagulation, neurological deficits, trauma, or headache were associated with head imaging abnormalities in these patients. Methods: A systematic review was performed using Ovid Medline, Embase, Clinicaltrials.gov, Web of Science, and Cochrane Central from conception to April 8, 2021. Citations were included if they described patients aged 65 years or older who received neuroimaging at the time of ED assessment for delirium, confusion, or AMS. Screening, data extraction, and bias assessment were performed in duplicate. The estimated proportion of patients with abnormal neuroimaging and odds ratios (ORs) for each predictor were calculated. Results: The search strategy identified 3014 unique citations, of which six studies reporting on 909 patients with confusion or AMS were included. None of the studies formally diagnosed delirium. Overall, the proportions of older ED patients with AMS or confusion were found to have an abnormal head computed tomography (CT) was 15.6% (95% confidence interval [CI] 7.3%–26.2%). The prevalence of focal neurologic findings was 13.0% (66/506) and for anticoagulation was 9.8% (33/337) among the studies who reported them. The presence of a focal neurological deficit was associated with abnormal head CT (OR 101.8, 95% CI 30.5–340.1). Anticoagulation was not associated with abnormal head CT (OR 1.2, 95% CI 0.4–3.3). No studies reported on the association between headache or trauma and abnormal neuroimaging. Conclusions: The proportion of abnormal findings on CT neuroimaging in older ED patients with AMS or confusion was 15.6%. The presence of a focal neurological deficit was a strong predictor for the presence of acute abnormality, whereas anticoagulation was not. [ABSTRACT FROM AUTHOR]

The article presents the discussion on Clinical Frailty Score (CFS) as a strong predictor of the risk of a number of adverse outcomes relevant to ED patients. Topics include increasing patient volumes, rising acuity and a boarding crisis, and tasked with screening for domestic violence, suicide risk, and substance use; and recommended adding age or frailty into the triage algorithm for improving identification of older adults in need of immediate medical attention.

The article focuses on emergency department (ED) visits each year increasing ED use by older adults is projected to exceed the capacity of the U.S. EDs. Topics include the traditional ED model of care is ill-equipped to address the many complex care needs of older adults, and the evolution of emergency care has developed as evidenced by consensus geriatric ED (GED) guidelines and the American College of Emergency Medicine's Geriatric Emergency Department Accreditation program.

The article focuses on balancing evidence and economics while adapting emergency medicine to the 21st century's geriatric demographic imperative. It mentions factors highlight opportunities to improve patient-centered, geriatric emergency care, yet underscore the need for innovations to raise the quality of care for older adults. It also mentions focus on the humanistic and ethical argument in support of continuing the innovation and dissemination of geriatric emergency medicine.

Objectives To examine 6-month change in life-space mobility as a predictor of subsequent 6-month mortality in community-dwelling older adults. Design Prospective cohort study. Setting Community-dwelling older adults from five Alabama counties in the University of Alabama at Birmingham ( UAB) Study of Aging. Participants A random sample of 1,000 Medicare beneficiaries, stratified according to sex, race, and rural or urban residence, recruited between November 1999 and February 2001, followed by a telephone interview every 6 months for the subsequent 8.5 years. Measurements Mortality data were determined from informant contacts and confirmed using the National Death Index and Social Security Death Index. Life-space was measured at each interview using the UAB Life-Space Assessment, a validated instrument for assessing community mobility. Eleven thousand eight hundred seventeen 6-month life-space change scores were calculated over 8.5 years of follow-up. Generalized linear mixed models were used to test predictors of mortality at subsequent 6-month intervals. Results Three hundred fifty-four deaths occurred within 6 months of two sequential life-space assessments. Controlling for age, sex, race, rural or urban residence, and comorbidity, life-space score and life-space decline over the preceding 6-month interval predicted mortality. A 10-point decrease in life-space resulted in a 72% increase in odds of dying over the subsequent 6 months (odds ratio = 1.723, P < .001). Conclusions Life-space score at the beginning of a 6-month interval and change in life-space over 6 months were each associated with significant differences in subsequent 6-month mortality. Life-space assessment may assist clinicians in identifying older adults at risk of short-term mortality. [ABSTRACT FROM AUTHOR]

Objectives To determine the relationship between neighborhood-level socioeconomic characteristics, life-space mobility, and incident falls in community-dwelling older adults. Design Prospective, observational cohort study with a baseline in-home assessment and 6-month telephone follow-up. Setting Central Alabama. Participants Community-dwelling adults aged 65 and older recruited from a random sample of Medicare beneficiaries (N = 1,000). Measurements Neighborhood disadvantage was measured using a composite index derived from baseline neighborhood-level residential census tract socioeconomic variables. Data on individual-level socioeconomic characteristics, clinical variables, and life-space collected at baseline were included as covariates in a multivariate model using generalized estimating equations to assess the association with incident falls in the 6 months after baseline. Results Of the 940 participants who completed baseline and follow-up assessments, 126 (13%) reported one or more new falls in the 6 months after baseline. There was an independent nonlinear association between neighborhood disadvantage (according to increasing quartiles of disadvantage) and incident falls after adjusting for confounders: The lowest quartile served as reference; 2nd quartile odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.2-4.6; 3rd quartile OR = 1.9, 95% CI = 1.0-3.7; 4th quartile OR = 3.2, 95% CI = 1.7-6.0. Each 10-point decrement in life-space ( OR = 1.2, 95% CI = 1.0-1.3) was associated with a higher risk of falls. Conclusion Greater neighborhood disadvantage was associated with greater risk of falls. Life-space also contributes separately to fall risk. Community-dwelling older adults in disadvantaged neighborhoods, particularly those with limited mobility, may benefit from a more-rigorous assessment of their fall risk by healthcare providers. Neighborhood level socioeconomic characteristics should also be an important consideration when identifying vulnerable populations that may benefit the most from fall prevention programs. [ABSTRACT FROM AUTHOR]

Objectives To determine the effect of falls and fractures on life-space mobility in a cohort of community-dwelling older adults. Design Prospective, observational study with a baseline in-home assessment and 6-month telephone follow-up interviews over 4 years. Setting Central Alabama. Participants Community-dwelling adults aged 65 and older recruited from a random sample of Medicare beneficiaries stratified according to sex, race, and urban versus rural residence (N = 970). Measurements Sociodemographic factors, medical history, depressive symptoms ( Geriatric Depression Scale), cognitive function ( Mini- Mental State Examination), mobility-related symptoms, transportation difficulty, and healthcare use were assessed during a baseline in-home interview of participants. Life-space mobility and falls or injuries (including fractures) were assessed at the baseline interview and at 6-month intervals in follow-up telephone calls. Results Four hundred fifty-four (47%) participants reported at least one fall during the 4-year follow-up. The life-space score fell 3.2 points from the beginning to the end of the 6-month interval during which a fall occurred, adjusting for other known predictors of decline in life-space mobility. The decrease in interval life-space score was progressively greater for a fall and an injury (−4.7 points), a fall and a fracture (−14.2 points), and a fall and a hip fracture (−23.6 points). Conclusion Falls, whether associated with an injury or not, were independently associated with a decrease in life-space mobility in the ensuing 6 months. Further studies are needed to determine reasons for life-space mobility decline in community-dwelling older adults with incident falls without any injuries. [ABSTRACT FROM AUTHOR]

The authors explore the hypothetical causes of the results reported in the article "Evaluation of older adult patients with falls in the emergency department: discordance with national guidelines" by G. Tirrell et al. which appeared within the journal. They discuss the questions arising from the National Institutes of Health (NIH) implementation science framework aimed at understanding why clinical practice lags behind research evidence, consensus statements and professional society guidelines.

The article focuses on emergency department (ED) geriatric care innovations. It discusses the problems associated with the strategy of admitting older adults who often visit ED with chief complaints, and cautionary points for the geriatric ED observation unit (EDOU) program with preliminary results demonstrating no increase in admissions to hospitals.