Dr. Shenvi sits down with Dr. Don Melady and Dr. John Schumacher to discuss their new book: Creating a Geriatric Emergency Department. The book is practical and accessible, providing essential guidance on assessing the ED care of older patients - and improving it.

Creating a Geriatric Emergency Department

Dr. Christina Shenvi and Dr. Robert Dachs discuss how ED clinicians can identify and manage vertebral compression fractures in older adults.

How to Diagnose and Manage Vertebral Compression Fractures in the ED

Dr. Christina Shenvi sits down with Dr. Kerstin de Wit to learn how much anticoagulation matters in terms of increasing the risk of intracranial hemorrhage after a ground-level fall.

Do Anticoagulants Matter After a Head Injury?

In this episode of GEMCast Dr. Christina Shenvi is joined by Dr. Chris Carpenter to discuss GEAR 2.0-Advancing Dementia Care. Learn how GEAR 2.0 identified and prioritized research gaps in emergency care for persons living with dementia and their care partners.

Dementia Research in ED Settings

Join Dr. Christina Shenvi and Dr. Teresita Hogan as they walk through the history of geriatric emergency medicine. Learn about the challenges, changes, and breakthroughs that have shaped this field over the past 40 years.

The Winding Road to Geriatric EM

How Paramedics Can Make a Difference in Geriatric Care

Any transition of care has risks, especially for older patients. In this episode of GEMCast, Dr. Shenvi and Dr. Magidson talk about the importance of thoughtful and deliberate transitions of care for older adults.

How to Create Safe Transitions of Care for Older Patients

Join Dr. Christina Shenvi and Dr. Cameron Gettel as they talk about a paper that provides the first benchmarks for emergency care process outcomes in geriatric EDs compared with nongeriatric EDs.

An Outcome Comparison Between Geriatric and Nongeriatric Emergency Departments

What ED Physicians need to know about Amyloid Targeting Treatments Part 1

What ED Physicians need to know about Amyloid Targeting Treatments Part 2

In 2021 constipation related visits to the ED reached over 1 million.The prevalence of constipation in elderly individuals in the community is between 15-30% and for those living in nursing homes or long-term care facilities it ranges between 50-75%. While constipation itself is not usually life-threatening, it can be indicative of life-threatening diseases or disorders and therefore a comprehensive history and physical assessment of patients is essential to avoid missing a critical diagnosis.

Sarah Lee is an emergency physician at the University of Maryland. In this episode she joins Dr. Christina Shenvi to discuss the presentation, risk factors, assessment and management of constipation in geriatric patients in the ED.

Constipation: What To Do Between a Rock and a Hard Place

Dr. Christina Shenvi and Dr. Mike Craig discuss the "Home Hospital" model and its potential to transform the way we care for older adults, by bringing hospital-level care to patients' homes.

Why Hospital at Home May be the Best Option for Your Next Patient

Alzheimer's disease (AD) begins developing in the brain 20-30 years before symptoms start to present in patients. Recent evidence suggests that up to 40% of AD cases could potentially be prevented by addressing modifiable risk factors such as insufficient education, hearing loss, hypertension, obesity, smoking, depression, social isolation, physical inactivity, diabetes, excessive alcohol consumption, air pollution, and traumatic brain injury. 

Dr. Christina Shenvi is joined once again by Dr. Richard Isaacson, M.D., a Harvard-trained preventive neurologist and world-renowned researcher at the Institute for Neurodegenerative Diseases in Florida. In 2013, he founded the Alzheimer's Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian, the first of its kind in the United States. In this episode of GEMCast they focus on the importance of individualized intervention and prevention as the future of AD treatment.

Preventing Dementia

Resuscitation of older adults in the emergency department poses unique challenges for physicians. Understanding the differences between a typical resuscitation process compared to a resuscitation of an older adult is essential to appropriately manage and treat this population. In this episode Dr. Cliff Reid joins Dr. Christina Shenvi to explore these differences and the associated challenges, and highlight some tools he uses in his own practice. Cliff Reid, MD, is an Emergency, Retrieval, and Critical Care Physician and educator in the greater Sydney area with a focus on resuscitation of adults and children.

Revive And Survive- Pearls For Resuscitation Of Older Adults In The ED

Dr. Cristina Shenvi is joined today by a panel to explore Geriatric Emergency Medicine (GEM) from a global perspective. As the global population ages, the importance of GEM and its continued development as a subspecialty becomes increasingly evident. This episode will examine the unique challenges that arise as GEM evolves and how different healthcare systems are adapting to meet these challenges. The panel will also discuss innovative practices and solutions that have emerged in their respective countries to advance GEM and improve care for elderly patients.

The expert panel features three distinguished guests: Dr. Mohd Idzwan Zakaria (@prof_idzwan), a senior consultant and professor of Emergency Medicine at University Malaya in Malaysia, specializing in innovative approaches to managing older patients; Dr. Rosa McNamara (@rosaMcNamara), a consultant at St. Vincent’s University Hospital in Dublin, Ireland, and GEM Special Interest Group Chair for the International Federation for Emergency Medicine, with extensive expertise in GEM and medical education; and Dr. Rasha Buhumaid (@Rbuhamaid), an Emergency Physician in Dubai, UAE, President of the Emirates Society for Emergency Medicine, working in both public health and private practice, and an Assistant Professor at Mohammed Bin Rashid University of Medicine and Health Sciences.

Global Perspectives On Geriatric EM Care

With the upcoming implementation of the new CMS age-friendly hospital measure, hospitals will be required to attest that they review medications to identify potentially inappropriate medications (PIMS) for older adults. Dr. Martin Casey, MD, MPH is an Assistant Professor in the Department of Emergency Medicine at UNC School of Medicine. Dr. Caseys’ work has focused on the identifying PIMS and finding opportunities to reduce the use of, and deprescribe, potentially harmful medications in the emergency department. 
  
In this episode, Dr. Christina Shenvi and Dr. Martin Casey will discuss strategies for ED physicians who face unique challenges when assessing older patients’ medications. Using case examples of deprescribing in practice, they illustrate how deprescribing is a nuanced skill and how to approach it.

Why Less Is More: Strategies For Deprescribing In The ED

Today’s episode provides an introduction and overview of the 5 domains of the CMS Age-Friendly Hospital Measure. Host Dr. Christina Shenvi is joined by Dr. Marcia Russell to help clarify what each of these domains entail and how they may be carried out in the ED. They also discuss concerns that may be brought about following the implementation of this measure on January 1, 2025, and how these issues might be addressed and minimised.

Dr. Marcia Russel is a colorectal surgeon and Associate Professor at UCLA. She has a special interest in the surgical care of older adults and has worked with ACS to improve geriatric surgery through the ACS Geriatric Surgery Verification Program.

High-Yield Overview Of The CMS Age-Friendly Measures

In this episode learn about how the Generational Health Program at Sharp Memorial Hospital in San Diego was developed and expanded to create an extensive care program that provides specialised care for older adults. What started as a pilot program in 2019 is now a multidisciplinary age-friendly collaboration that begins right at admission.  

Host Christina Shenvi is joined by 3 experts from Sharp Memorial Hospital who provide insight into how this program operates to provide the highest level of care for older patients. Diane Wintz, MD, a trauma surgeon who was heavily involved in creating the Generational Health Program. Her goal was to change how traditional health care models approach elderly patients presenting to the ED. Kelly Wright, RN, trained as an oncology nurse and now serves as manager of the program, and Stacy Nilsen, PhD RN, who’s focus is on the feasibility, implementation, education and data assessment of the program. Together they discuss the creation and expansion of the program and highlight the most important aspects of what makes it a success.

Creating A Generational Health Program

Postmenopausal Problems - Geriatric Gynecology in the ED

In today’s episode host Dr. Christina Shenvi is joined by Dr. Robert Sternberg, Ultrasound Director at Akron General to discuss ultrasound-guided nerve blocks for precise pain relief in older patients. Ultrasound-guided nerve blocks provide relief from one of the most common emergency department complaints: pain. In addition to their use in acute pain management, nerve blocks can help reduce the use of opioids, reduce hospital length of stay, and improve patient outcomes and experiences. 

Using case examples, Dr. Sternberg talks through how to perform 4 common types of nerve blocks you may use in the emergency department with an elderly patient: Fascia Iliaca Compartment Block (FICB), Pericapsular Nerve Group (PENG) Block, Serratus Anterior Plane (SAP) Block and Erector Spinae Block (ESB). Tune in to hear indications, key anatomical landmarks, dosing, and techniques for each of the nerve blocks.

Precision Relief: Nerve Blocks for Pain in Older Patients

Getting ED Specific with Medication Safety

Our population is aging, and with that comes an increase in the number of older adults in emergency departments. Delirium affects up to 1/3 older adults who present to the ED and is a medical emergency that is often overlooked by ED clinicians. In this episode of GEMCast host Dr. Christina Shenvi discusses the importance of recognising delirium, documenting it, and intervening where possible in the ED with Dr. Kayla Furlong and Dr. Gillian Sheppard. 

Dr. Furlong and Dr. Sheppard are both emergency medicine physicians in St. John’s, Newfoundland & Labrador, who are experts in point of care ultrasound (POCUS). Dr. Furlong is a Clinical Assistant Professor in the Faculty of Medicine at Memorial University and is the Chair of the CAEP Geriatric EM Committee. Dr. Sheppard is an Associate Professor and Chair of the Discipline of Emergency Medicine at Memorial University. She is also a Diplomate of the Royal College of Physicians of Canada with an Area of Focused Competence in POCUS and is the education lead for the Canadian Association of Emergency Physicians Emergency Ultrasound Committee.

They have taken a special interest in whether the use of POCUS increases the ED clinicians’ ability to determine the aetiology of a geriatric patient’s delirium or agitation, and in doing so have developed the ABLE approach. They discuss why and how POCUS can be a useful tool and provide helpful tips for ED clinicians for how to implement POCUS. Tune in to learn more about how to approach older adults in the ED considering delirium, agitation, and the challenges they present. 

For further show notes head to https://gedcollaborative.com/resource/delirium/delirium-agitation-and-the-role-of-pocus-in-older-adults-in-the-ed/

POCUS for Delirium and Agitation: Be ABLE

ED Boarding of Older Adults: Risks and Opportunities

Climate change, and the associated increase in frequency and severity of heat waves, poses a threat to health. Amongst the most at risk for heat-related emergencies are older adults; age-associated physiologic vulnerabilities, chronic conditions, medications that disrupt thermoregulatory responses, and social determinants all contribute to an increased risk of heat-related illness in this population. When an older adult presents to the emergency department (ED) with vague or subtle symptoms of heat exhaustion or heat stroke, they may be missed by ED practitioners – a concerning thought as these patients are at a greater risk of mortality from heat-related emergencies. Optimal management of these presentations requires clinical recognition and treatment within the ED as well as pre-hospital interventions that can be given by emergency medical services (EMS).

GEMCast host Dr. Christina Shenvi is joined by Geoff Comp, Associate Program Director at Creighton University School of Medicine/Valleywise Health Medical Center in Phoenix, Arizona, as the two do an in-depth review of this critical topic. Dr. Comp holds a wilderness medicine fellowship through the Wilderness Medical Society and is an expert in heat-related illness.

Show notes are available on the Geriatric Emergency Department Collaborative (GEDC) website. 
https://gedcollaborative.com/resource/atypical-presentations/getting-hotter-heat-emergencies-in-older-adults/

Getting Hotter Heat Emergencies in Older Adults

In this episode of GEMCast, host Dr. Christina Shenvi is joined by Dr. James Van Oppen, emergency physician and frailty expert at the University of Sheffield, to discuss the rising importance of frailty in emergency medicine. Frailty, defined as the loss of physiological resilience, is both common and clinically significant for older adults presenting to the emergency department (ED). The two discuss what frailty means, how it can be identified, and how to approach ED assessment and management in a frail patient, emphasizing the value of person-centred care. Furthermore, they highlight recent studies regarding frailty, which can be found in the resources below, and discuss the need for system-wide changes to support frailty care.

Alongside his work as an emergency physician and clinical lecturer, Dr. van Oppen is the chair of the geriatric emergency medicine section of the European Society of Emergency Medicine. Tune in to this episode to expand your understanding of frailty and hear some practical tips to improve your clinical practice.

Frailty Frontline: How to identify frailty, and what to do next

Acute Care of Persons Living with Dementia: From the Clinic to the ED and Back

Kevin Biese describes the signs and symptoms of delirium in older adults, and drops some pearls on how to manage it safely.

For the shownotes and blog site, see: http://gempodcast.com/2015/11/11/diagnosing-and-managing-delirium-in-older-adults/

Welcome to GEMCAST! In this inaugural episode, first published 09/2015, Kevin Biese talks us through some practical tips for preventing, identifying, and managing delirium in older adults in the Emergency Department.
Delirium is incredibly common among older adults in the ED, but is easy to miss. It is also an independent predictor of 6 month mortality. How is it diagnosed? Why does it matter that we identify it? How can you prevent it? How do you safely treat symptoms of agitation in an older adult? How can you differentiate it from dementia in the acute care setting? – Take a listen.
References:
1. Barrio K, Biese K. Delirium, dementia, and other mental health disorders of older adults. In: Tintinalli JE, Stapczynski JS, Ma OJ, et al, eds. Tintinalli’s emergency medicine: A comprehensive study guide. 8th ed. ; 2011. Accessed 07/23/2015.
2. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911-922. PMID: 23992774
3. Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK. The interface between delirium and dementia in elderly adults. Lancet Neurol. 2015;14(8):823-832. PMID: 26139023
4. Han JH, Eden S, Shintani A, et al. Delirium in older emergency department patients is an independent predictor of hospital length of stay. Acad Emerg Med. 2011;18(5):451-457. PMID: 21521405
5. Han JH, Shintani A, Eden S, et al. Delirium in the emergency department: An independent predictor of death within 6 months. Ann Emerg Med. 2010;56(3):244-252.e1. PMID: 20363527
6. Han JH, Wilson A, Vasilevskis EE, et al. Diagnosing delirium in older emergency department patients: Validity and reliability of the delirium triage screen and the brief confusion assessment method. Ann Emerg Med. 2013;62(5):457-465. PMID: 23916018
7. Marcantonio ER. Delirium. In: Pacal JT, Sullivan GM, eds. Geriatrics review syllabus: A core curriculum in geriatric medicine. 7th ed. New York, NY: American Geriatrics Society; 2010

This podcast uses sound 173181 from freesound.com by jobro


Diagnosing and Managing Delirium in Older Adults

Judith Tintinalli discusses her thoughts about caring for an older patient with a severe ICH as part of a multidisciplinary team. 

For the show notes and blog site, see: http://gempodcast.com/2015/11/11/15/

What does Dr. Tintinalli do when she has a dying patient and a family who needs help to make decisions and understand the options? – She gets involved. She calls the PCP. She gets palliative care on the line. She advocates for the patient to help make sure their wishes are understood and honored. There comes a time when you go from prolonging life to prolonging death. Knowing when that point is can be hard. Listen to hear her thoughts in this post from 10/2015.

There are many models for how palliative care can work in an ED. We can provide it ourselves to a certain extent, and in some cases, can consult palliative care services to help with end-of-life decisions. But we should do something to make sure we consider the patient’s wishes before performing aggressive measures that could leave the patient with a quality of life that would not be meaningful for them.

References:
1. Rosenberg M, Rosenberg L. Integrated model of palliative care in the emergency department. West J Emerg Med. 2013;14(6):633-636. PMID: 24381685
2. Rosenberg M, Lamba S, Misra S. Palliative medicine and geriatric emergency care: Challenges, opportunities, and basic principles. Clin Geriatr Med. 2013;29(1):1-29 PMID: 23177598
3. Grudzen CR, Richardson LD, Hopper SS, Ortiz JM, Whang C, Morrison RS. Does palliative care have a future in the emergency department? discussions with attending emergency physicians. J Pain Symptom Manage. 2012;43(1):1-9. PMID: 21802899
4. Grudzen CR, Richardson LD, Morrison M, Cho E, Morrison RS. Palliative care needs of seriously ill, older adults presenting to the emergency department. Acad Emerg Med. 2010;17(11):1253-1257. PMID: 21175525
5. Quest TE, Marco CA, Derse AR. Hospice and palliative medicine: New subspecialty, new opportunities. Ann Emerg Med. 2009;54(1):94-102. PMID: 19185393
6. Penrod JD, Deb P, Dellenbaugh C, et al. Hospital-based palliative care consultation: Effects on hospital cost. J Palliat Med. 2010;13(8):973-979. PMID: 20642361
7. Penrod JD, Deb P, Luhrs C, et al. Cost and utilization outcomes of patients receiving hospital-based palliative care consultation. J Palliat Med. 2006;9(4):855-860. PMID: 16910799
8. Beemath A, Zalenski RJ. Palliative emergency medicine: Resuscitating comfort care? Ann Emerg Med. 2009;54(1):103-105. PMID: 19346031
9. Ciemins EL, Blum L, Nunley M, Lasher A, Newman JM. The economic and clinical impact of an inpatient palliative care consultation service: A multifaceted approach. J Palliat Med. 2007;10(6):1347-1355. PMID: 18095814
10. Barbera L, Taylor C, Dudgeon D. Why do patients with cancer visit the emergency department near the end of life? CMAJ. 2010;182(6):563-568. PMID: 20231340

This podcast uses sounds from freesound.org by Jobro and HerbertBoland.
Image from: http://news.unchealthcare.org/som-vital-signs/2013/nov-7/2013-berryhill-lecture-video-available

Dr. Tintinalli on End-of-Life Decisions

David Silfen, an EMS provider describes a program he has helped initiate to intervene with older adults who have a high falls risk.
See www.gempodcast.com for full details and show notes.

This podcast uses sounds from freesound.org by Jobro and HerbertBoland.
Image credit: https://pixabay.com/en/step-falling-tripping-danger-98822/

Preventing Falls in the Elderly: an EMS story

Shan Liu talks about why we should avoid the term "mechanical fall" and how we can help prevent future falls from the ED. 
See www.gempodcast.com for references and more.

Preventing Future Falls

Dr. Lauren Southerland and I discuss her recent paper on the importance of and how to do a discharge risk assessment in elderly patients in the ED. For more, go to www.gempodcast.com

How to Do a Discharge Risk Assessment

Welcome to GEMCAST! Shownotes and more info are available on https://gedcollaborative.com/resources/?type=podcast. GEMCAST is a Geriatric Emergency Medicine Podcast created to help clinicians, nurses, or paramedics who take care of older adults, particularly in the Emergency Department setting. Welcome! I'm your host, Christina Shenvi. You can connect with me on twitter @clshenvi

Disclaimer: By listening to this podcast, you agree not to use this podcast or website as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall this podcast, website, or any contributors to it be responsible for damages arising from use of the podcast. Furthermore, this podcast should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast.

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