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

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

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.

Preventing Dementia

GEMCAST

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