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Adults over the age of 65 represent as many as 25% of the patients seen in the Emergency Department (ED). Older adults have unique physiological, medical and social requirements that make their care in the ED more challenging. These patients frequently have multiple co-morbidities and may present to the ED with atypical symptoms when compared to younger patients.
When combined with the high-paced, high-stress ED environment, this complexity may lead to an approach focused on treatment of the presenting complaint in isolation of other existing concerns such as falls, cognitive impairment, medication and declining function.
The Geriatric Emergency Management (GEM) was developed to meet the needs of high-risk older adults who present to the ED. Within the Champlain Local Health Integration Network, there are currently 9 ED’s with GEM programs: Pembroke, Renfrew, Arnprior, Ottawa (The Ottawa Hospital , Queensway Carleton and Montfort), Cornwall and Hawkesbury.
The GEM nurse provides a structured geriatric assessment focused on geriatric concerns and facilitates direct referral to Specialized Geriatric Services (SGS) such as Geriatric Assessment Outreach Teams, Geriatric Day Hospitals, Community Geriatric Psychiatry Services, as well as community support services such as the Going Home Program and Community Care Access Centre.
This approach ensures that high-risk seniors obtain age appropriate care that meets their needs, while supporting their safe, sustainable discharge home. The ability of GEM nurses to access SGS and community services in a timely manner reduces the likelihood of unnecessary repeat ED visits and hospital admissions.
The GEM program represents a consistent, evidence-based approach to screening, management and follow-up of high risk seniors being discharged home from the ED and integrates individualized and coordinated strategies to optimize and support the capacity of seniors to remain safe and independent in the community.
Article written by: AnnMarie DiMillo, Regional Program Manager – Geriatric and Community Intervention Program, Regional Geriatric Program of Eastern Ontario