GEMCAST

For the Show Notes, see the gemcast website: http://gempodcast.com/2015/11/11/high-risk-medications-and-adverse-drug-events/ Adverse drug events (ADEs) are a major problem among older adults who present to the Emergency Department. ADEs come in 5 types. 1 in 6 hospitalizations among older adults involves an ADE, and half of the hospitalizations for ADEs are deemed preventable. What medications should be used with caution or avoided in older adults? What are safer alternatives? In this podcast we discuss the types of ADEs, which patients are at greatest risk, the highest risk medications, alternatives to the high-risk medications, and ways to prevent ADEs. Leah Hatfield, an ED pharmacist, shares her wisdom. References: 1. By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American geriatrics society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015. 2. Hanlon JT, Semla TP, Schmader KE. Alternative medications for medications in the use of high-risk medications in the elderly and potentially harmful drug-disease interactions in the elderly quality measures. J Am Geriatr Soc. 2015. 3. Alhawassi TM, Krass I, Bajorek BV, Pont LG. A systematic review of the prevalence and risk factors for adverse drug reactions in the elderly in the acute care setting. Clin Interv Aging. 2014;9:2079-2086. 4. Pretorius RW, Gataric G, Swedlund SK, Miller JR. Reducing the risk of adverse drug events in older adults. Am Fam Physician. 2013;87(5):331-336. 5. Passarelli MC, Jacob-Filho W, Figueras A. Adverse drug reactions in an elderly hospitalised population: Inappropriate prescription is a leading cause. Drugs Aging. 2005;22(9):767-777. 6. Saedder EA, Lisby M, Nielsen LP, Bonnerup DK, Brock B. Number of drugs most frequently found to be independent risk factors for serious adverse reactions: A systematic literature review. Br J Clin Pharmacol. 2015;80(4):808-817. Image credit: https://pixabay.com/en/pill-capsule-medicine-medical-1884775/ Sound credits: sounds from freesound.org by Jobro and HerbertBoland

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

Kevin Biese, an expert in geriatric emergency medicine and author on delirium, shares invaluable insights on managing delirium in older adults. He discusses the critical signs and symptoms that often go unnoticed, the importance of accurate diagnosis, and practical tips for prevention. Biese explains how to differentiate delirium from dementia, and highlights challenges in treating agitated patients. With case studies and advanced management strategies, he provides a comprehensive look at improving care for older adults in emergency settings.