Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine.

PURPOSE: Despite the rapidly expanding knowledge in the field of Geriatric Emergency Medicine in Europe, widespread implementation of change is still lacking. Many opportunities in everyday clinical care are missed to improve care for this susceptible and growing patient group. The aim was to develop expert clinical recommendations on Geriatric Emergency Medicine to be disseminated across Europe. METHODS: A group of multi-disciplinary experts in the field of Geriatric Emergency Medicine in Europe was assembled. Using a modified Delphi procedure, a prioritized list of topics related to Geriatric Emergency Medicine was created. Next, a multi-disciplinary group of nurses, geriatricians and emergency physicians performed a review of recent guidelines and literature to create recommendations. These recommendations were voted upon by a group of experts and placed on visually attractive posters. The expert group identified the following eight subject areas to develop expert recommendations on: Comprehensive Geriatric Assessment in the Emergency Department (ED), age/frailty adjusted risk stratification, delirium and cognitive impairment, medication reviews in the ED for older adults, family involvement, ED environment, silver trauma, end of life care in the acute setting. RESULTS: Eight posters with expert clinical recommendations on the most important topics in Geriatric Emergency Medicine are now available through https://posters.geriemeurope.eu/ . CONCLUSION: Expert clinical recommendations for Geriatric Emergency Medicine may help to improve care for older patients in the Emergency Department and are ready for dissemination across Europe.

[Aspects of multimodal pain therapy in old age]. / Aspekte der multimodalen Schmerztherapie im Alter.

Chronic pain in older adults should be explained and treated on the basis of the biopsychosocial model. With its interdisciplinary and interprofessional approach, multimodal pain therapy is the method of choice. In old age freedom from pain is usually not the primary goal. It is more important to restore the quality of life of those affected and to maintain independence and autonomy with a versatile treatment offer. This article explains the basics of multimodal pain therapy and its special features in old age.

[Long-term care facilities during the COVID-19 pandemic : Considerations on the way back to normality]. / Langzeitpflegeeinrichtungen in der COVID-19-Pandemie : Überlegungen auf dem Weg zurück in die Normalität.

Long-term care facilities (LTCF) were and are particularly affected by the COVID-19 pandemic. The dimensions of the outbreaks and the high mortality among residents led to massive restrictions in LTCFs, especially in the area of social contacts and activities but also in areas of medical care. With the start of vaccinations and the improved testing options, the situation has now changed and existing restrictions must be evaluated to determine whether they are still appropriate. In an interprofessional and interdisciplinary group of experts, considerations have been formulated on how a way back to normality could look like in LTCFs.

Recommendations for the management of COVID-19 pandemic in long-term care facilities.

Long-term care facilities (LTCF) and their vulnerable residents are particularly affected by the coronavirus disease 2019 (COVID-19) pandemic. Estimates from various countries suggest that 3-66% of all COVID-19 deaths were residents of LTCF, of which 80% died in their facilities. Despite these significant numbers, recommendations for LTCF for the prevention and medical care of residents during the COVID-19 pandemic are still lacking. These recommendations are based on the existing literature and the expertise of the authors who are specialists in geriatric medicine. The recommendations are addressed to LTCF management, their operators, physicians working in LTCFs and also politicians, to provide the necessary framework conditions. We are confident that our recommendations will offer important help and guidance for LTCFs as well as their physicians. Adherence to these recommendations is likely to improve the outcomes and care of residents in long-term facilities during the COVID-19 pandemic.

[Geriatrics in times of corona]. / Geriatrie in Zeiten von Corona.

The current corona crisis affects older patients as well as the geriatric infrastructure in all sectors. This article provides an overview about the current state of knowledge on COVID-19 with special consideration of geriatric aspects and the consequences for the geriatric care system.

[HELP - Hospital Elder Life Program - multimodal delirium prevention in elderly patients]. / HELP ­ Hospital Elder Life Program ­ ein multimodales Interventionsprogramm zur Delirprävention bei älteren Patienten.

Delirium in older adults is associated with an increased risk for cognitive and functional decline. Multiple risk factors, such as underlying dementia, multiple comorbidities, anticholinergic medication or visual and hearing impairment foster the incidence of delirium. By identification of patients at risk and the initiation of a multiple component delirium prevention program delirium is preventable in 30-40% of all cases. There is broad evidence for comprehensive multicomponent delirium prevention strategies in patient care, but their implementation is still lacking in many hospitals. The Hospital Elder Life Program (HELP), designed in 1999 by S.K. Inouye, is a comprehensive protocol for hospitalized elderly patients and has been implemented successfully in more than 200 hospitals worldwide. In German hospitals, positive experiences with HELP, with minor modifications, have been made. The core of the HELP concept is the identification of a patient's delirium risk profile and an individually assigned intervention protocol consisting of (re-)orientation, cognitive activation, simple mobilization or meal companionship and nonpharmacological sleep promotion. Many strategies for the prevention of delirium in elders integrate substantial elements of HELP; however, a measurable preventive effect requires the modification of multiple predisposing and precipitating factors. The article reviews the original Hospital Elder Life Program and its implementation in German hospitals.

Accuracy of Point-of-Care B-Line Lung Ultrasound in Comparison to NT-ProBNP for Screening Acute Heart Failure.

AIM: The objective of this pilot study was to determine the accuracy of point-of-care B-line lung ultrasound in comparison to NT Pro-BNP for screening acute heart failure. MATERIALS AND METHODS: An 8-zone lung ultrasound was performed by experienced sonographers in patients presenting with acute dyspnea in the ED. AHF was determined as the final diagnosis by 2 independent reviewers. RESULTS: Contrary to prior studies, B-line ultrasound in our study was highly specific, but moderately sensitive for identifying patients with AHF. There was a strong association between elevated NT-proBNP levels and an increased number of B-lines. CONCLUSION: In conclusion, point-of-care lung ultrasound is a helpful tool for ruling in or ruling out important differential diagnoses in ED patients with acute dyspnea.

[Aortic valve replacement in the elderly]. / Aortenklappenersatz im Alter.

The treatment of severe symptomatic aortic valve stenosis by conventional aortic valve replacement (AVR) or by transcatheter aortic valve implantation (TAVI) has a good perinterventional prognosis even for patients of advanced age. Having a heart team select the best management strategies based on current guidelines for each individual patient is essential for success. Especially in elderly and increasingly multimorbid patients with sometimes severe preconditions, the detection of functional deficits is relevant not only for the mortality but also for perioperative and postoperative complications as well as the functional outcome. Various methods of geriatric assessment are important supplements to standard risk scores. The aim is to implement targeted interventions to minimize the risk factors and to improve the prognosis for elderly patients. The aim of this article is to provide an overview of the current therapy options for aortic valve replacement and to summarize current aspects of treatment options for elderly patients.

[Nutritional management in geriatric traumatology]. / Ernährungsmanagement in der Alterstraumatologie.

The prevalence of malnutrition or the risk of malnourishment is high among orthogeriatric patients and a poor nutritional status is associated with a negative outcome. A comprehensive management of preoperative and postoperative nutritional and fluid intake in these patients can help to improve the situation. The management includes identification of patients affected, a thorough assessment of the nutritional status, work-up of possible underlying causes, documentation of nutritional and fluid intake and, most importantly, procedures to improve the preoperative and postoperative nutritional situation. This article gives an overview of the recently updated recommendations on nutritional management in orthogeriatric patients as published by the orthogeriatric working group of the German Geriatric Society.

[Recognition of infections in elderly emergency patients]. / Erkennen von Infektionen beim älteren Notfallpatienten.

BACKGROUND: Elderly patients represent an increasing population in the emergency department (ED) and physicians often have to deal with multimorbidity and complexity. Infections are one of the major reasons for ED presentations of older patients and the main cause of mortality; however, infections are often difficult to diagnose in older patients. AIM: This article provides a review of important indicators for infections, diagnostic tools and limitations in elderly patients. MATERIAL AND METHODS: A literature search was carried out using PubMed in the period 1990-2015 and in addition own published data are presented. RESULTS AND CONCLUSION: Infections in the elderly are difficult to assess in the emergency department due to atypical symptoms. Even subtle changes need to be recognized. For the diagnosis of infections in older ED patients unspecific symptoms, vital parameters, laboratory parameters, including C-reactive protein (CRP) and procalcitonin levels, cognitive function and functionality of the patient need to be taken into account.

[Chest pain units or chest pain algorithm?]. / Chest Pain Units oder Chest-Pain-Algorithmus?

BACKGROUND: A large number of patients present to the emergency department (ED) for evaluation of acute chest pain. About 10-15% are caused by acute myocardial infarction (MI), and over 50% of cases are due to noncardiac reasons. Further improvement for chest pain evaluation appears necessary. OBJECTIVES: What are current options to improve chest pain evaluation in Germany? METHODS: A selective literature search was performed using the following terms: "chest pain", "emergency department", "acute coronary syndrome" and "chest pain evaluation". RESULTS AND DISCUSSION: A working group of the German Society of Cardiology published recommendations for infrastructure, equipment and organisation of chest pain units in Germany, which should be separated from the ED of hospitals and be under the leadership of a cardiologist. A symptom-based decision for acute care would be preferable if all differential diagnoses of diseases could be managed by one medical specialty: However, all four main symptoms of patients with acute MI (chest pain, acute dyspnea, abdominal pain, dizziness) are also caused by diseases of different specialties. Evaluation and treatment of acute chest pain by representatives of one specialty would lead to over- or undertreatment of affected patients. Therefore we suggest a multidisciplinary evaluation of patients with acute chest pain including representatives of emergency and critical care physicians, cardiologists, internists, geriatricians, family physicians, premedics and emergency nurses. Definition of key indicators of performance and institutionalized feedback will help to further improve quality of care.

[Catalogue of learning goals for pregraduate education in geriatric medicine. A recommendation of the German Geriatric Society (DGG), the German Society of Gerontology and Geriatrics (DGGG), the Austrian Society of Geriatrics and Gerontology (ÖGGG) and the Swiss Society of Geriatric Medicine (SFGG) on the basis of recommendations of the European Union of Medical Specialists Geriatric Medicine Section (UEMS-GMS) 2013]. / Lernzielkatalog für die studentische Lehre im Fachbereich "Geriatrie" an Fakultäten für Humanmedizin. Eine Empfehlung der Deutschen Gesellschaft für Geriatrie (DGG), der deutschen Gesellschaft für Gerontologie und Geriatrie (DGGG), der Österreichischen Gesellschaft für Geriatrie und Gerontologie (ÖGGG) und der Schweizerischen Fachgesellschaft für Geriatrie (SFGG) auf Basis der Empfehlungen der Europäischen Facharztvereinigung-Sektion Geriatrie (UEMS-GMS) 2013.

Sound knowledge in the care and management of geriatric patients is essential for doctors in almost all medical subspecialties. Therefore, it is important that pregraduate medical education adequately covers the field of geriatric medicine. However, in most medical faculties in Europe today, learning objectives in geriatric medicine are often substandard or not even explicitly addressed. As a first step to encourage undergraduate teaching in geriatric medicine, the European Union of Medical Specialists -Geriatric Medicine Section (UEMS-GMS) recently developed a catalogue of learning goals using a modified Delphi technique in order to encourage education in this field. This catalogue of learning objectives for geriatric medicine focuses on the minimum requirements with specific learning goals in knowledge, skills and attitudes that medical students should have acquired by the end of their studies.In order to ease the implementation of this new, competence-based curriculum among the medical faculties in universities teaching in the German language, the authors translated the published English language curriculum into German and adapted it according to medical language and terms used at German-speaking medical faculties and universities of Austria, Germany and Switzerland. This article contains the final German translation of the curriculum. The Geriatric Medicine Societies of Germany, Austria, and Switzerland formally endorse the present curriculum and recommend that medical faculties adapt their curricula for undergraduate teaching based on this catalogue.