Geriatric Emergency Medicine is of interest for every emergency department, in every country, in every setting (rural vs academic).
I recently attended a conference in Brisbane called the Global Acute Care Excellence Forum preceded by the interRAI group meeting where I was invited as a guest. It was an incredible and rewarding experience. I had the chance to meet many passionate clinicians and researchers about geriatric emergency medicine. But something struck me. We have the same challenges and barriers, and yet, the very same ambition: better care for older adults. Although we seem to be successful in our own environment, we are currently not so successful to expose our stories to the world. Result: we reinvent the wheel each time.
Geriatric ED guidelines were published in 2014 by an american expert committee (ED physicians, nurses, geriatrician). In consequence, other countries don’t feel like it is applicable to them. The silver book is from the UK and states the same principles, adapted. Australia is now working to publish their own guidelines. But why? It is all the same basic concepts: education, interdisciplinarity, equipment, procedures and research! And it takes a significant amount of work to gather these statement together, a precious time that could be used to do better things if only we had this: the geriatric emergency department international guidelines (GEDIGs? OK I’ll work on something better).
There are some efforts. I heard today about the International Consortium of Emergency Geriatrics. A group composed of brilliant physicians and nurses throughout Canada, USA, Aussie, Thailand, UK, India, etc. The idea is great! But the upcoming event on the website was in 2014…
I met with Dr Guruprasad Nagaraj, an emergency physician from Sydney who is the lead of geriatric emergency medicine in Australia. He works hard to spread his work and he is actually helping multiple ED to start senior-friendly initiative. His work is mostly in the ED, with the team, trying to build something concrete. It is amazing. He is lacking time to publish and to properly evaluate outcomes from his work. Same thing on our side of the ocean. What would be a good outcome to measure? Admission rate? ED revisit? LOS in the ED? In hospital? Easy to measure but is it meaningful for our older adult population? What about more patient-centered outcome like functional decline, LOS at home or long term care disposition. Are we actually doing something good? I am absolutely convinced that we are but at what level?
Here are a few possible solutions.
First, the guidelines need to be updated and reformatted. Why not do it as a collaborative work (it is our mantra anyway) and publish the very first international guidelines for Geriatric Emergency Medicine (IGGEM?…no!).
Second, we should discuss together a way to publicize our work and determine how we should measure outcomes of our projects. What would be the best outcome?
Third, we definitely should organize an open conference for both emergency physicians and geriatricians. A sharing experience that will allow us to bridge these islands together in a whole aligned “archipel” of knowledge, language and ambition to build a Senior-Friendly Emergency Department, a Senior-Friendly health care system.
We are a small community. In French we have an expression for it “Dans les petits pots, les meilleurs onguents”. It means that the best things are usually found in smallest and the least obvious place. But at some point, we need to share our grandmother recipe and make sure that everybody adapts it to their local cuisine because one thing is absolutely certain, everybody will love it!