Geriatric Emergency Medicine Research
Goals & Description
The goal of this research area is to evaluate and improve the system of medical care for older adults with acute healthcare needs. There are many factors that limit these patients' access to safe, patient-centered, efficient, high-quality, acute care. These factors foster unneccessary ED use, adverse events in the ED for which older adults are particularly at-risk, and unnecessary medical costs. This research is particularly important due to the increasing number of older adults.
Telemedicine for Acute Illnesses and Injuries
We are developing and evaluating a telemedicine-enhanced care model that improves access to safe, high quality, acute illness care; fosters appropriate use of health services; and reduces unnecessary expenditures. In our current AHRQ-funded study we are evaluating the impact of telemedicine for a cohort of older adults who reside in senior living communities. We hypothesize that telemedicine will decrease the rate of emergency department (ED) use; decrease the net cost of healthcare; decrease hospitalization for ambulatory care sensitive conditions; and improve stakeholder satisfaction. Additional studies are in the process of being developed, including telemedicine to support prehospital care and to support community paramedicine activities.
Prehospital Triage of Older Adults with Injuries
We are leading and participating in a number of federally funded projects to better understand how older adults with traumatic injuries are cared for and triaged by EMS providers. The projects include:
- Evaluating the classification accuracy of the Field Triage Decision Scheme in younger vs. older patients;
- Deriving an older adult specific Field Triage Decision Scheme;
- Describing and optimizing the process used by EMS providers to identify older patients with traumatic brain injury.
Findings from these studies have the potential to shift clinical practice in the prehospital setting by informing future recommendations for the triage of injured older adults.
Improving Syncope Risk Stratification in Older Adults
We are participating in a national, multi-centered prospective, observational study of older adults with unexplained syncope to describe existing care, derive and validate a novel risk prediction model for significant outcomes, and estimate diagnostic yield and costs of implementing risk-based decision algorithms. The long-term goal is to eliminate unnecessary admissions of older adults with unexplained syncope by improving risk prediction.
Community Paramedicine for Older Adults
For over 10 years we have been investigating the use of prehospital emergency medical technicians and paramedics to screen older adults who have unmet medical and psychosocial needs. Through funding from the NIH, HRSA, and foundations, we have evaluated the feasibility, acceptability, and validity of prehospital screening. We have developed and sustained a prehospital program to screen and refer older EMS patients with needs. We are currently developing new community paramedicine programs and working to evaluate them.
Ichwan B, Darbha S, Thompson L, Shah MN, Thompson L, Evans DC, Boulger C, Caterino JM. Geriatric-specific triage criteria are more sensitive than standard adult criteria in identifying need for trauma center care in injured older adults. Annals of Emergency Medicine. 2014 June 5.
Hwang U, Shah MN, Carpenter CR, Han J, Adams J, Siu A. The CARE SPAN—Transforming emergency care for older adults. Health Affairs. 2013 Dec;32(12):2116-21.
Shah MN, Gillespie SM, Wood N, Wasserman EB, Nelson DL, Dozier A, McConnochie KM. High-intensity telemedicine-enhanced acute care for older adults: an innovative health care delivery model. Journal of the American Geriatrics Society. 2013; 61: 2000-2007.
Shah MN, Morris D, Jones CMC, Gillespie SM, Nelson DL, McConnochie KM, Dozier A. A qualitative evaluation of a telemedicine-enhanced emergency care program for older adults. Journal of the American Geriatrics Society. 2013;61:571–576.
Shah MN, McDermott R, Gillespie SM, Philbrick EB, Nelson D. Potential of telemedicine to provide acute medical care for adults in senior living communities. Academic Emergency Medicine. 2013;20(2):162-8.
Shah MN, Swanson P, Nobay F, Peterson LKN, Caprio TV, Karuza J. A novel internet based geriatric education program for emergency medical services providers. Journal of the American Geriatrics Society. 2012;60(9):1749-54. NIHMS385596.
|AHRQ||R01||Telemedicine for Acute Illnesses and Injuries|
|CDC||U01||Prehospital Triage of Older Adults with Injuries|
|NIH/NHLBI||R01||Improving Syncope Risk Stratification in Older Adults|
|NIH/NIA||R03||Deriving a Prehospital Triage Decision Scheme for Injured Older Adults|
|SAEM||Institutional Research Training Grant|
Research & Academic Newsletter
Geriatric Research Links
- U of R Division of Geriatrics & Aging
- NIH - National Institute on Aging
- Beeson Aging Research Program
- Alliance for Aging Research
Emergency Medicine Research