Geriatric Emergency Medicine Research

Goal

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.

Ongoing Projects

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.

Telemedicine Tested Among Seniors - News

Learn more about Telemedicine

Prehospital Triage of Older Adults with Injuries

We are leading and participating in a number of NIH and CDC funded projects to better understand the epidemiology of older adults with traumatic injuries who are cared for by ambulance-based emergency medical technicians or paramedics. 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 the process used by EMS providers in the prehospital setting to identify older patients with traumatic brain injury (TBI).

Finding 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.

Recent Publications

Duckles J, Elliot A, Sellers CR, Christensen T, Shah MN. "A Qualitative Exploration of Emergency Department Revisits by Older Adults." Journal of the American Geriatrics Society. [In Press]

Shah MN, Wasserman EB, Gillespie SM, Nelson DL, Wood N, Doyle M, Li S, McConnochie KM. "Performance of an Emergency Care Telemedicine Program for Older Adults." Journal of the American Geriatrics Society .

Shah, M. N., D. Morris, C. M. Jones, S. M. Gillespie, D. L. Nelson, K. M. McConnochie and A. Dozier (2013). "A Qualitative Evaluation of a Telemedicine-Enhanced Emergency Care Program for Older Adults." J Am Geriatr Soc 2013; 61:571–576

Shah, M. N., R. McDermott, S. M. Gillespie, E. B. Philbrick and D. Nelson (2013). "Potential of telemedicine to provide acute medical care for adults in senior living communities." Acad Emerg Med 20(2): 162-168.

Shah M, Richardson T, Jones CMC, Swanson P, Schneider S, Katz P, Conwell Y. "Depression and Cognitive Impairment in Older Adult Emergency Department Patients: Changes Over Two Weeks" J. American Geriatrics Society. 2011; 59: 321-326.

Fan L, Shah MN, Veazie P, Friedman B. "Factors Associated With Emergency Department Use Among the Rural Elderly" The Journal of Rural Health 2011; 27: 39-49

Xian Y, Holloway R, Noyes K, Shah MN, Friedman B."Racial Differences in Mortality Among Patients with Acute Ischemic Stroke" American College of Physicians 2011; 154: 152-160.

Archived Publications

(click for more publications)

Complete listing of recent faculty publications and articles in press.

Funding

Source	Type	Description
AHRQ	R01	Telemedicine for Acute Illnesses and Injuries
CDC		Prehospital Triage of Older Adults with Injuries
NIH/NHLBI		Improving Syncope Risk Stratification in Older Adults
		Community Paramedicine for Older Adults