GEMCAST

Dr. Danya Khoujah joins GEMCast host Dr. Christina to dive into the first clinical practice guideline in the Geriatric Emergency Department (GED) Guidelines 2.0, which is dedicated to delirium. Delirium is a clinical syndrome characterised by acute and fluctuating disturbances of attention, awareness, perception or consciousness and it commonly affects older adults presenting to the ED. However, it is often missed, which has significant impacts on mortality and functional status of older patients. Khoujah is an attending physician in the Department of Emergency Medicine at AdventHealth Tampa in Florida, and host of GEDC’s expert-panel webinars. She is part of the multidisciplinary team that created this GRADE-based clinical guideline, and in this episode, she talks through the development and recommendations arising from the guideline.

The group aimed to assess the quality and applicability of direct and indirect evidence, with the goal of providing ED clinicians a patient-centred approach to delirium. To do so they asked 3 key questions: Which older patients in the ED are at higher risk of delirium? Which diagnostic tests are effective at identifying ED delirium? Do older ED patients with delirium need a CT head?

Tune in to today’s episode to hear more about screening, diagnosing and brain imaging for delirium in the ED, and keep an eye out for upcoming clinical guidelines in the GED Guidelines 2.0 series including medication safety, fall prevention,

Find more information about this topic at https://gedcollaborative.com/resource/delirium/delirium-clinical-practice-guidelines-what-do-we-know-and-what-should-we-do/

GEMCAST is a Geriatric Emergency Medicine Podcast created to help clinicians, nurses, or paramedics who take care of older adults, particularly in the Emergency Department setting. GEMCast episodes, show notes and recommended resources can be found on the GEDC website at gedcollaborative.com/resources/?type=podcast.

In this GEMCast episode host Dr. Christina Shenvi is joined by Dr. Meredith Busman, Director of Observation Medicine at Corewell Health West in Grand Rapids Michigan, Program Director for the Observation Medicine Fellowship at Emergency Care Specialists, and co-chair of the ACEP Accelerate Observation Medicine: Science and Solutions conference. Observation medicine is an outpatient service that encompasses rapid treatment, assessment, and reassessment of select patients with the hopes of avoiding admission. Learn more about this new and rapidly developing subspecialty of emergency medicine, how ED-directed observation units function, and how they are particularly beneficial for older patients or those with dementia.

The care provided in an observation unit uses predetermined protocols and pathways, leading to the notably shorter length of stay (LOS) – Dr. Busmans’ unit has an average LOS of just 17 hours! A rapid turnaround, coupled with efficient care from specialists and multidisciplinary input, leads to better outcomes for patients. In older patients who are susceptible to unfavorable outcomes such as delirium and deconditioning from either ED boarding or inpatient stays, the impact of a specialized service can be significant on acute and long-term health. Alongside the benefits for patients, an observation unit helps offload patients from other services and can improve patient flow through busy EDs.

For more show notes visit https://gedcollaborative.com/resource/boarding/the-17-hour-turnaround-rapid-safe-observation-care-for-older-adults/.

Dr. Stephen Gamboa is an Adjunct Associate Professor at UNC and medical director of UNC Health Pardee's emergency department in Hendersonville, North Carolina. In today’s GEMCast episode, he shares his first-hand experiences from two major natural disasters: the 2017 Tubbs Fire in Northern California and Hurricane Helene, which hit Western North Carolina in 2024. As he joins host Dr. Christina Shenvi, the two talk about how these events have a disproportionate impact amongst our frail older patients, which can be attributed to age-related comorbidities, reduced mobility, and higher care needs.

Tune in and hear a variety of innovative solutions brought about by the various challenges that these major events can pose. The immediate impacts of natural disasters, such as smoke inhalation and needing to rapidly evacuate homes and skilled nursing facilities (SNFs), are just the tip of the iceberg. Older patients with decompensation or exacerbations of chronic conditions made up a large proportion of the increased demand on EDs following these disasters. Coupled with power outages, electricity shortages, no internet connectivity, and pharmacies closing, Dr. Gamboa describes how his team had to adapt quickly and how system-level support from UNC during Hurricane Helene, including staff, equipment and transport, was crucial to providing care to these vulnerable patients.

Find more information about this topic at https://gedcollaborative.com/resource/falls/fire-flood-and-fragility-disasters-through-a-geriatric-lens/ .

GEMCAST is a Geriatric Emergency Medicine Podcast created to help clinicians, nurses, or paramedics who take care of older adults, particularly in the Emergency Department setting. GEMCast episodes, show notes and recommended resources can be found on the Geriatric Emergency Department Collaborative (GEDC) website at https://gedcollaborative.com/resources/?type=podcast.

In this episode of GEMCast, Dr. Christina Shenvi sits down with Dr. Christina Prather, Director of Geriatrics and Palliative Medicine at George Washington University, for a dynamic, coffee-style conversation about innovations and challenges in geriatric emergency care. They explore strategies for supporting older adults with dementia, preventing avoidable ED visits, and advancing patient-centered care through better communication, system protocols, and interdisciplinary teamwork. Listen in for practical tips, real-world stories, and insights on how emergency clinicians and leaders can better navigate the complexities of cognitive impairment and deliver compassionate, collaborative care to our aging population.

Additional resources can be found at https://gedcollaborative.com/resource/dementia/acute-care-of-persons-living-with-dementia-from-the-clinic-to-the-ed-and-back/.

In this episode of GEMCast, host Dr. Christina Shenvi is joined by Dr. James Van Oppen, emergency physician and frailty expert at the University of Sheffield, to discuss the rising importance of frailty in emergency medicine. Frailty, defined as the loss of physiological resilience, is both common and clinically significant for older adults presenting to the emergency department (ED). The two discuss what frailty means, how it can be identified, and how to approach ED assessment and management in a frail patient, emphasizing the value of person-centred care. Furthermore, they highlight recent studies regarding frailty, which can be found in the resources below, and discuss the need for system-wide changes to support frailty care.

Alongside his work as an emergency physician and clinical lecturer, Dr. van Oppen is the chair of the geriatric emergency medicine section of the European Society of Emergency Medicine. Tune in to this episode to expand your understanding of frailty and hear some practical tips to improve your clinical practice.