Debra Eagles

Tuesday, May 29, 2018 • 13:00 - 14:30
Track 2 - GERIATRIC EMERGENCY MEDICINE
Track Chair: Dr. Debra Eagles

A Frailty Assessment for Emergency Medicine? - Dr. Judah Goldstein

Description: This presentation will review the state of the evidence on frailty and its implications to Emergency Medicine. Current frailty screening and assessment measures will be discussed focusing on feasibility, clinical properties, and their operationalization.

Learning Objectives:

  1. Improve understanding of frailty and how it can be defined
  2. Identify screening and assessment tools that may be amenable for use in Emergency Medicine
  3. Explore controversies around frailty evaluation and management in Emergency Medicine

Pearls:

  1. Frailty is a state of extreme vulnerability that can be measured
  2. Frailty and acuity both contribute to patient outcomes
  3. Grading frailty can help with care planning in Emergency Medicine

Biography: Judah Goldstein is the Research Coordinator for Emergency Health Services, Nova Scotia. He is a Primary Care Paramedic and has completed an Interdisciplinary PhD from Dalhousie University.Judah is an Assistant Professor with the Dalhousie University Department of Emergency Medicine, Division of Emergency Medical Services and affiliated scientist with the Nova Scotia Health Authority, Department of Emergency Medicine.

Frailty evaluation and management in acute care: Is there a role for paramedicine? - Dr. Judah Goldstein

Description: This presentation will discuss current evidence on the role of paramedicine and mobile integrated healthcare in geriatric evaluation and management.  Alternatives to traditional paramedic treatment and transport pathways will be described in the context of frailty.

Learning Objectives:

  1. Describe current mobile integrated healthcare/ community paramedic programs that include an element of geriatric evaluation and management
  2. Explore alternatives to traditional paramedic treatment and transport
  3. Identify key components of successful programs

Pearls:

  1. Paramedic clinical assessments combined with in-home observations provide rich information that can inform geriatric care
  2. Community paramedic programs can be targeted to specific frailty levels
  3. EMS resources can be leveraged to support older adults with frailty in the community

Biography: Judah Goldstein is the Research Coordinator for Emergency Health Services, Nova Scotia. He is a Primary Care Paramedic and has completed an Interdisciplinary PhD from Dalhousie University.Judah is an Assistant Professor with the Dalhousie University Department of Emergency Medicine, Division of Emergency Medical Services and affiliated scientist with the Nova Scotia Health Authority, Department of Emergency Medicine.

Applying the CTAS to Appropriately Prioritize the Elderly - Dr. Michael Bullard

Description: Aging leads to respiratory, circulatory and neuro-regulatory changes and altered responses to homeostatic challenges. In addition, cognitive impairment, frailty, atypical presentations of common diseases, polypharmacy, and greater injury from low impact trauma. New CTAS educational materials aim to support triage nurses interpret and apply existing modifiers along with a new frailty modifier to support safe and appropriate triage prioritization.

Learning Objectives:

  1. Understanding how aging affects physiologic response to stressors and how to apply CTAS vital sign modifiers
  2. Extended ED wait times for frail, vulnerable individuals negatively impacts ED outcomes. The new frailty modifier will be explained
  3. The challenges of cognitive changes to appropriate interpretation of presenting ED complaint and how to prioritize

Pearls:

  1. A respiratory rate of greater than 27 per minute is highly predictive for identifying critically ill elderly patients. Following trauma in the elderly, a systolic blood pressure of less than 110 mmHg is a sensitive predictor of severe injury.

Biography: Professor, Department of Emergency Medicine, University of Alberta, key member of the Canadian Triage and Acuity Scale (CTAS) National Working Group, with research interests in triage, knowledge translation and electronic clinical decision support. Have a long history of international work helping EM development in other countries.

Confused? Evaluation of Altered Mental Status in Older ED Patients - Dr. Debra Eagles

Description: Altered mental status is common in older ED patients and associated with increased morbidity and mortality. Limited use of appropriate ED screening and diagnostic tools results in under-recognition of this serious medical emergency. This presentation will present an approach to evaluating and managing altered mental status in older ED patients.

Learning Objectives:

  1. Review recommendations for cognitive assessments in older ED patients.
  2. Develop a cognitive evaluation toolbox: including (1) Ottawa 3DY Scale; and (2) Confusion Assessment Method
  3. Discuss management of the agitated delirious older ED patient.

Pearls:

  1. Screen all older ED patients for cognitive impairment.
  2. If altered mental status and baseline unknown, assume it is new and test for delirium.
  3. Haldol…..start low and go slow.

Biography: Dr. Debra Eagles is a staff physician at the Ottawa Hospital, an assistant professor at the University of Ottawa and an associate scientist with the Ottawa Hospital Research Institute. Her research focuses on improving the care and outcomes of older patients presenting to the Emergency Department.  She has a special interest in altered mental status, both dementia and delirium, frailty and minor trauma in the elderly.