Geriatric Emergency Medicine—A Model for Frailty Friendly Healthcare

Simon P. Mooijaart; Christopher R. Carpenter; Simon P. Conroy

Disclosures

Age Ageing. 2022;51(3):afab280 

In This Article

Abstract and Introduction

Abstract

As the world's population continues to age over the decades ahead, medical educators and researchers in every adult medical and surgical specialty will need to 'geriatricise' their clinical science. Many have already engaged with geriatrics. Here we describe the progress that has been made and the opportunities ahead in the field of Geriatric Emergency Medicine (GEM), a field that has taken large steps in integrating holistic care. Future opportunities exist in the three domains of evidence-based medicine: including patient preferences and needs, generating scientific evidence, and improving physician knowledge and expertise. Implementation requires new innovations also in the organisation of care. Similar strategies may be useful in other fields of medicine, in making holistic care the standard for older people.

Introduction

An ageing world has transformed the clinical populations for all non-paediatric physicians into one in which older people predominate. Life expectancy has increased, in part because more effective treatment options now exist for specific diseases like cancer and cardiovascular disease. These disease-specific advancements built upon improved foundations of knowledge ranging from the cellular level to clinical implementation. Continued progress in the quality of life in older persons will require a shift towards the geriatric paradigm.

Using Comprehensive Geriatric Assessment (CGA) contributes to better outcomes for older people in various healthcare settings,[1–3] making CGA the bread and butter of geriatricians in the community, in nursing homes and in hospitals. However, the principles of holistic care that are the basis of CGA have not been integrated to the full extent in disease-specific treatment guidelines. For example, randomised controlled trials are considered the highest level of evidence, but historically only 7% specifically studied older people[4] and poorly report the heterogeneity of the included older participants[5] and outcomes relevant to older people.[6] As a result, there is often uncertainty about the risks and benefits of disease-specific interventions (as opposed to more holistic interventions) in older people.[7]

As the world's population continues to age over the decades ahead, medical educators and researchers in every adult medical and surgical specialty will need to 'geriatricise' their clinical science; many have already engaged with geriatrics. Here we describe the progress that has been made and the opportunities ahead in the field of Geriatric Emergency Medicine (GEM), a field that has taken large steps in integrating holistic care, which may serve as an example for other specialties.

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