June 19, 2019
By Will Boggs MD
NEW YORK (Reuters Health) - Four geriatric-evaluation and -management strategies ("GEMS") can help hospitalists routinely and efficiently assess acutely ill older adults.
"We believe that these evaluations will facilitate your acute care, guide your daily discussions, and ease transitions of care from becoming a hospital patient, through the course of the acute care, to going home or to postacute care," Dr. Lillian Min of the University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, in Ann Arbor, told Reuters Health by email.
In a report online June 18 in Annals of Internal Medicine, Dr. Min and Dr. Lona Mody describe the four strategies to use when admitting acutely ill older adults to the hospital.
First, it's important to evaluate the patient's physical function by questioning every patient about activities of daily living (bathing, toileting, walking, and so on) and by assessing mobility in addition to walking (including the use of assistive devices and whether the patient has fallen in the past 6 months).
Second, cognitive function should be assessed. For this, the authors recommend two attention tests: have the patient spell the word "world" forward and backward; and have the patient repeat a span of numbers forward and backward (normal is 5 digits backward for 7 digits forward).
Third, right from the start, it's critical to assess the patient's social support and to initiate safe-discharge planning, the authors say.
Fourth, the hospitalist should glean information about whom the patient relies on for help with decision-making. It can be useful to assemble a team of a few trusted friends or relatives that can help the patient make challenging decisions that often arise during the hospital course and discharge planning.
"These are 4 steps that we do for all of our acutely ill older patients," Dr. Min said. "We envisioned how busy the hospitalists are, and we recommended these GEMS not for just the ideal situations."
"This is a checklist that should be quickly performed for all older patients," she said. "For some patients all four steps can happen very quickly. For some patients it will take a bit more time, but these patients are the ones who need the care that it takes to preplan a safer discharge."
"Done efficiently, we believe that the time is well spent (or even saved) by clearer communication and facilitated planning later on in the hospitalization, especially when making decisions about care during the hospitalization and planning for discharge," Dr. Min said.
"Try these GEMS," she suggested. "Practicing and repetition is the only way to get consistency of these evaluations."
Ann Intern Med 2019.
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