Criteria used when assessing elderly patients

Geriatric emergency management (GEM) nurses at Toronto's Humber River Regional Hospital (HRHH) use a strict set of criteria when assessing elderly patients in the ED and determining if they are "high-risk" patients.

"They include being over 70, taking five meds or more, having a history of frequently falling, if they live alone at home, and if they do not have other support in the community," notes Sonia del Castillo, RN, BSN, a GEM nurse at HRRH.

Other criteria include multiple visits to hospitals and multiple comorbidities, adds Rakesh Kumar, MD, CCFP, chief of emergency services, who notes that this assessment is critical to the department's fall prevention strategy.

del Castillo says, "We assess their safety and whether they must use a cane or a walker to assist them. Then we decide what alternative help they will need in the community."

In addition, she says, the GEM nurse will collaborate with the pharmacist to see if the patient is having problems with medication interaction, a common issue. "They also arrange for an assessment of the home to see how safe it is," adds Kumar. The GEM nurses also continue to follow up with patients who are admitted to acute care units, to ensure they have the help they need when they are ready to return home.