Authors,
Year
Sample
(N)
200
patients
Setting
Emergency
departments
Robinson &
Mercer,
2007
206
patients
midwestern
emergency
department
Rogers, et
al., 2012
3,902
patients
Trauma
Registry of
Pennsylvania
Trauma
Systems
Foundation
Findings
Strengths/Limitations
results of the study indicate that patients treated in
the geriatric focused ED had “slightly but
significantly” lower mortality rates than their
counterparts seen in tradition ED. Salvi, et al.
,2008
The results demonstrated the characteristics of the
older adult patient indicating that 60.2% were
triaged as urgent, 35% as emergent, and the two
most common diagnosis were fall related injury
and respiratory complication. Of the nurses
surveyed 37 percent of the nurses had an average
length of experience of twelve years. On the
survey the ED nurses scored lowest on perceptions
of appropriateness of pressure ulcer prevention and
pain medication administration for older adults.
The nurses surveyed all indicated their lack of
knowledge of geriatric care at least somewhat
interfered with the care they provided.
The strengths of this study include a clear purpose,
methodology, large sample size, demographics, and its
ability to be replicated for future studies. The major
limitations is the study is not free of selection biases
and cofounders.
The strengths of this study include a clear purpose,
sample size, description of sampling method, and
GIAP results. The study utilized reliable validated
instruments and analyzed for consistency. Data from
multiple months during the year was analyzed to
reduce the effect of seasonal use of the ED. The major
limitation of this study is that it was conducted in only
one emergency department in the Midwest. Some of
the issues identified may be specific to this emergency
department or geographic area, which decreases the
generalizability of the findings. Also, since the study
data was collected by chart review it was dependent on
complete and accurate charting and documentation and
limited by what types of information is legally
documentable.
The strengths of this study include a clear purpose,
sample size spanning 10 years, description of sampling
method, and description of calculations. Limitations
include that patients functional status was not taken
into account in relation to their triage score.
Additionally, many older adults have advanced
directives specifying no aggressive life saving
treatment and this could affect mortality rates and
trauma activation possibly increasing under triaged
The results revealed that 14.4% of the older adult
patients were under triaged. The results showed
that under triaging was a significant predictor of
mortality. Under triaged patients were nearly twice
as likely to die from their injuries as compared to
correctly triaged patients.
Authors,
Year
Sample
(N)
Setting
Findings
(Hwang et
al, 2010
1,031
patients
urban tertiary
care
emergency
department
The results of this study indicate that there are
differences in acute pain care treatment for older
adults in ED’s. Lower overall reduction of pain
scores and less opioid use for the treatment of
painful conditions in older patients identified a
disparity of pain management. Older adults have
lower overall reduction of pain scores and less
opioid use for the treatment of painful conditions
than their younger counterparts.
(landmark
study)
146
nurses, 63
patients
Nurses
working with
older adults
in hospitals
The results of the study suggest that the geriatric
specific continuing education program enhances
nurses knowledge of and attitudes about older
adult clients. However, there was no measureable
effect on patient satisfaction or perception of
nursing care as a result of the continuing education
program. Harrison & Novak, 1988
Brymer et
al., 1996
120 nurses
emergency
department
nurses from
urban and
rural facilities
in 3 counties
The results revealed half (51.3%) of the
participants had taken a course on adult physical
assessment and only 61.8% had received education
on the normal aging process. Almost two thirds
(72%) of the nurses could not provide examples on
how to determine cognitive impairment in older
Strengths/Limitations
rates.
The strengths of this study include a clear purpose,
large sample size, description of sampling method, and
description of data calculation and analysis.
Multivariate analysis was used to adjust for potential
confounding covariates One limitation to this study is
the hypothesis that advanced age, polypharmacy and
comorbidities are associated with longer time to pain
control and these factors were not adjusted for in this
study. Other studies also indicate that pain sensitivity
may decline as patients’ age. Therefore, this could
account for part of the overall mean pain reduction
score for older adults as compared to their younger
counterparts.
The strengths of this study include a clear purpose,
clear hypotheses, sample size and selection variation,
description of sampling method, and description of data
calculation and analysis. Limitations of the study are
that the same older adult subjects could not be
interviewed both before and after the continuing
education program but same units were used to
normalize the results and make them more
generalizable.
The strengths of this study include a clear purpose,
clear hypothesis, inclusion of the questionnaire and
representation of results in table format. A strength of
this study is that a test, re-test reliability for the
questionnaire was over 90%. A limitation of the study
is the sample size was only 120 participants from three
Authors,
Year
Sample
(N)
Setting
of ontario
George, C.
2011
12
Geriatric
emergency
departments
in the US
Hirschman,
et all., 2010
892
patients
older adult
patients
admitted to
the ED of a
large, urban,
tertiary
academic
health center
Leah, V., &
Adams, J.
666
patients
District
general
Findings
Strengths/Limitations
adults. The nurses also chose an average of 6.4
topics on geriatric education they felt they lacked.
Based on the study findings the authors indicate
the deficiency of care of older adults reflects a lack
of knowledge of older adult care.
It states that seniors emergency departments or
seniors emergency centers yield fewer harmful
drug interactions, higher patient satisfaction
decreased hospital readmission rates and higher
quality care than generic emergency departments.
A lower incidence of injuries such as falls within
senior emergency departments reduces the need for
treatment and ultimately alleviates costs.
counties of Ontario, which weakens the results.
Forty-two percent of elderly patients presented
with deficits in orientation and recall as assessed
by the SIS. An additional 36% of elderly patients
with no impairment in orientation or recall had
deficits in executive function as assessed by the
CLOX1. Only age was significantly associated
with executive functioning deficits in the ED
screened using the clock drawing task. These
findings have several implications for patients seen
in the ED. The SIS coupled with a clock drawing
task (CLOX1) provide a rapid and simple method
for assessing and documenting cognition when
lengthier assessment tools are not feasible.
In the four months of the study period, the ATOP
prevented admission of 178 of the 666 patients
The strengths of this study include a clear purpose,
clear hypotheses, large sample size, sample size taken
over 1 year, description of sampling method, and
adjusted analysis. Limitations include that the study
only looked at admitted patients. Further research on
provider use of these tools and potential implication for
quality improvement is needed.
The strengths of this study include a clear purpose,
clear hypothesis and that detailed descriptive studies of
these ED’s were done. Limitations are that geriatric
ED’s have only existed in the US since 2008 thus the
small sample size to compare to generic ED’s.
The strengths of this study include a clear purpose,
clear hypotheses, large sample size, , description of
Authors,
Year
2010
Sample
(N)
Setting
Findings
hospital
seen. Of these 178 patients, 19 re-attended the
hospital and six were admitted.
Known strategies that have been effective in
improving outcomes for older people within the
hospital and residential care setting can be
generalized into emergency department care.
Geriatric emergency management nurses work
collaboratively with the emergency department
team to facilitate change in the way that
emergency department care is provided to the older
person experiencing health emergencies.
The Triage Risk Stratification Tool (TRST)
demonstrated moderate predictive ability of the
tool to identify return to the emergency department
(ED) or hospitalization in a older adult patient
when used in actual clinical practice.
Flynn, D.,
et al. 2010
10 ED’s
Ontario
emergency
departments
Lee et al.
2008
788
patients
3 ED’s in
Toronto
McCusker,
J., et al.
2003
14 studies
(reported
in 15
articles)
were
reviewed,
Strange,
1,193,743
10
communitybased
articles and
four using
clinical
samples.
A multicenter
Need is usually the primary determinant of ED
visits in older people. Controlling for need,
predisposing and enabling factors that promote
access to primary medical care are associated
with reduced ED utilization by older adults.
Fifteen percent of the ED visits were made by
Strengths/Limitations
sampling method, and adjusted analysis. Limitations
include that the findings are initial findings and were
reported after only 4 months of intervention therefore
sustainability of such programs though effective is not
determinable.
The strengths of this study include a clear purpose,
clear hypotheses, table of results, and analysis.
Limitations include that the findings are all from one
area therefore may be geographically specific and less
generalizable.
The strengths of this study include a clear purpose,
clear hypotheses, clear tables of results, 95%
confidence interval. Limitations include that the
findings are only moderately predictive with great
variability indicating that a more sensitive tool would
be more ideal for actual practice.
The strengths of this study include a clear purpose,
sample size, data was abstracted and checked by two
authors once extracted from the studies and
multivariate analyses. Limitations are that relevant
articles were identified through medline but no other
article databases were used so this review was limited
to medline articles.
The strengths of this study include a clear purpose,
Authors,
Year
G.R., Chen,
E.H., &
Sanders
A.B. 1992
Sample
(N)
patients
Setting
computer
data base of
70 hospitals
in 25 states.
Findings
Strengths/Limitations
patients 65 years or older. Thirty-two percent of
elderly patients seen in EDs were admitted to the
hospital, compared with 7.5% of nonelderly
patients. Seven percent of elderly patients were
admitted to ICUs, compared with 1% of nonelderly
patients. Thirty percent of elderly patients seeking
emergency care used ambulance transports
compared with 8% of nonelderly. Compared with
the nonelderly, the elderly are 4.4 times more
likely to use ambulance transport, 5.6 times more
likely to be admitted to the hospital, 5.5 times
more likely to be admitted to an intensive care bed,
and 6.1 times more likely to be classified as a
comprehensive ED level of service. In our sample,
36% of all patients arriving by ambulance to the
ED, 43% of all ED admissions, and 48% of all
intensive care admissions were geriatric patients.
With the rapid growth of the size of the elderly
population, it is important that we assess the
emergency medical resources needed to care for
the geriatric population.
very large diverse sample size selected from many
areas, strong generalizability, clearly represented data.
Limitations include that additional patient descriptors
such as race, etc. prevented from electronic
documentation are not available to further analyze
results.