老年急诊的综合管理_West China Medical Journal

Authors：

 陈善萍 , 邹川 ,  董碧蓉

四川大学华西医院老年医学中心（成都 610041）;

Corresponding author：

董碧蓉, Email: birongdong@163.com

Keywords：

老年人; 急诊; 评估; 照护模式

DOI：

10.7507/1002-0179.20150281

Video：

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随着人口老龄化时代的到来，老年人群、特别是75岁以上的高龄老年患者急诊就诊率远高于其他年龄段人群。2004年老年患者在急诊就诊人群中占14%，预计到2030年将上升至25%。结合急诊老年患者的特点，调整急诊的照护模式以更好地服务老年患者显得尤为重要。老年急诊的改变及管理应渗透到急诊科的每一个环节，从急诊室的环境设施、急诊医护人员的知识技能、筛选和评估工具、照护模式及后期的随访，以充分发挥急诊室在老年患者就诊及整个照护系统中的重要作用。

Citation： 陈善萍, 邹川, 董碧蓉. 老年急诊的综合管理. West China Medical Journal, 2015, 30(5): 987-990. doi: 10.7507/1002-0179.20150281 Copy

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16.	Then KL, Rankin JA, Fofonoff DA. Atypical presentation of acute myocardial infarction in 3 age groups[J]. Heart Lung, 2001, 30(4):285-293.
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18.	Grosmaitre P, Le VO, Yachouh E, et al. Significance of atypical symptoms for the diagnosis and management of myocardial infarction in elderly patients admitted to emergency departments[J]. Arch Cardiov Dis, 2013, 106(11):586-592.
19.	Olsson T, Terent A, Lind L. Charlson Comorbidity Index can add prognostic information to Rapid Emergency Medicine Score as a predictor of long-term mortality[J]. Eur J Emerg Med, 2005, 12(5):220-224.
20.	Barron EA, Holmes J. Delirium within the emergency care setting, occurrence and detection:a systematic review[J]. Emerg Med J, 2013, 30(4):263-268.
21.	Kakuma R, Fort D, Galbaud G, et al. Delirium in older emergency department patients discharged home:effect on survival[J]. J Am Geriatr Soc, 2003, 51(4):443-450.
22.	Hustey FM, Meldon SW, Smith MD, et al. The effect of mental status screening on the care of elderly emergency department patients[J]. Ann Emerg Med, 2003, 41(5):678-684.
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29.	Chen YC, Wang SJ, Lai HY, et al. Potentially inappropriate medication for emergency department visits by elderly patients in Taiwan[J]. Pharmacoepidemiol Drug Safety, 2009, 18(1):53-61.
30.	Wilber ST, Blanda M, Gerson LW. Does functional decline prompt emergency department visits and admission in older patients?[J]. Acad Emerg Med, 2006, 13(6):680-682.
31.	Rodríguez-Molinero A, López-Diéguez M, Tabuenca AI, et al. Functional assessment of older patients in the emergency department:comparison between standard instruments, medical records and physicians' perceptions[J]. BMC Geriatr, 2006, 6(1):13.
32.	Caplan GA, Brown A, Croker WD, et al. Risk of admission within 4 weeks of discharge of elderly patients from the emergency department-the DEED study[J]. Age Ageing, 1998, 27(6):697-702.
33.	Ross MA, Compton S, Richardson D, et al. The use and effectiveness of an emergency department observation unit for elderly patients[J]. Ann Emerg Med, 2003, 41(5):668-677.
34.	Mccusker J, Bellavance F, Cardin S, et al. Detection of older people at increased risk of adverse health outcomes after an emergency visit:the ISAR screening tool[J]. J Am Geriatr Soc, 1999, 47(10):1229-1237.
35.	Salvi F, Belluigi A, Cherubini A. Predictive validity of different modified versions of the identification of seniors at risk[J]. J Am Geriatr Soc, 2013, 61(3):462-464.
36.	Asomaning N, Loftus C. Identification of Seniors at Risk (ISAR) Screening Tool in the emergency department:implementation using the plan-do-study-act model and validation results[J]. J Emerg Nurs, 2014, 40(4):357-364.
37.	lie M, Rousseau F, Cole M, et al. Prevalence and detection of delirium in elderly emergency department patients[J]. Ca Med Associat J, 2000, 163(8):977-981.
38.	Hustey FM. The use of a brief depression screen in older emergency department patients[J]. Acad Emerg Med, 2005, 12(9):905-908.
39.	Adams JG, Gerson LW. A new model for emergency care of geriatric patients[J]. Acad Emerg Med, 2003, 10(3):271-274.
40.	Adams J, Adinaro D, Baumlin K, et al. GEDI WISE:geriatric emergency department innovations in care through workforce, informatics, and structural enhancements[J]. Ann Emerg Med, 2013, 62(4):S54-S55.

1. Grief CL. Patterns of ED use and perceptions of the elderly regarding their emergency care:a synthesis of recent research[J]. J Emerg Nurs, 2003, 29(2):122-126.
2. Nawar EW, Niska RW, Xu J. National hospital ambulatory medical care survey:2005 emergency department summary[J]. Adv Data, 2007, 29(386):1-32.
3. Aminzadeh F, Dalziel WB. Older adults in the emergency department:a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions[J]. Ann Emerg Med, 2002, 39(3):238-247.
4. Salvi F, Morichi V, Grilli A, et al. The elderly in the emergency department:a critical review of problems and solutions[J]. Inter Emerg Med, 2007, 2(4):292-301.
5. Samaras N, Chevalley T, Samaras D, et al. Older patients in the emergency department:a review[J]. Ann Emerg Med, 2010, 56(3):261-269.
6. Carmel S, Anson O, Levin M. Emergency department utilization:a comparative analysis of older-adults, old and old-old patients[J]. Aging (Milano), 1990, 2(4):387-393.
7. Halter JB. Hazzard's geriatric medicine and gerontology[M]. 6 th ed. New York:McGraw-Hill Companies, 2009.
8. Carter MW, Gupta S. Characteristics and outcomes of injury-related ED visits among older adults[J]. Am J Emerg Med, 2008, 26(3):296-303.
9. Downing A, Wilson R. Older people's use of Accident and Emergency services[J]. Age Ageing, 2004, 34(1):24-30.
10. Roberts DC, Mckay MP, Shaffer A. Increasing rates of emergency department visits for elderly patients in the United States, 1993 to 2003[J]. Ann Emerg Med, 2008, 51(6):769-774.
11. Yim VW, Graham CA, Rainer TH. A comparison of emergency department utilization by elderly and younger adult patients presenting to three hospitals in Hong Kong[J]. Int J Emerg Med, 2009, 2(1):19-24.
12. Sanders AB. Older persons in the emergency medical care system[J]. J Am Geriatr Soc, 2001, 49(10):1390-1392.
13. Khan S, Miskelly F, Platt J, et al. Missed diagnoses among elderly patients discharged from an accident and emergency department[J]. J Accid Emerg Med, 1996, 13(4):256-257.
14. Strange GR, Chen EH. Use of emergency departments by elder patients:a five-year follow-up study[J]. Acad Emerg Med, 1998, 5(12):1157-1163.
15. Sklar DP, Crandall CS, Loeliger E, et al. Unanticipated death after discharge home from the emergency department[J]. Ann Emerg Med, 2007, 49(6):735-745.
16. Then KL, Rankin JA, Fofonoff DA. Atypical presentation of acute myocardial infarction in 3 age groups[J]. Heart Lung, 2001, 30(4):285-293.
17. Coronado BE, Pope JH, Griffith JL, et al. Clinical features, triage, and outcome of patients presenting to the ED with suspected acute coronary syndromes but without pain:a multicenter study[J]. Am J Emerg Med, 2004, 22(7):568-574.
18. Grosmaitre P, Le VO, Yachouh E, et al. Significance of atypical symptoms for the diagnosis and management of myocardial infarction in elderly patients admitted to emergency departments[J]. Arch Cardiov Dis, 2013, 106(11):586-592.
19. Olsson T, Terent A, Lind L. Charlson Comorbidity Index can add prognostic information to Rapid Emergency Medicine Score as a predictor of long-term mortality[J]. Eur J Emerg Med, 2005, 12(5):220-224.
20. Barron EA, Holmes J. Delirium within the emergency care setting, occurrence and detection:a systematic review[J]. Emerg Med J, 2013, 30(4):263-268.
21. Kakuma R, Fort D, Galbaud G, et al. Delirium in older emergency department patients discharged home:effect on survival[J]. J Am Geriatr Soc, 2003, 51(4):443-450.
22. Hustey FM, Meldon SW, Smith MD, et al. The effect of mental status screening on the care of elderly emergency department patients[J]. Ann Emerg Med, 2003, 41(5):678-684.
23. Hustey FM, Meldon SW. The prevalence and documentation of impaired mental status in elderly emergency department patients[J]. Ann Emerg Med, 2002, 39(3):248-253.
24. Chung MK, Bartfield JM. Knowledge of prescription medications among elderly emergency department patients[J]. Ann Emerg Med, 2002, 39(6):605-608.
25. Hohl CM, Robitaille C, Lord V, et al. Emergency physician recognition of adverse drug-related events in elder patients presenting to an emergency department[J]. Acad Emerg Med, 2005, 12(3):197-205.
26. Terrell KM, Heard K, Miller DK. Prescribing to older ED patients[J]. Am J Emerg Med, 2006, 24(4):468-478.
27. Hohl CM, Dankoff J, Colacone A, et al. Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department[J]. Ann Emerg Med, 2001, 38(6):666-671.
28. Caterino JM, Emond JA, Camargo CA. Inappropriate medication administration to the acutely ill elderly:a nationwide emergency department study, 1992-2000[J]. J Am Geriatr Soc, 2004, 52(11):1847-1855.
29. Chen YC, Wang SJ, Lai HY, et al. Potentially inappropriate medication for emergency department visits by elderly patients in Taiwan[J]. Pharmacoepidemiol Drug Safety, 2009, 18(1):53-61.
30. Wilber ST, Blanda M, Gerson LW. Does functional decline prompt emergency department visits and admission in older patients?[J]. Acad Emerg Med, 2006, 13(6):680-682.
31. Rodríguez-Molinero A, López-Diéguez M, Tabuenca AI, et al. Functional assessment of older patients in the emergency department:comparison between standard instruments, medical records and physicians' perceptions[J]. BMC Geriatr, 2006, 6(1):13.
32. Caplan GA, Brown A, Croker WD, et al. Risk of admission within 4 weeks of discharge of elderly patients from the emergency department-the DEED study[J]. Age Ageing, 1998, 27(6):697-702.
33. Ross MA, Compton S, Richardson D, et al. The use and effectiveness of an emergency department observation unit for elderly patients[J]. Ann Emerg Med, 2003, 41(5):668-677.
34. Mccusker J, Bellavance F, Cardin S, et al. Detection of older people at increased risk of adverse health outcomes after an emergency visit:the ISAR screening tool[J]. J Am Geriatr Soc, 1999, 47(10):1229-1237.
35. Salvi F, Belluigi A, Cherubini A. Predictive validity of different modified versions of the identification of seniors at risk[J]. J Am Geriatr Soc, 2013, 61(3):462-464.
36. Asomaning N, Loftus C. Identification of Seniors at Risk (ISAR) Screening Tool in the emergency department:implementation using the plan-do-study-act model and validation results[J]. J Emerg Nurs, 2014, 40(4):357-364.
37. lie M, Rousseau F, Cole M, et al. Prevalence and detection of delirium in elderly emergency department patients[J]. Ca Med Associat J, 2000, 163(8):977-981.
38. Hustey FM. The use of a brief depression screen in older emergency department patients[J]. Acad Emerg Med, 2005, 12(9):905-908.
39. Adams JG, Gerson LW. A new model for emergency care of geriatric patients[J]. Acad Emerg Med, 2003, 10(3):271-274.
40. Adams J, Adinaro D, Baumlin K, et al. GEDI WISE:geriatric emergency department innovations in care through workforce, informatics, and structural enhancements[J]. Ann Emerg Med, 2013, 62(4):S54-S55.

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老年急诊的综合管理

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