GEMCAST

In this GEMCast episode host Dr. Christina Shenvi is joined by Dr. Meredith Busman, Director of Observation Medicine at Corewell Health West in Grand Rapids Michigan, Program Director for the Observation Medicine Fellowship at Emergency Care Specialists, and co-chair of the ACEP Accelerate Observation Medicine: Science and Solutions conference. Observation medicine is an outpatient service that encompasses rapid treatment, assessment, and reassessment of select patients with the hopes of avoiding admission. Learn more about this new and rapidly developing subspecialty of emergency medicine, how ED-directed observation units function, and how they are particularly beneficial for older patients or those with dementia. The care provided in an observation unit uses predetermined protocols and pathways, leading to the notably shorter length of stay (LOS) – Dr. Busmans’ unit has an average LOS of just 17 hours! A rapid turnaround, coupled with efficient care from specialists and multidisciplinary input, leads to better outcomes for patients. In older patients who are susceptible to unfavorable outcomes such as delirium and deconditioning from either ED boarding or inpatient stays, the impact of a specialized service can be significant on acute and long-term health. Alongside the benefits for patients, an observation unit helps offload patients from other services and can improve patient flow through busy EDs. For more show notes visit https://gedcollaborative.com/resource/boarding/the-17-hour-turnaround-rapid-safe-observation-care-for-older-adults/.

Dr. Stephen Gamboa is an Adjunct Associate Professor at UNC and medical director of UNC Health Pardee's emergency department in Hendersonville, North Carolina. In today’s GEMCast episode, he shares his first-hand experiences from two major natural disasters: the 2017 Tubbs Fire in Northern California and Hurricane Helene, which hit Western North Carolina in 2024. As he joins host Dr. Christina Shenvi, the two talk about how these events have a disproportionate impact amongst our frail older patients, which can be attributed to age-related comorbidities, reduced mobility, and higher care needs. Tune in and hear a variety of innovative solutions brought about by the various challenges that these major events can pose. The immediate impacts of natural disasters, such as smoke inhalation and needing to rapidly evacuate homes and skilled nursing facilities (SNFs), are just the tip of the iceberg. Older patients with decompensation or exacerbations of chronic conditions made up a large proportion of the increased demand on EDs following these disasters. Coupled with power outages, electricity shortages, no internet connectivity, and pharmacies closing, Dr. Gamboa describes how his team had to adapt quickly and how system-level support from UNC during Hurricane Helene, including staff, equipment and transport, was crucial to providing care to these vulnerable patients. Find more information about this topic at https://gedcollaborative.com/resource/falls/fire-flood-and-fragility-disasters-through-a-geriatric-lens/ . GEMCAST is a Geriatric Emergency Medicine Podcast created to help clinicians, nurses, or paramedics who take care of older adults, particularly in the Emergency Department setting. GEMCast episodes, show notes and recommended resources can be found on the Geriatric Emergency Department Collaborative (GEDC) website at https://gedcollaborative.com/resources/?type=podcast.

In this episode of GEMCast, Dr. Christina Shenvi sits down with Dr. Christina Prather, Director of Geriatrics and Palliative Medicine at George Washington University, for a dynamic, coffee-style conversation about innovations and challenges in geriatric emergency care. They explore strategies for supporting older adults with dementia, preventing avoidable ED visits, and advancing patient-centered care through better communication, system protocols, and interdisciplinary teamwork. Listen in for practical tips, real-world stories, and insights on how emergency clinicians and leaders can better navigate the complexities of cognitive impairment and deliver compassionate, collaborative care to our aging population. Additional resources can be found at https://gedcollaborative.com/resource/dementia/acute-care-of-persons-living-with-dementia-from-the-clinic-to-the-ed-and-back/.

In this episode of GEMCast, host Dr. Christina Shenvi is joined by Dr. James Van Oppen, emergency physician and frailty expert at the University of Sheffield, to discuss the rising importance of frailty in emergency medicine. Frailty, defined as the loss of physiological resilience, is both common and clinically significant for older adults presenting to the emergency department (ED). The two discuss what frailty means, how it can be identified, and how to approach ED assessment and management in a frail patient, emphasizing the value of person-centred care. Furthermore, they highlight recent studies regarding frailty, which can be found in the resources below, and discuss the need for system-wide changes to support frailty care. Alongside his work as an emergency physician and clinical lecturer, Dr. van Oppen is the chair of the geriatric emergency medicine section of the European Society of Emergency Medicine. Tune in to this episode to expand your understanding of frailty and hear some practical tips to improve your clinical practice.

Climate change, and the associated increase in frequency and severity of heat waves, poses a threat to health. Amongst the most at risk for heat-related emergencies are older adults; age-associated physiologic vulnerabilities, chronic conditions, medications that disrupt thermoregulatory responses, and social determinants all contribute to an increased risk of heat-related illness in this population. When an older adult presents to the emergency department (ED) with vague or subtle symptoms of heat exhaustion or heat stroke, they may be missed by ED practitioners – a concerning thought as these patients are at a greater risk of mortality from heat-related emergencies. Optimal management of these presentations requires clinical recognition and treatment within the ED as well as pre-hospital interventions that can be given by emergency medical services (EMS). GEMCast host Dr. Christina Shenvi is joined by Geoff Comp, Associate Program Director at Creighton University School of Medicine/Valleywise Health Medical Center in Phoenix, Arizona, as the two do an in-depth review of this critical topic. Dr. Comp holds a wilderness medicine fellowship through the Wilderness Medical Society and is an expert in heat-related illness. Show notes are available on the Geriatric Emergency Department Collaborative (GEDC) website. https://gedcollaborative.com/resource/atypical-presentations/getting-hotter-heat-emergencies-in-older-adults/

Our population is aging, and with that comes an increase in the number of older adults in emergency departments. Delirium affects up to 1/3 older adults who present to the ED and is a medical emergency that is often overlooked by ED clinicians. In this episode of GEMCast host Dr. Christina Shenvi discusses the importance of recognising delirium, documenting it, and intervening where possible in the ED with Dr. Kayla Furlong and Dr. Gillian Sheppard. Dr. Furlong and Dr. Sheppard are both emergency medicine physicians in St. John’s, Newfoundland & Labrador, who are experts in point of care ultrasound (POCUS). Dr. Furlong is a Clinical Assistant Professor in the Faculty of Medicine at Memorial University and is the Chair of the CAEP Geriatric EM Committee. Dr. Sheppard is an Associate Professor and Chair of the Discipline of Emergency Medicine at Memorial University. She is also a Diplomate of the Royal College of Physicians of Canada with an Area of Focused Competence in POCUS and is the education lead for the Canadian Association of Emergency Physicians Emergency Ultrasound Committee. They have taken a special interest in whether the use of POCUS increases the ED clinicians’ ability to determine the aetiology of a geriatric patient’s delirium or agitation, and in doing so have developed the ABLE approach. They discuss why and how POCUS can be a useful tool and provide helpful tips for ED clinicians for how to implement POCUS. Tune in to learn more about how to approach older adults in the ED considering delirium, agitation, and the challenges they present. For further show notes head to https://gedcollaborative.com/resource/delirium/delirium-agitation-and-the-role-of-pocus-in-older-adults-in-the-ed/

ED Boarding of Older Adults: Risks and Opportunities by Christina Shenvi

Getting ED Specific with Medication Safety by Christina Shenvi

In today’s episode host Dr. Christina Shenvi is joined by Dr. Robert Sternberg, Ultrasound Director at Akron General to discuss ultrasound-guided nerve blocks for precise pain relief in older patients. Ultrasound-guided nerve blocks provide relief from one of the most common emergency department complaints: pain. In addition to their use in acute pain management, nerve blocks can help reduce the use of opioids, reduce hospital length of stay, and improve patient outcomes and experiences. Using case examples, Dr. Sternberg talks through how to perform 4 common types of nerve blocks you may use in the emergency department with an elderly patient: Fascia Iliaca Compartment Block (FICB), Pericapsular Nerve Group (PENG) Block, Serratus Anterior Plane (SAP) Block and Erector Spinae Block (ESB). Tune in to hear indications, key anatomical landmarks, dosing, and techniques for each of the nerve blocks.

Postmenopausal Problems - Geriatric Gynecology in the ED by Christina Shenvi

In this episode learn about how the Generational Health Program at Sharp Memorial Hospital in San Diego was developed and expanded to create an extensive care program that provides specialised care for older adults. What started as a pilot program in 2019 is now a multidisciplinary age-friendly collaboration that begins right at admission.   Host Christina Shenvi is joined by 3 experts from Sharp Memorial Hospital who provide insight into how this program operates to provide the highest level of care for older patients. Diane Wintz, MD, a trauma surgeon who was heavily involved in creating the Generational Health Program. Her goal was to change how traditional health care models approach elderly patients presenting to the ED. Kelly Wright, RN, trained as an oncology nurse and now serves as manager of the program, and Stacy Nilsen, PhD RN, who’s focus is on the feasibility, implementation, education and data assessment of the program. Together they discuss the creation and expansion of the program and highlight the most important aspects of what makes it a success.

Today’s episode provides an introduction and overview of the 5 domains of the CMS Age-Friendly Hospital Measure. Host Dr. Christina Shenvi is joined by Dr. Marcia Russell to help clarify what each of these domains entail and how they may be carried out in the ED. They also discuss concerns that may be brought about following the implementation of this measure on January 1, 2025, and how these issues might be addressed and minimised. Dr. Marcia Russel is a colorectal surgeon and Associate Professor at UCLA. She has a special interest in the surgical care of older adults and has worked with ACS to improve geriatric surgery through the ACS Geriatric Surgery Verification Program.

With the upcoming implementation of the new CMS age-friendly hospital measure, hospitals will be required to attest that they review medications to identify potentially inappropriate medications (PIMS) for older adults. Dr. Martin Casey, MD, MPH is an Assistant Professor in the Department of Emergency Medicine at UNC School of Medicine. Dr. Caseys’ work has focused on the identifying PIMS and finding opportunities to reduce the use of, and deprescribe, potentially harmful medications in the emergency department. In this episode, Dr. Christina Shenvi and Dr. Martin Casey will discuss strategies for ED physicians who face unique challenges when assessing older patients’ medications. Using case examples of deprescribing in practice, they illustrate how deprescribing is a nuanced skill and how to approach it.

Dr. Cristina Shenvi is joined today by a panel to explore Geriatric Emergency Medicine (GEM) from a global perspective. As the global population ages, the importance of GEM and its continued development as a subspecialty becomes increasingly evident. This episode will examine the unique challenges that arise as GEM evolves and how different healthcare systems are adapting to meet these challenges. The panel will also discuss innovative practices and solutions that have emerged in their respective countries to advance GEM and improve care for elderly patients. The expert panel features three distinguished guests: Dr. Mohd Idzwan Zakaria (@prof_idzwan), a senior consultant and professor of Emergency Medicine at University Malaya in Malaysia, specializing in innovative approaches to managing older patients; Dr. Rosa McNamara (@rosaMcNamara), a consultant at St. Vincent’s University Hospital in Dublin, Ireland, and GEM Special Interest Group Chair for the International Federation for Emergency Medicine, with extensive expertise in GEM and medical education; and Dr. Rasha Buhumaid (@Rbuhamaid), an Emergency Physician in Dubai, UAE, President of the Emirates Society for Emergency Medicine, working in both public health and private practice, and an Assistant Professor at Mohammed Bin Rashid University of Medicine and Health Sciences.

Resuscitation of older adults in the emergency department poses unique challenges for physicians. Understanding the differences between a typical resuscitation process compared to a resuscitation of an older adult is essential to appropriately manage and treat this population. In this episode Dr. Cliff Reid joins Dr. Christina Shenvi to explore these differences and the associated challenges, and highlight some tools he uses in his own practice. Cliff Reid, MD, is an Emergency, Retrieval, and Critical Care Physician and educator in the greater Sydney area with a focus on resuscitation of adults and children.

Alzheimer's disease (AD) begins developing in the brain 20-30 years before symptoms start to present in patients. Recent evidence suggests that up to 40% of AD cases could potentially be prevented by addressing modifiable risk factors such as insufficient education, hearing loss, hypertension, obesity, smoking, depression, social isolation, physical inactivity, diabetes, excessive alcohol consumption, air pollution, and traumatic brain injury.  Dr. Christina Shenvi is joined once again by Dr. Richard Isaacson, M.D., a Harvard-trained preventive neurologist and world-renowned researcher at the Institute for Neurodegenerative Diseases in Florida. In 2013, he founded the Alzheimer's Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian, the first of its kind in the United States. In this episode of GEMCast they focus on the importance of individualized intervention and prevention as the future of AD treatment.

In 2021 constipation related visits to the ED reached over 1 million.The prevalence of constipation in elderly individuals in the community is between 15-30% and for those living in nursing homes or long-term care facilities it ranges between 50-75%. While constipation itself is not usually life-threatening, it can be indicative of life-threatening diseases or disorders and therefore a comprehensive history and physical assessment of patients is essential to avoid missing a critical diagnosis. Sarah Lee is an emergency physician at the University of Maryland. In this episode she joins Dr. Christina Shenvi to discuss the presentation, risk factors, assessment and management of constipation in geriatric patients in the ED.

Dr. Christina Shenvi and Dr. Mike Craig discuss the "Home Hospital" model and its potential to transform the way we care for older adults, by bringing hospital-level care to patients' homes.

What ED Physicians need to know about Amyloid Targeting Treatments Part 2 by Christina Shenvi

What ED Physicians need to know about Amyloid Targeting Treatments Part 1 by Christina Shenvi

Join Dr. Christina Shenvi and Dr. Cameron Gettel as they talk about a paper that provides the first benchmarks for emergency care process outcomes in geriatric EDs compared with nongeriatric EDs.

Any transition of care has risks, especially for older patients. In this episode of GEMCast, Dr. Shenvi and Dr. Magidson talk about the importance of thoughtful and deliberate transitions of care for older adults.

How Paramedics Can Make a Difference in Geriatric Care by Christina Shenvi

Join Dr. Christina Shenvi and Dr. Teresita Hogan as they walk through the history of geriatric emergency medicine. Learn about the challenges, changes, and breakthroughs that have shaped this field over the past 40 years.

In this episode of GEMCast Dr. Christina Shenvi is joined by Dr. Chris Carpenter to discuss GEAR 2.0-Advancing Dementia Care. Learn how GEAR 2.0 identified and prioritized research gaps in emergency care for persons living with dementia and their care partners.

In this episode of GEMCast Dr. Christina Shenvi is joined by Pamela Martin and Dr. Ula Hwang to learn about Geriatric transitional care nurses and how they can be incorporated into an ED to improve care for older patients.

Dr. Christina Shenvi is joined by Dr. Lucas Da Silva for a conversation about the concept of patient experience and why it is important to older adult care in the emergency department.

In this episode, GEMCast host Dr. Christina Shenvi is joined by Dr. Katie Buck to discuss the challenges surrounding diagnosing older adults with pneumonia.

Dr. Christina Shenvi sits down with Dr. Kerstin de Wit to learn how much anticoagulation matters in terms of increasing the risk of intracranial hemorrhage after a ground-level fall.

Dr. Christina Shenvi and Dr. Robert Dachs discuss how ED clinicians can identify and manage vertebral compression fractures in older adults.

Dr. Christina Shenvi and Dr. Lauren Southerland have a conversation about self-neglect; a complicated geriatric syndrome that is both a diagnostic and care coordination challenge.

Dr. Shenvi is joined by Dr. Alice Gray and Dr. Brittany Ellis to discuss geriatric experiential education.

Dr. Shenvi sits down with Dr. Elizabeth Goldberg to discuss ways to prevent and manage falls for older adults in the ED.

Dr. Shenvi sits down with Dr. Don Melady and Dr. John Schumacher to discuss their new book: Creating a Geriatric Emergency Department. The book is practical and accessible, providing essential guidance on assessing the ED care of older patients - and improving it.

Dr. Shenvi sits down with Dr. Maura Kennedy to discuss safe and effective management of agitated older patients, and the role of dementia in producing these symptoms.

Infections in older adults are common, and often present atypically leading to delayed diagnosis and increased morbidity and mortality - Dr. Shenvi and Dr. Khoujah discuss

Dementia in the ED is a critical and often overlooked issue. Dr Binkley and Dr. Shenvi discuss.

In this episode we discuss inadequate pain assessment in older adults, opiophobia, lack of current pharmacologic knowledge, and how to better manage pain in older adults in the ED.

Debra Eagles and Danya Khoujah discuss delirium as a medical emergency and how to prevent, recognize, diagnose, and treat delirium in the ED.

Dr. Selman and I discuss the value and importance of understanding and evaluating frailty in older adults in the Emergency Department.

Nicole Soria and Danya Khoujah join in as we discuss the importance of GU emergencies in older adults and get clinical tips to do better in your ED.

Dr. Kusum Mathews discusses her experience as the attending on the first week of the COVID ICU in her hospital. We discuss vent management, ethics, protecting our families, and coping skills. There are links to the surviving sepsis COVID-19 recommendations and other training resources at www.gempodcast.com

Dr. Tess Hogan and I discuss COVID-19 and the elderly. Mortality is highest in this population. What can we do to make sure we don't miss it, and to help prevent spread? See: www.gempodcast.com for show notes. Image from cdc.gov.

Dr. Lauren Southerland describes her recent work in defining the four main models of geriatric ED care used by Geriatric EDs in the U.S. This is a practical blueprint for anyone interested in pursuing Geriatric ED Accreditation. See the reference and more at: gempodcast.com/2020/02/04/ged-models/

Christian Nickel describes and explains the 10 "commandments" of geriatric EM care. See www.gempodcast.com for references and more.

Paul Deknoing and Lauren Bailey run this session with fast-paced, high-yield principles of geriatric EM care. See www.gempodcast.com for more info and references.

Dr. Lauren Southerland and I discuss her recent paper on the importance of and how to do a discharge risk assessment in elderly patients in the ED. For more, go to www.gempodcast.com

Leah Hatfield and I discuss the potential benefits of clevidipine for management of Hypertensive Emergencies. Learn more about indications, dosing, titration, and potential contra-indications. For full shownotes, credits, and references, see www.gempodcast.com

Drs. Ferdinando Mirarchi and Marie-Carmelle Elie explain the meaning and ramifications of different types of advance care planning orders and what they mean to physicians, APPs, or nurses caring for patients. Image credit: pixabay.com/photos/business-signature-contract-962355/ Sound credit:www.freesound.org/people/HerbertBoland/sounds/128544/

Shan Liu talks about why we should avoid the term "mechanical fall" and how we can help prevent future falls from the ED. See www.gempodcast.com for references and more.