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duce ED inappropriate utilization among patients experiencing homelessness.

Implementing a dedicated homeless clinic with these features can reduce ED inappropriate utilization among patients experiencing homelessness.

Ambulatory-care-sensitive conditions (ACSCs) represent emergency department (ED) visits and hospital admissions that might have been avoided through earlier primary care intervention. We characterize the current frequency and cost of ACSCs among older adults (≥65 years of age) in the ED.

This study is a retrospective analysis of Centers for Medicare and Medicaid Services (CMS) national claims data distributed by the Research Data Assistance Center, a CMS contractor based at the University of Minnesota. We analyzed outpatient ED-based national claims data for visits made by traditional fee-for-service (FFS) Medicare beneficiaries in 2016. ACSCs were identified according to the Agency for Healthcare Research and Quality's Prevention Quality Indicators criteria, which require that the ACSC be the primary diagnosis for the visit. Analysis was done in Alteryx and R.

We documented nearly 1.8 million ACSC ED visits in 2016, finding that ≈10.6% of all ED visits by older adult FFS Medicare beneficiaries were ass patients.Agitation and aggression are common in older emergency department (ED) patients, can impede the expedient diagnosis of potentially life-threatening conditions, and can adversely impact ED functioning and efficiency. Agitation and aggression in older adults may be due to multiple causes, but chief among them are primary psychiatric disorders, substance use, hyperactive delirium, and symptoms of dementia. Understanding the etiology of agitation in an older adult is critical to proper management. Effective non-pharmacologic modalities are available for the management of mild to moderate agitation and aggression in patients with dementia. Pharmacologic management is indicated for agitation related to a psychiatric condition, severe agitation where a patient is at risk to harm self or others, and to facilitate time-sensitive diagnostic imaging, procedures, and treatment. Emergency physicians have several pharmacologic agents at their disposal, including opioid and non-opioid analgesics, antipsychotics, benzodiazepines, ketamine, and combination agents. Emergency physicians should be familiar with geriatric-specific dosing, contraindications, and common adverse effects of these agents. This review article discusses the common causes and non-pharmacologic and pharmacologic management of agitation in older adults, with a specific focus on dementia, delirium, and pain.

High-risk alcohol use in the elderly is a common but underrecognized problem. selleck chemicals llc We tested a brief screening instrument to identify high-risk individuals.

This was a prospective, cross-sectional study conducted at a single emergency department. High-risk alcohol use was defined by National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines as >7 drinks/week or >3 drinks/occasion. We assessed alcohol use in patients aged ≥ 65 years using the timeline follow back (TLFB) method as a reference standard and a new, 2-question screener based on NIAAA guidelines. The Alcohol Use Disorders Identification Test (AUDIT) and Cut down, Annoyed, Guilty, Eye-opener (CAGE) screens were used for comparison. We collected demographic information from a convenience sample of high- and low-risk drinkers.

We screened 2250 older adults and 180 (8%) met criteria for high-risk use. Ninety-eight high-risk and 124 low-risk individuals were enrolled. The 2-question screener had sensitivity of 98% (95% CI, 93%-100%) and specificity of 87% (95% CI, 80%-92%) using TLFB as the reference. It had higher sensitivity than the AUDIT or CAGE tools. The high-risk group was predominantly male (65% vs 35%,

< 0.001). They drank a median of 14 drinks per week across all ages from 65 to 92. They had higher rates of prior substance use treatment (17% vs 2%,

< 0.001) and current tobacco use (24% vs 9%,

= 0.004).

A rapid, 2-question screener can identify high-risk drinkers with higher sensitivity than AUDIT or CAGE screening. It could be used in concert with more specific questionnaires to guide treatment.

A rapid, 2-question screener can identify high-risk drinkers with higher sensitivity than AUDIT or CAGE screening. It could be used in concert with more specific questionnaires to guide treatment.Acute flank and abdominal pain represent a common presenting complaint in the emergency department. The etiology can be broad, ranging from the chest to the groin, from benign to catastrophic. There are common causes such as nephrolithiasis and pyelonephritis for which more than 1 million Americans are diagnosed with in the United States each year.1 Other etiologies are more rare and difficult to diagnose. The following case discusses a rare syndrome involving a young man with flank pain and a few other symptoms.Urinary catheter dysfunction is a common emergency department presentation for patients with neurogenic bladders. Many of these patients have cystostomies requiring routine suprapubic catheter exchange. On complication of outpatient catheter replacement, patients are often sent to the emergency department (ED). We describe the case of an 81-year-old male presenting with painless hematuria and blood from the urinary meatus after undergoing routine cystostomy exchange. During Foley replacement, the suprapubic catheter entered the proximal urethra and the balloon was inflated while in the prostatic urethra, leading to urethral injury and cystic clot formation. Emergency physicians should be aware of this rare complication of suprapubic catheter placement.We present a case of abdominal pain due to chronic hip dislocation of 75 years duration. Hip dislocations are not uncommon, but long-term, unreduced dislocations are vanishingly rare in the developed world. This 80-year-old female, who emigrated to the United States as an adult, presented to the emergency department for acute abdominal pain. Workup showed no intra-abdominal cause for her pain. History revealed she had suffered a traumatic hip dislocation at 5 years of age that was unable to receive adequate treatment because of limited health care access. After several years, she regained functional ability because of anatomic and compensatory musculoskeletal changes in the pelvis. The adaptations likely caused excessive muscular strain resulting in muscle spasm at the location of her abdominal pain. To our knowledge, this is the only reported case of a hip that remained dislocated for 75 years.