“It takes a village!”
High-quality assessment and care of the older person in the ED is a team effort. Admissions are avoided and outcomes are better if you can mobilize a team to help assess the person who has fallen and to arrange for safe discharge to the community.
Team members – including the MD — need to be familiar with each other’s roles and be able to communicate effectively with each other.
Some departments have:
- a designated advanced or focussed practice nurse or a social worker to coordinate the non-medical components of the visit;
- access to a physiotherapist and or an occupational therapist who can do mobility and function assessments
- a pharmacist available to assess medication use, interactions, and compliance;
- access to community-based care coordinator to arrange additional home care or assessment of the home for safety and mobility
The following video segments all relate to the ED assessment of Don Cooper, a 78-year-old man who has fallen at home where he lives independently. He came by ambulance because of painful right hip and an inability to walk. Mr. Cooper lives alone in a two-storey house with bathroom and bedroom on the second floor.
His medication list includes:
- Amitriptyline “for tingling”,
- Clonzepam “for nerves”
- Terazosin “for prostate”
- Ramipril and Atenolol “for blood pressure”
- Diphenhydramine “for sleep”
- Glyvuride “for sugar”
- Warfarin “for my heart”
- Colchicine “for my gout”
- Watch each of the brief videos about how different professionals approach this case and the various contributions they make. Think about your answer to the question below as you watch.
- Name three tips that you learned from your colleagues that you can use next time you’re assessing an older person who has fallen?