103 Geriatric education program for emergency physicians CHAPTER 5 Introduction Demographic changes have lead to a worldwide increase of older adults attending the Emergency Departments (EDs) [1-3]. This trend is a major challenge for the ED in the context of limited specific skills of emergency professionals in caring for this population [2,4]. Providing emergency care to older adults is often perceived by ED professionals as time-consuming and complex in a setting that has been organized according to single organ assessment and the management of (multi)trauma and acute organ failure. However, older adults are known to present at the ED with atypical presentation of symptoms, multiple co-morbidity and polypharmacy [5,6]. Various studies have reported that physicians feel incompetent and unconfident in dealing with such complex older patients due to the under-representation of older patient care issues in the medical curricula [7-11]. Moreover, emergency physicians (EPs) are not specifically trained nor have guidelines for the care of older people, especially relating to frailty and geriatric syndromes [12]. The lack of competence and confidence of EPs in dealing with complex older patients is considered an important factor for why older adults more often have unnecessary diagnostics and treatment at the ED [11,13], a prolonged ED length of stay [14,15], a higher risk of hospitalization [14,16], and more frequent ED revisits compared to younger adults who visit the ED [17]. To attain better quality of care for older adults attending the ED, it is important for EPs to acquire adequate geriatric knowledge and skills of the most common geriatric emergency problems. The competencies associated with geriatric medicine, such as delirium identification and falls management are just as important in the acute as they are in the more typical geriatric ward setting [12]. In an attempt to equip EPs better, and consequently improve the quality of geriatric emergency care for older adults, we developed a 9-month geriatric emergency education program. The purpose of this study is to evaluate the effect of the program on EPs’ geriatric knowledge, attitude and medical practice when treating older adults at the ED, and to explore EPs’ experiences with the program. Materials and Methods Design We used a mixed-methods study to quantitatively evaluate the effect of the program on EPs’ knowledge, attitude and medical practice, and qualitatively gain insight into the perceived effects of and experiences with the program.
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