110 Chapter 5 EP 4: The organization of prehospital elderly care is a complete maze, totally incomprehensible for everyone involved. (...) A transfer nurse had to come over to explain how it all worked. And that really helped us in gaining a clear view of the situation. At least now we know what we are talking about. Interviewees indicated that the program did not only improve their ability to define and recognize frailty. The program helped EPs to shift from a traditional approach of focusing on the patient’s acute medical problem towards a more holistic view of the patient’s condition and needs. EP 4: The fact that you are able to distinguish between an elderly patient who basically needs regular treatment and a frail elderly patient who needs to receive a different type of treatment. (...) That is one of the most important things I have learned now. EP 5: We are simply not used to inquire after the home situation of patients. We prefer quick and fast and not too complicated and not too long. And that is not a problem when you are dealing with a 36-year-old patient with a fractured ankle. The question is whether you can expect that from someone who is 83 years old, whose wife has just died and who has to look after his son for the first time in his life. The [program] has certainly created that specific type of awareness which I did not have before. Moreover, EPs expressed to better understand the implications of caring for a frail older person at the ED after following the program. For example, the importance of consulting the geriatrician on time, considering treatment restrictions/end-of-life care, gaining insight into the patient’s social situation, and being more alert on the patient’s medication use and possible side effects. EP 3: I am much more aware now of frail patients and (...) of futile medical treatment (...) We are very quick to turn to the medical protocol, but perhaps that protocol is not very well suited to elderly patients with many co morbidities. EP 2: For instance when you are dealing with an elderly patient with a fractured arm. You tend to think: “Well, the fracture has been set in any case.” But a whole network has to be organized around the patient. We have been made very much aware of the importance of that. Effects on attitudes towards older adults The attitude of EPs and ED residents towards older adults did not change before and after the program (p=0.27; table IV). When comparing scores of EPs and ED residents as separate groups, no significant difference in attitudes before and after the program was found either (p=0.35 and p=0.80, respectively).
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