17 General introduction and outline of the thesis CHAPTER 1 Literature shows that an ED visit may predict functional decline, frailty and increased dependency for an older patient (44). Screening of older adults in the ED may be a first opportunity to intervene and improve outcomes. The implementation of simple-to-use screening tools has proven to help identify patients at risk and to prevent poor outcomes by resulting in the referral of patients to appropriate health care resources, both in- and outpatient (45, 46). A second intervention becoming more common is the use of geriatric consultation services in the ED (47, 48). Although studies on such interventions have demonstrated improved quality of care (49, 50), randomized controlled trials are lacking to prove a reduction in ED length of stay and readmission. A third intervention employed to improve geriatric care is the better implementation of follow-up care, as hospitalization of older adults is associated with high rates of delirium, iatrogenic complications, and functional decline (51). Although a decrease in inappropriate hospital admissions is one of the main goals in geriatric care, discharge from the ED is a significant challenge, as care cannot be provided appropriately at home. Effective transition of care is required to facilitate outpatient care (52, 53). Given the lack of time and heavy workload in the ED, this transition process presents difficulties, as effective, reliable discharge instructions are time-consuming (54). A few strategies have been developed to improve the comprehension of discharge instructions (55, 56). The teach-back method is one of these improvement methods to confirm full comprehension of instructions provided to patients (57). Although teach-back is considered an effective intervention to improve ED discharge (58), limited knowledge is available on the effect of teach-back in the ED, particularly for older adults. We believe that implementation of the teach-back method could help prevent re-admissions to the ED and contribute to alleviating crowding of the ED. A fourth intervention to improve care for older adults in the ED may be the implementation of geriatric emergency medicine education for ED professionals (59). With emergency care professionals who are better trained in geriatric care, EDs can optimize ED visits, effectively deliver care, and coordinate resources. The need for education for ED professionals has been recognized, as they often lack sufficient geriatric care skills (59, 60). Although studies have shown that emergency care residents and staff benefit from geriatric emergency training (6163), clinical evaluation of these programs is needed to confirm the improvement of patient care.
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