Elderly

A National Survey of Geriatric Emergency Health Care: Insights into Current Practice

Original Articles, Volume 24, Issue 2, Pages 61 – 108 (2025)

Background: Emergency departments (EDs) are increasingly managing elderly patients who present unique clinical challenges. This study explores the current management practices for patients aged 75 years and older in Belgian EDs.
Methods: An electronic survey was sent to 105 heads of Belgian EDs. The Collected data underwent descriptive analysis.
Results: Geriatric protocols, adapted equipment, availability of geriatricians, and paramedical staff improve the quality of care for older patients in the EDs. However, the limited use of geriatric scores, prolonged stays in the ED, and lack of hospital beds are frequent problems that negatively impact quality of care.
Conclusion: Given the variable level of care provided to the elderly in the EDs, care protocols should be standardized and improved at the national scale.

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Examining trainee awareness of dermatoses and dermatological assessments during acute admissions (A quality improvement project)

Original Articles, Volume 17, Issue 3, Pages 117 – 172 (2018)

Abstract

Studies demonstrate 67% of elderly patients can have dermatoses, which could result in functional and psychological consequences. Elderly presentations are further complicated by comorbidities and polypharmacy. This combined with limited dermatology training at undergraduate and postgraduate levels creates diagnostic challenges. This project investigated dermatology assessments by trainees using the Trust’s acute medical admissions proforma. 100 proforma were reviewed for skin assessments alongside nursing skin care bundles. Subsequently, a skin survey was conducted amongst trainees evaluating knowledge and confidence when diagnosing and managing common dermatoses. Successively, a dermatology teaching series was delivered. Post-intervention the above were reassessed, demonstrating  improvements in most areas. The dermatology teaching series will continue alongside a Trust hospital guideline to sustain improvements in dermatological care on admission.

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An unusual cause of ‘pleuritic’ chest pain

Case Reports, Volume 7, Issue 2, Pages 61 - 104 (2008)

A 77 year old man presented to A&E with sudden onset left sided chest pain. This chest pain was severe enough to wake him up from sleep in the early hours of the morning. The pain was pleuritic in nature and severe enough to require administration of intravenous morphine. He had a past medical history of ischaemic heart disease (1997), pulmonary embolism (1997), and left sided pnuemothorax (1998). Drug history consisted of lansoprazole 30mg od, isosorbide mononitrate 60mg od, nicorandil 10mg bd, aspirin 75mg od, beclomethasone 100 inhaler 1 puff bd, salbutamol 100 inhaler prn and combivent nebuliser qds. He was a retired miner, having worked for 40 years underground. There was also a 20 pack year smoking history although he had stopped for 20 years. He was independent and had a 100 to 200 yard exercise tolerance on the flat. Observations showed respiratory rate of 18, temperature of 36.5 degrees Celsius, BP 133/69, oxygen saturation of 98% on air and a regular pulse of 70 beats per minute. Clinical examination did not reveal any abnormality, with no abdominal or chest wall tenderness.

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Inclusion body myositis a clinical review with illustrative case report

Clinical Reviews, Volume 7, Issue 2, Pages 61 - 104 (2008)

Every acute physician has come across elderly patients presenting with muscle weakness and falls. Distinction between normal age related muscle wasting and pathological muscle atrophy can be difficult. It is important for acute physicians to be aware of the differential diagnosis of such a presentation. Inclusion body myositis(IBM) is the most common type of acquired myopathy above the age of 50.1 This article aims to highlight the diagnosis and management of this chronic illness. It is frequently misdiagnosed as polymyositis and wrongly treated with steroids.3 The typical symptoms and signs are illustrated by a recent case which presented to our department (see box 1).

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