title: Palliative care needs of seriously ill, older adults presenting to the emergency department.
abstract: OBJECTIVE
  The objective was to identify the palliative care needs of seriously ill, older adults in the emergency department (ED).
  
  
  METHODS
  The authors conducted a cross-sectional structured survey. A convenience sample of 50 functionally impaired adults 65 years or older with coexisting cancer, congestive heart failure, end-stage liver or renal disease, stroke, oxygen-dependent pulmonary disease, or dementia was recruited from an urban academic tertiary care ED. Face-to-face interviews were conducted using the Needs Near the End-of-Life Screening Tool (NEST), McGill Quality of Life Index (MQOL), and Edmonton Symptom Assessment Survey (ESAS) to assess 1) range and severity of symptoms, 2) goals of care, 3) psychological well-being, 4) health care utilization, 5) spirituality, 6) social connectedness, 7) financial burden, 8) the patient-clinician relationship, and 9) overall quality of life (QOL).
  
  
  RESULTS
  Mean (±SD) age was 74.3 (±6.5) years and cancer was the most common diagnosis. Mean (±SD) QOL on the MQOL was 3.6 (±2.9). Over half of the patients exceeded intratest severity-of-needs cutoffs in four categories of the NEST: physical symptoms (47/50, 94%), finances (36/50, 72%), mental health (31/50, 62%), and access to care (29/50, 58%). The majority of patients reported moderate to severe fatigue, pain, dyspnea, and depression on the ESAS.
  
  
  CONCLUSIONS
  Seriously ill, older adults in an urban ED have substantial palliative care needs. Future work should focus on the role of emergency medicine and the new specialty of palliative care in addressing these needs.
authors.affiliation: Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, USA. corita.grudzen@mssm.edu
authors.forename: Corita R
authors.initials: CR
authors.lastname: Grudzen
authors.forename: Lynne D
authors.initials: LD
authors.lastname: Richardson
authors.forename: Matthew
authors.initials: M
authors.lastname: Morrison
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cho
authors.forename: R Sean
authors.initials: RS
authors.lastname: Morrison
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000706:statistics & numerical data*; D011788:Quality of Life; D011795:Surveys and Questionnaires