title: Research priorities for high-quality geriatric emergency care: medication management, screening, and prevention and functional assessment.
abstract: BACKGROUND
  Geriatric adults represent an increasing proportion of emergency department (ED) users and can be particularly vulnerable to acute illnesses. Health care providers have recently begun to focus on the development of quality indicators (QIs) to define a minimal standard of care.
  
  
  OBJECTIVE
  The original objective of this project was to develop additional ED-specific QIs for older patients within the domains of medication management, screening and prevention, and functional assessment, but the quantity and quality of evidence were insufficient to justify unequivocal minimal standards of care for these three domains. Accordingly, the authors modified the project objectives to identify key research opportunities within these three domains that can be used to develop QIs in the future.
  
  
  METHODS
  Each domain was assigned one or two content experts who created potential QIs based on a systematic review of the literature, supplemented by expert opinion. Candidate QIs were then reviewed by four groups: the Society for Academic Emergency Medicine (SAEM) Geriatric Task Force, the SAEM Geriatric Interest Group, and audiences at the 2008 SAEM Annual Meeting and the 2009 American Geriatrics Society Annual Meeting, using anonymous audience response system technology as well as verbal and written feedback.
  
  
  RESULTS
  High-quality evidence based on patient-oriented outcomes was insufficient or nonexistent for all three domains. The participatory audiences did not reach a consensus on any of the proposed QIs. Key research questions for medication management (three), screening and prevention (two), and functional assessment (three) are presented based on proposed QIs that the majority of participants accepted.
  
  
  CONCLUSIONS
  In assessing a minimal standard of care by which to systematically derive geriatric QIs for medication management, screening and prevention, and functional assessment, compelling clinical research evidence is lacking. Patient-oriented research questions that are essential to justify and characterize future QIs within these domains are described.
authors.affiliation: Division of Emergency Medicine, Washington University in St. Louis, MO, USA. carpenterc@wustl.edu
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Carpenter
authors.forename: Kennon
authors.initials: K
authors.lastname: Heard
authors.forename: Scott
authors.initials: S
authors.lastname: Wilber
authors.forename: Adit A
authors.initials: AA
authors.lastname: Ginde
authors.forename: Kirk
authors.initials: K
authors.lastname: Stiffler
authors.forename: Lowell W
authors.initials: LW
authors.lastname: Gerson
authors.forename: Neal S
authors.initials: NS
authors.lastname: Wenger
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Miller
mesh_terms: D000058:Accidental Falls; D000369:Aged, 80 and over; D019468:Disease Management; D004632:Emergency Medical Services / Q000592:standards*; D004636:Emergency Service, Hospital; D015577:Geriatric Assessment; D006801:Humans; D017064:Process Assessment, Health Care; D019984:Quality Indicators, Health Care / Q000592:standards*; D012106:Research