Recruiting People With Dementia in Emergency Research: Insights From Geriatric Emergency Care Applied Research 2.0 Network ( <scp>GEAR</scp> 2.0) Pilot Studies

Academic Emergency Medicine · 2026-04-01

The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Motivating Factors for Participating in the Geriatric Emergency Department Guidelines 2.0

Academic Emergency Medicine · 2026-02-01

BACKGROUND: One in five emergency department (ED) visits is by older adults aged 65+ years. Clinical practice guidelines are needed to optimize patient care by translating the best available evidence into actionable recommendations to guide person-centered management for this medically complex and growing patient population. Our objective was to understand contributors' experiences and share best practices to inform other guideline working groups. METHODS: We conducted a qualitative study based on thematic analysis with an interpretivist paradigm in June-July 2025, using semi-structured interviews of Geriatric Emergency Department (GED) Guidelines 2.0 contributors to understand their experiences. Interviews were transcribed, independently reviewed by team members, and reflexively coded to identify themes. RESULTS: We interviewed 18 participants. Four main themes emerged: (1) motivations for participation, (2) varying opportunities to be involved, (3) personal benefits, and (4) challenges for improvement. Participants contrasted the strengths of shared learning and development with the burdens of organization and coordination. CONCLUSION: Contributors to the GED Guidelines 2.0 reported a positive experience. They joined because they wanted to contribute to better care of older patients and to achieve personal and professional goals. Many cited that their roles aligned with their strengths and expertise. They also gained skills and knowledge on systematic reviews and benefited from networking. Future groups planning a similar process should consider having multiple levels of leadership, experts in systematic reviews, regular reminders, and creative incentives to improve the process and foster improved networking opportunities within their disciplines.

<scp>ALERT</scp> ‐ <scp>ED</scp> : Awareness and Linkage to Resources for At‐Risk Emergency Department Patients: Interviews with Older Patients, Caregivers, and Nurses

Academic Emergency Medicine · 2026-03-01

BACKGROUND: Falls are a leading cause of morbidity among older adults. Although emergency departments (EDs) routinely screen for fall risk, few patients are connected to prevention programs after discharge. Digital tools could automate notification and referral, yet few have been developed or tested in acute care settings with ED end-users in mind. OBJECTIVE: To assess the feasibility, acceptability, and usability of ALERT-ED, a novel digital intervention designed to automate fall risk notification and referral. METHODS: We conducted semi-structured interviews with English- and Spanish-speaking ED patients aged ≥ 65, caregivers, and nurses across multiple hospitals within a large integrated healthcare system. ALERT-ED automatically embeds a QR code in the After Visit Summary of high fall risk ED patients, linking to a chatbot (Livi) that supports self-screening, fall education, and referral to community programs. Thematic analysis of interview transcripts informed optimization of the intervention ahead of a planned clinical trial. RESULTS: Interviews of 6 nurses, 12 patients, and 4 caregivers revealed seven themes: (1) feasibility depends on dissemination strategies and workflow alignment; (2) barriers include limited awareness and nursing time constraints; (3) acceptability improves trust, readability, and personalization; (4) expanding scope to enhance engagement; (5) privacy and artificial intelligence skepticism persist; (6) usability is high due to the QR interface; and (7) accessibility gaps remain for users with impairments. CONCLUSION: ALERT-ED demonstrates strong feasibility, acceptability, and usability among older adults, caregivers, and ED nurses. By automating fall risk notification and referral, ALERT-ED offers a pathway for integrating public health interventions into emergency care.

Characteristics of Emergency Department Visits Among Midlife and Older Adults Screening Positive for Alcohol Misuse

Academic Emergency Medicine · 2026-03-01 · 1 citations

BACKGROUND: Alcohol misuse among midlife and older adults is increasing, and age-related physiological vulnerability heightens the risk for adverse outcomes. Emergency departments (EDs) are key health system touchpoints for identifying alcohol misuse, yet the delivery of evidence-based interventions following screening in this population remains poorly described. METHODS: We conducted a retrospective cohort study of ED encounters from January 1, 2019-December 31, 2023, across 11 hospital-based EDs in a large integrated health system. We included patients aged ≥ 55 years old who screened positive for alcohol misuse using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C; ≥ 4 for men, ≥ 3 for women). Primary outcomes were delivery of evidence-based interventions, including brief intervention and referral to treatment and provision of medication for alcohol use disorder (MAUD). Secondary measures included demographics, co-occurring substance use, clinical presentation, and health care utilization. Age-adjusted logistic regression evaluated associations between AUDIT-C score and outcomes. RESULTS: Of 698,308 ED encounters among adults aged ≥ 55 years old, 39,912 (5.7%) screened positive for alcohol misuse. Men accounted for 58% of encounters, with gender differences narrowing with age. Co-use of substances was common: 21% reported illicit drug use, 27% cannabis use, and 23% tobacco use, with higher prevalence in younger age groups. Recent opioid and benzodiazepine prescriptions were documented in 12% and 6% of encounters, respectively. Brief intervention and referral to treatment occurred in 30% of encounters overall and in 46% among those with severe misuse. Despite guideline support for pharmacotherapy, MAUD was prescribed in only 3% of encounters. CONCLUSIONS: Among midlife and older ED patients who screen positive for alcohol misuse, delivery of evidence-based interventions, particularly pharmacotherapy, is uncommon despite substantial healthcare utilization and co-occurring risk factors. These findings highlight a gap between identification and treatment and underscore the ED's potential role in initiating evidence-based interventions for alcohol misuse.

Emergency Department Visit Outcomes of a Multicenter Randomized Trial of a Fall Prevention Intervention

Academic Emergency Medicine · 2026-01-01

BACKGROUND: Emergency department (ED) visits by older adults for falls are an opportunity to initiate fall prevention interventions. The GAPcare II trial tested an effective ED-based fall prevention program at two health systems. Our objective was to assess successful completion of intervention processes across sites including consultation completion rates, time to consultation, consultation duration, and types of recommendations made. PARTICIPANTS AND SETTING: Community-dwelling adults ≥ 65 years old presenting to three EDs (two in Rhode Island, one in Colorado) within 7 days of an accidental fall who were expected to be discharged and were without mobility-limiting injuries. METHODS: GAPcare II was a randomized controlled trial conducted from August 2021 to January 2025. Participants were randomly assigned to intervention (pharmacy and physical therapy (PT) consultations) or usual ED care arms. Pharmacists reviewed medications for fall risk and recommended modifications. Physical therapists performed validated mobility/balance assessments and provided recommendations for assistive devices, outpatient services, and disposition. RESULTS: Of 852 eligible ED patients, 196 were enrolled (96 intervention, 100 control). Participants' median age was 78 years, 68% were female, and 83% were white. In the intervention arm, 93% received pharmacy consultations and 83% received PT consultations. Median time from initial consultation request to bedside evaluation was 24 min (pharmacy) and 47 min (PT). Pharmacists recommended changing medication timing (26%), stopping fall-risk medications (19%), and dose adjustments (18%). Physical therapists recommended assistive devices (66%), outpatient services (36%), and skilled nursing facility admission (25%). ED length of stay did not differ between the intervention and usual care arms (4.6 vs. 4.4 h, p = 0.90). CONCLUSIONS: The GAPcare II trial demonstrated that an ED-based fall prevention program is feasible to implement across two health systems with varied operations, volume, and staffing with similar results. Consultations generated actionable recommendations and did not prolong ED length of stay.

Validation of a chart review method for identifying delirium in the emergency department

The American Journal of Emergency Medicine · 2025-06-16 · 1 citations

Adapting an emergency department fall prevention intervention for persons living with dementia through patient, caregiver, and expert interviews

Scientific Reports · 2025-11-21 · 1 citations

Study objective Although falls are up to three times more common in persons living with dementia (PLWD), limited fall prevention interventions exist for this population. Adapting promising interventions, such as the GAPcare intervention, which reduced fall-related ED visits by 66% and did not prolong ED length of stay, may address this need. In GAPcare patients receive pharmacy and physical therapy (PT) consultation to reduce modifiable risk factors for falls prior to ED discharge. In this qualitative descriptive study, we conducted semi-structured interviews with PLWD who recently visited the ED, their caregivers, and national experts in dementia care or ED operations to elicit perspectives on how GAPcare should be adapted for PLWD. Interviews were conducted in English and Spanish. We analyzed interviews using rapid qualitative analysis guided by Castro's framework for adapting prevention interventions. We interviewed 7 patients, 2 caregivers, and 15 experts (5 physicians, 3 nurses, 3 PTs, 3 pharmacists, 1 PhD scientist). Participants strongly supported improved ED falls care for PLWD. They also indicated that tailoring at multiple levels (patient and caregiver, ED, and external factors, e.g., insurance status) would be required to support the complexities in PLWDs' circumstances (e.g., living arrangements, income) and cognitive abilities. Participants suggested training of ED staff in dementia care and caregiver support. PLWD, caregivers, and experts in dementia care and ED operations are supportive of adapting our existing GAPcare intervention for PLWD. Early feedback from relevant informants guided GAPcareAD intervention refinement and fit with ED workflows.

Free-Text Responses in a Nationally Representative Experimental Survey about End-of-Life Care Choices: ChatGPT-4o-Assisted Qualitative Analytical Study

JMIR Aging · 2025-09-22 · 1 citations

Background: Little is known about how surrogates make end-of-life care choices for patients who lack the ability to make decisions for themselves. Objective: The study aims (1) to identify key themes that emerged from participants' free-text responses to a large nationally representative vignette survey about surrogate decision-making in end-of-life care and (2) to determine if an advanced artificial intelligence (AI) chatbot could assist us in accurately and efficiently performing qualitative analyses. Methods: Our dataset included 3931 free-text responses from a nationally representative survey of 6109 individuals. In this qualitative study, we first familiarized ourselves with the free-text responses and hand-coded the first 200 responses until we reached saturation. We then created a codebook, initial themes, subthemes, and illustrative quotes. Subsequently, we prompted ChatGPT-4o to analyze the entire dataset of 3931 responses and identify frequent keywords and generate themes and quotable quotes. We validated responses by comparing the AI's keyword counts to qualitative software (NVivo, Lumivero) counts and cross-validating AI-generated quotes with the original transcripts. Results: We identified several key themes: surrogates more often chose comfort care for care recipients with dementia, particularly at advanced stages. They also strongly weighed the patients' perceived quality of life and functional status. Many reported making surrogate decisions based on their own lived experiences or values, rather than making decisions aligned with the patients' previously stated wishes. There was no significant difference between the AI and qualitative software's keyword counts. The most frequent keywords included "life" (2051/81,713, 2.51%), "quality" (903/81,713, 1.11%), and dementia (507/81,713, 0.62%). Overall, AI-generated themes closely aligned with aforementioned human-generated themes. Manual coding of the first 200 free-text responses required 4 hours, including codebook development. In contrast, ChatGPT-4o generated themes in <10 seconds using the predefined codebook. However, dataset preparation, output verification, iterative prompting, debugging, and validation required several weeks. Conclusions: Surrogates often base end-of-life decisions on dementia stage, perceived quality of life, and their own lived experiences, rather than patient preferences. Using an AI chatbot to perform qualitative analysis on free-text responses may help extend the work of qualitatively trained investigators, especially for large datasets such as free-text responses to large surveys.

Reply: Comparative Dose-Response of Diazepam, Lorazepam, and Phenobarbital for Alcohol Withdrawal in the Emergency Department

Annals of Pharmacotherapy · 2025-11-11

Predictors of naltrexone prescribing for alcohol use disorder from the emergency department

Alcohol Clinical and Experimental Research · 2025-09-29 · 2 citations

BACKGROUND: Excessive alcohol use is a leading cause of preventable death in the United States, with the emergency department (ED) serving as a critical touchpoint for individuals with alcohol use disorder (AUD). Despite clinical guidelines recommending initiation of medication for AUD (MAUD), such as naltrexone, ED prescribing remains rare. The objective of this study is to characterize clinician naltrexone prescribing practices for ED patients with hazardous drinking or AUD and identify patient- and encounter-level predictors of naltrexone prescribing within a large, integrated health system. METHODS: We conducted a retrospective cohort study of adult ED encounters across 12 hospitals from 2022 to 2024. Eligible encounters included patients with a positive Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screen, indicating hazardous alcohol use or an active AUD, who had no exclusion criteria contraindicating naltrexone and were discharged from the ED. The primary outcome was provision of a naltrexone prescription at ED discharge, and the secondary outcome was prescription fill. We used a multivariable logistic regression model with generalized estimating equation (GEE) to identify predictors of prescribing. RESULTS: Of 52,701 treatment-eligible ED encounters, only 0.5% resulted in a naltrexone prescription. Prescriptions were more likely in encounters involving younger, male patients with higher AUDIT-C scores, alcohol-related complaints, and those occurring at an academic ED. In the logistic GEE model, academic setting, alcohol withdrawal diagnosis, and greater alcohol misuse severity were independently associated with increased prescribing. Nearly half (45%) of ED naltrexone prescriptions were filled. CONCLUSIONS: Naltrexone prescribing among treatment-eligible patients is rare. Encouragingly, nearly half of patients receiving a prescription proceeded to fill it, highlighting a promising opportunity for ED-based prescribing of naltrexone to initiate AUD treatment. To improve AUD care, systematic ED-based strategies are urgently needed that go beyond universal screening to address barriers to MAUD initiation.