Dr. Jacques Lee highlights SREMI’s mission to advance geriatric emergency medicine through research on delirium, social isolation, and mentorship.

Guided by a Clear North Star: Advancing Geriatric Emergency Medicine Research at SREMI

Jacques Lee, Canada

At the Schwartz/Reisman Emergency Medicine Institute (SREMI), the Pole Star for our Geriatric Emergency Medicine (GEM) research program remains clear and unwavering:

To improve the care of older people treated in emergency departments by creating and disseminating new knowledge.

To accomplish this, we must continually

1. Develop and expand our international recognition as a global leader in GEM research
2. Attract and train the best and brightest to be the next generation of leaders in GEM research
3. Expand capacity and funding for SREMI and
4. Build sustainability and succession plans to enable enduring impact

As the inaugural Chair in GEM Research at SREMI, I currently lead a dynamic team of emergency medicine fellows, graduate and medical students, and undergraduates. Our research centres around three core themes:

1. Delirium: Recognition, Prevention, and Mechanistic Insight

Delirium continues to be a high-stakes, under-recognised clinical challenge in the ED. Despite its prevalence, only 25–50% of delirium cases are identified. Unrecognised delirium significantly increases mortality, complicates discharge, and leaves patients unable to participate in their care.

• BEDDER Study (Better ED Delirium Recognition)

We are conducting a large prospective cohort study across two centres to establish baseline delirium recognition rates by ED staff. This will be compared with:

• A novel tablet-based game developed by our team
• Specially trained hospital volunteers using a simple single-question screening tool

The findings will inform the co-design of a frontline clinician-led strategy to improve recognition and management.

• RAPID Study (Regional Anesthesia to Prevent Incident Delirium)

Our prior CIHR-funded cluster RCT showed that ultrasound-guided regional anaesthesia reduced delirium risk by up to 23% in older adults with hip fractures. However, uptake was limited.

In July 2025, we received CIHR funding to launch a new patient-level RCT to rigorously compare delirium outcomes between usual care and a strategy promoting aggressive use of regional anaesthesia.

• FIND-UM Study (Femoral fractures Identifying New Delirium Using Urine Metabolomics)

In collaboration with centres in Toronto, Ottawa, and Quebec City, we have enrolled over 190 older adults with hip fractures in a prospective cohort study. By collecting urine samples at baseline and tracking delirium development, we aim to:

• Identify metabolomic changes associated with incident delirium
• Develop diagnostic tools for early detection
• Uncover the underlying pathophysiology of delirium in this high-risk group

2. Social Isolation and Loneliness (SIL): A Post-Pandemic Research Priority

Social isolation and loneliness emerged as critical but overlooked social determinants of health, especially among older ED patients.

In response, we launched a multi-pronged research program, including:

• HOW RU Trial (North America):
  Adapted from the work of Australian GEM researcher Dr Judith Lowthian, this intervention has been tested in a 3-arm clinical trial with 142 participants enrolled. Data analysis is now underway.
• Qualitative and mixed-methods research to explore how loneliness is experienced by older people presenting to the ED.
• Development of a single-item SIL screening tool for use by ED clinicians.
• Cultural adaptation of HOW RU for use among isolated Francophone populations, ensuring broader reach and relevance.

3. Improving GEM Research Methodology: Building the Next Generation

Recognising the importance of mentorship in developing the field, we have created a GEM Research Mentorship and Coaching Series. This program guides trainees and early-career researchers through key stages of the research journey:

1. Choosing a research topic you can live with
2. Build a case – Introduction to research designs

• Writing a competitive grant

1. How to write and HOW TO WRITE
2. Research ethics and the study of older people who need ED care
3. It starts with a sample size

This structured mentorship is helping to cultivate a new cadre of capable, passionate GEM researchers ready to advance the field.