The first European Geriatric Emergency Medicine Guidelines

Bas de Groot 

In 2021 the European Taskforce for Geriatric Emergency Medicine (GEM) presented the first European GEM guidelines at the EUGMS and EUSEM, which were published in European Geriatric Medicine (Lucke et al, Eur Geriatric Med, 2021).

The European Task Force for Geriatric Emergency Medicine is a collaboration of the European Society for Emergency Medicine (EUSEM) and the European Geriatric Medicine Society (EuGMS). The Task Force has the aim to develop clinically sustainable and cost-effective, patient-centered health care systems that improve relevant outcomes for older patients in Emergency Medicine.

Previously, a European Curriculum was composed based on which various courses have been organized to increase knowledge and experience of health care workers in Geriatric Emergency Medicine. However, other parallel approaches are needed to increase impact on everyday clinical care for older ED patients throughout Europe. Developing and disseminating pragmatic guidance for Geriatric Emergency Medicine professionals, based on the latest knowledge and expert recommendations, may further help to increase knowledge and competencies of professionals, and hence improve outcomes of acutely ill older patients, attempting to bridge the ‘know-do gap’. The aim was to develop expert clinical recommendations based on expert consensus, by the review of recent guidelines and literature, on a prioritized list of topics relevant to Geriatric Emergency Medicine throughout Europe.

In Europe, a large diversity in healthcare systems, available resources and existing care protocols do not allow for recommendations that are both general to all patients and specific to each healthcare setting. For instance, the presence of a strong General Practice network (which is not the case in every single country) may influence ED patient population and epidemiology as well as recommendations on post-acute care. However, with the involvement of professionals from countries across Europe we have made these expert clinical recommendations as tailored to the European situation as possible.

The development of the guidelines started already in 2019 but was delayed by the COVID pandemic. Using a modified Delphi method, the involved experts created a top 8 of most important topics the guidelines should address and then created working groups lead by one geriatrician and one emergency physician. In the working groups each topic was structured using the golden circle of Simon Simek addressing Why the topic was important, how the topic could be addressed and what physicians across Europe could specifically do to improve care for the older patient in the ED. The 8 most important topics for which recommendations were formulated were age/frailty adjusted risk stratification, delirium and cognitive impairment, medication reviews in the ED for older adults, family involvement, ED environment, silver trauma, end of life care in the acute setting. For each topic a poster was made summarizing the most important recommendations with QR codes referring to toolboxes and relevant literature. The posters are freely available on the website and can be translated in different languages so that every country has a practical way to start improving care for older patients.