Lakeridge Health’s ‘GEMs’ help Frail Seniors maintain Independence
By Linda White
Bowmanville senior Betty Graham is independent and is known to have a stubborn streak, so it comes as no surprise to her family that she wants to remain in the comfort of her own home, even though the number of falls she experienced in recent months raised alarms. Interestingly, it was concerns regarding her blood count and blood pressure that led the 84-year-old to her local hospital on the advice of her primary care physician. While there, Graham’s family discovered a hidden ‘gem’ that is giving them all peace of mind.
Upon their arrival at the Lakeridge Health Bowmanville (LHB) Emergency Department (ED), the family met with Geriatric Emergency Management (GEM) nurse Julie Earle.
“She took the time to talk to my mom about her health and recommended a clinic that would provide further geriatric assessment to address these reoccurring falls,” says Bill Graham, Betty’s son.
For the Graham family, the GEM nurse has made an important difference in their lives.
“I can’t say enough about Julie and the care she provided. I didn’t even know the GEM service existed until we arrived at LHB,” he says. “It was probably the best experience I’ve ever had in a hospital, which is usually a place most of us want to avoid.”
In addition to basic competencies of nursing practice, GEM nurses have a specialized knowledge of aging and understand common geriatric syndromes and atypical presentation patterns.
“As the body ages, a lot of substantial changes occur, making geriatric care very different from that of the healthy adult,” explains Earle, an Advanced Practice Nurse and Clinical Nurse Specialist in Geriatrics.
ED staff call on the specialized GEM nurse when an elderly patient meets the criteria for an assessment. Typically – though not always – these frail seniors are aged 75 years or older and their problems might include one or more geriatric syndrome: falls, delirium, dementia, depression, elder abuse, pressure ulcers, incontinence, malnutrition and functional decline.
The GEM nurse position began in 2004 and is funded by the Ontario Ministry of Health and Long-Term Care. It has since grown from one nurse to more than 65 across the province.
“Elderly people are more likely to be hospitalized than any other age group in Canada and hospitalization rates increase with age in later life,” says
Earle.
Lakeridge Health (LH) introduced the position at its Oshawa campus in 2007 and added a second GEM nurse serving its Bowmanville and Port Perry campuses in 2009. According to a 2006 LH audit, 60 per cent of admitted patients were over the age of 75 and the average patient age was 82, reports Earle.
The main goals of LH’s GEM nurses are to provide a holistic assessment, prevent unnecessary admission to hospital, facilitate safe aging at home, and work with the community to make sure the patient is where they need to be at the appropriate time.
“The position has been a huge addition to our ED in many ways,” says Dr. Benj Fuller, Chief of Emergency Medicine and Medical Director Critical Care/Emergency Medicine at LH. “Our GEM nurse helps get support for our elderly patients in the community and is a knowledgeable resource for the ED physician with regard to geriatrics.”
“She serves as a conduit for various preventative programs, such as the Specialized Assessment of the Frail Elderly (SAFE)/Falls Prevention Clinic, stroke and Community Care Access Centres. She expedites discharges and has without a doubt prevented admissions. She works almost as an on-site geriatrician and is one of our most valuable positions.” added Dr. Fuller.
Earle typically conducts two to six consultations a day.
“If I can help each of those patients achieve an optimal quality of life each day, my job is complete.”
She takes pride in making a difference.
“A family recently wrote to thank me for helping a patient use his walker instead of a cane – it was a simple fix that made a substantial difference to his life. What I completed in a short visit could have taken his family member three months to accomplish and it enabled him to go home, significantly reducing his risk of falling.”
Linda White is a writer at Lakeridge Health. Reposted with permission from Lakeridge Health. This article appears in the April 2010 edition of Hospital News.