Annals for Hospitalists Inpatient Notes - Four “GEMS”—Geriatric Evaluation and Management Strategies When Admitting an Acutely Ill Older Adult to the Hospital
Authors: Lillian Min, Lona Mody
Journal: Annals of Internal Medicine (2019)

Web Exclusives18 June 2019Annals for Hospitalists Inpatient Notes - Four “GEMS”—Geriatric Evaluation and Management Strategies When Admitting an Acutely Ill Older Adult to the HospitalLillian Min, MD, MSHS and Lona Mody, MD, MScLillian Min, MD, MSHSDepartment of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, and Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (L.M., L.M.)Search for more papers by this author and Lona Mody, MD, MScDepartment of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, and Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (L.M., L.M.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-1372 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Hospitalists spend at least 40% of their professional time caring for patients 65 years of age or older (1). Acute illness is often accompanied by functional and cognitive decline in older patients. To help hospitalists routinely and efficiently assess these patients, we suggest 4 GEMS (Geriatric Evaluation and Management Strategies) when admitting older patients to the hospital.GEM 1: Assess Physical FunctionWhat was the patient's preillness level of physical function? Has the patient deteriorated from that baseline since becoming ill? Acute functional decline can often be a presenting feature of acute illness in older patients (2). Understanding the degree ...References1. HCUP Facts and Figure 2008–Section 1. Healthcare Cost and Utilization Project (HCUP). October 2010. Rockville, MD: Agency for Healthcare Research and Quality. Accessed at www.hcup-us.ahrq.gov/reports/factsandfigures/2008/section1_TOC.jsp on 25 March 2019. Google Scholar2. Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-associated disability: “She was probably able to ambulate, but I'm not sure”. JAMA. 2011;306:1782-93. [PMID: 22028354] doi:10.1001/jama.2011.1556 CrossrefMedlineGoogle Scholar3. Inouye SK, Foreman MD, Mion LC, et al. Nurses' recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Arch Intern Med. 2001;161:2467-73. [PMID: 11700159] CrossrefMedlineGoogle Scholar4. Fick DM, Inouye SK, Guess J, et al. Preliminary development of an ultrabrief two-item bedside test for delirium. J Hosp Med. 2015;10:645-50. [PMID: 26369992] doi:10.1002/jhm.2418 CrossrefMedlineGoogle Scholar5. Johns Hopkins Medicine. Activity and Mobility Promotion Toolkit. Accessed at www.hopkinsmedicine.org/physical_medicine_rehabilitation/education_training/amp/mobility-scale.html on 26 March 26 2019. Google Scholar Author, Article, and Disclosure InformationAffiliations: Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, and Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (L.M., L.M.)Disclosures: Dr. Mody reports grants from NIH, grants from AHRQ, and other support from Sage and Gojo Industries outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1372.Corresponding Author: Lillian Min, MD, MSHS, University of Michigan Medical School Division of Geriatric and Palliative Care Medicine, 300 North Ingalls Building, Room 900, Ann Arbor, MI 48109; e-mail, [email protected]umich.edu PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists - 18 June 2019 David H. Wesorick and Vineet Chopra Metrics Cited byCommentary: Special care considerations in older adults hospitalized with COVID-19Predicting Readmissions—With a Twist 18 June 2019Volume 170, Issue 12Page: HO2-HO3KeywordsCognitionDeliriumDisclosureGeriatricsHospital medicineHospitalistsInpatientsPhysical functioningType 2 diabetesWalking ePublished: 18 June 2019 Issue Published: 18 June 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...