Editorial 239
The European curriculum for geriatric emergency medicine Abdelouahab Belloua, Simon P. Conroyb and Colin A. Grahamc European Journal of Emergency Medicine 2016, 23:239 a Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA, bDepartment of Health Sciences, Centre for Medicine, College of Medicine, Biological Sciences and
The United Nations has defined old age as at least 60 years [1], although in the developing world old age is often defined by a change in role rather than by years. There are more older individuals alive now than at any other time in history [2]. There will be 1.2 billion individuals aged at least 60 by 2025, increasing to 1.9 billion in 2050 [3]. Europe has 23 of the world’s 25 ‘oldest’ countries, and older people will represent 28.7% of the European Union (EU) population by 2080 compared with 18.5% in 2014 [4]. The EU’s old-age dependency ratio is projected to increase from 28.1% in 2014 to 51% by 2080 [4]. This demographic transition demands action at all levels. Older individuals must not be seen as a burden on society, but as an asset. With the support of the European Society for Emergency Medicine (EuSEM), emergency medicine (EM) is now recognized as a primary specialty in most EU countries. The Council of the Union of European Medical Specialists approved the European Curriculum of Emergency Medicine in 2009 [5,6]. The curriculum defines EM as a symptom-oriented specialty in which a global clinical approach is essential for generating diagnostic hypotheses, starting the best treatment, and deciding an appropriate destination for the patient after emergency department (ED) care. Geriatric medicine (GM) is also a symptom-based medical specialty in which somatic, psychological, and social dimensions are simultaneously involved in older patients who require a holistic approach. Multiple organs and systems can be involved at the same time, increasing the complexity of older patients’ care. The major challenges faced by GM and EM are usually observed in older patients (typically ≥ 75 years old) who are frail and have loss of autonomy. ED visits of older patients are often precipitated by a crisis, and frailty is a critical risk factor for negative outcomes. The early detection of frailty in older patients in the ED setting could improve outcomes. Because many acute clinical presentations are atypical, diagnosis and treatment are often delayed. The complexity of older patient ED care is one of the factors involved in ED boarding. The evidence base for geriatric emergency medicine (GEM) is not strong. Most very elderly individuals (≥85 years) are excluded from clinical trials despite being major users of ED services. Data registries for older patients for emergency care are still lacking. The complexity of acute ED care of older patients requires a multidisciplinary approach involving teams of geriatricians and emergency physicians. The 0969-9546 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Psychology, University of Leicester, Leicester, UK and cDepartment of Emergency Medicine, Chinese University of Hong Kong, Shatin, Hong Kong Correspondence to Professor Abdelouahab Bellou E-mail: [email protected]
GEM care model concept was first described in the USA in 1996 [7], but little is known on GEM in Europe. To address this, the EuSEM Section of GEM and the GEM Special Interest Group of the European Union of Geriatric Medicine Society (EUGMS) worked together, through the European GEM Task Force, to create a European Curriculum for GEM to improve the quality of care of older patients in European EM settings. The task force has created a GEM curriculum that outlines competencies that are relevant to the care of older individuals, especially those with frailty, in emergency settings. After a modified Delphi process, 15 areas of knowledge were recommended for the training of geriatricians and emergency physicians. The detailed curriculum is available on the EuSEM and EUGMS websites [8]. The GEM Curriculum has been approved by the Executive Committee and Council of EuSEM, the Board and Council of EUGMS, and the Union of European Medical Specialists sections of EM and GM. A comprehensive report of the development of the GEM curriculum has just been published [9]. The new curriculum could significantly improve the quality of care of older patients in emergency settings throughout Europe.
Acknowledgements Conflicts of interest
There are no conflicts of interest.
References 1 2 3 4 5
6 7
8
9
WHO. Definition of an ‘older or elderly person’. Available at: http://www.who. int/healthinfo/survey/ageingdefnolder/en/. [Accessed 17 June 2016]. McMurdo ME. A healthy old age: realistic or futile goal? BMJ 2000; 321:1149–1151. World Population Prospects. The 2002 revision, highlights. New York, NY: United Nations Population Division; 2003. Population structure and ageing. Available at: http://ec.europa.eu/eurostat/ statistics-explained/index.php/. [Accessed 17 June 2016]. EuSEM Task Force on Curriculum. European curriculum for emergency medicine. Brussels: European Society for Emergency Medicine, UEMS Multidisciplinary Joint Committee on Emergency Medicine; 2009. Petrino R. A curriculum for the specialty of emergency medicine in Europe. Eur J Emerg Med 2009; 16:113–114. Sanders AB, Witzke DB, Jones JS, Richmond K, Kidd P. Principles of care and application of the geriatric emergency care model. In: Sanders AB, editor. Emergency Care of the Elder Person. St Louis, MO: Beverly-Cracom Publications; 1996. pp. 59–93. The European Geriatric Emergency Medicine Curriculum. Available at: http:// www.eusem.org/cms/assets/1/european%20curriculum%20of%20geriatric %20emergency%20medicine%20(apr16).pdf. [Accessed 17 June 2016]. Conroy S, Nickel CH, Jonsdottir AB, Fernandez M, Banerjee J, Mooijaart S, et al. The development of a European curriculum in geriatric emergency medicine. Eur Ger Med J 2016. doi: 10.1016/j.eurger.2016.03.011. DOI: 10.1097/MEJ.0000000000000414
Copyright r 2016 Wolters Kluwer Health, Inc. All rights reserved.
The European curriculum for geriatric emergency medicine Abdelouahab Belloua, Simon P. Conroyb and Colin A. Grahamc European Journal of Emergency Medicine 2016, 23:239 a Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA, bDepartment of Health Sciences, Centre for Medicine, College of Medicine, Biological Sciences and
The United Nations has defined old age as at least 60 years [1], although in the developing world old age is often defined by a change in role rather than by years. There are more older individuals alive now than at any other time in history [2]. There will be 1.2 billion individuals aged at least 60 by 2025, increasing to 1.9 billion in 2050 [3]. Europe has 23 of the world’s 25 ‘oldest’ countries, and older people will represent 28.7% of the European Union (EU) population by 2080 compared with 18.5% in 2014 [4]. The EU’s old-age dependency ratio is projected to increase from 28.1% in 2014 to 51% by 2080 [4]. This demographic transition demands action at all levels. Older individuals must not be seen as a burden on society, but as an asset. With the support of the European Society for Emergency Medicine (EuSEM), emergency medicine (EM) is now recognized as a primary specialty in most EU countries. The Council of the Union of European Medical Specialists approved the European Curriculum of Emergency Medicine in 2009 [5,6]. The curriculum defines EM as a symptom-oriented specialty in which a global clinical approach is essential for generating diagnostic hypotheses, starting the best treatment, and deciding an appropriate destination for the patient after emergency department (ED) care. Geriatric medicine (GM) is also a symptom-based medical specialty in which somatic, psychological, and social dimensions are simultaneously involved in older patients who require a holistic approach. Multiple organs and systems can be involved at the same time, increasing the complexity of older patients’ care. The major challenges faced by GM and EM are usually observed in older patients (typically ≥ 75 years old) who are frail and have loss of autonomy. ED visits of older patients are often precipitated by a crisis, and frailty is a critical risk factor for negative outcomes. The early detection of frailty in older patients in the ED setting could improve outcomes. Because many acute clinical presentations are atypical, diagnosis and treatment are often delayed. The complexity of older patient ED care is one of the factors involved in ED boarding. The evidence base for geriatric emergency medicine (GEM) is not strong. Most very elderly individuals (≥85 years) are excluded from clinical trials despite being major users of ED services. Data registries for older patients for emergency care are still lacking. The complexity of acute ED care of older patients requires a multidisciplinary approach involving teams of geriatricians and emergency physicians. The 0969-9546 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Psychology, University of Leicester, Leicester, UK and cDepartment of Emergency Medicine, Chinese University of Hong Kong, Shatin, Hong Kong Correspondence to Professor Abdelouahab Bellou E-mail: [email protected]
GEM care model concept was first described in the USA in 1996 [7], but little is known on GEM in Europe. To address this, the EuSEM Section of GEM and the GEM Special Interest Group of the European Union of Geriatric Medicine Society (EUGMS) worked together, through the European GEM Task Force, to create a European Curriculum for GEM to improve the quality of care of older patients in European EM settings. The task force has created a GEM curriculum that outlines competencies that are relevant to the care of older individuals, especially those with frailty, in emergency settings. After a modified Delphi process, 15 areas of knowledge were recommended for the training of geriatricians and emergency physicians. The detailed curriculum is available on the EuSEM and EUGMS websites [8]. The GEM Curriculum has been approved by the Executive Committee and Council of EuSEM, the Board and Council of EUGMS, and the Union of European Medical Specialists sections of EM and GM. A comprehensive report of the development of the GEM curriculum has just been published [9]. The new curriculum could significantly improve the quality of care of older patients in emergency settings throughout Europe.
Acknowledgements Conflicts of interest
There are no conflicts of interest.
References 1 2 3 4 5
6 7
8
9
WHO. Definition of an ‘older or elderly person’. Available at: http://www.who. int/healthinfo/survey/ageingdefnolder/en/. [Accessed 17 June 2016]. McMurdo ME. A healthy old age: realistic or futile goal? BMJ 2000; 321:1149–1151. World Population Prospects. The 2002 revision, highlights. New York, NY: United Nations Population Division; 2003. Population structure and ageing. Available at: http://ec.europa.eu/eurostat/ statistics-explained/index.php/. [Accessed 17 June 2016]. EuSEM Task Force on Curriculum. European curriculum for emergency medicine. Brussels: European Society for Emergency Medicine, UEMS Multidisciplinary Joint Committee on Emergency Medicine; 2009. Petrino R. A curriculum for the specialty of emergency medicine in Europe. Eur J Emerg Med 2009; 16:113–114. Sanders AB, Witzke DB, Jones JS, Richmond K, Kidd P. Principles of care and application of the geriatric emergency care model. In: Sanders AB, editor. Emergency Care of the Elder Person. St Louis, MO: Beverly-Cracom Publications; 1996. pp. 59–93. The European Geriatric Emergency Medicine Curriculum. Available at: http:// www.eusem.org/cms/assets/1/european%20curriculum%20of%20geriatric %20emergency%20medicine%20(apr16).pdf. [Accessed 17 June 2016]. Conroy S, Nickel CH, Jonsdottir AB, Fernandez M, Banerjee J, Mooijaart S, et al. The development of a European curriculum in geriatric emergency medicine. Eur Ger Med J 2016. doi: 10.1016/j.eurger.2016.03.011. DOI: 10.1097/MEJ.0000000000000414
Copyright r 2016 Wolters Kluwer Health, Inc. All rights reserved.
