Patients with electrolyte abnormalities may be appropriate for the observation unit (OU) depending on the severity of the disturbance, the patient’s comorbidities, and the suspected etiology of the imbalance. Patients with potential for requiring life-saving interventions or prolonged treatments are better suited for inpatient admission. Abnormalities, both hyper (high) and hypo (low), of potassium, calcium, magnesium, sodium and phosphate may be treated in the OU.

Management of transient ischemic attack (TIA) patients in an observation unit (OU) results in reduced risk for subsequent stroke, greater compliance with diagnostic evaluation, shorter length of stay, lower cost, decreased hospital overcrowding and ambulance diversion. OU management should evaluate TIA mimics, differentiate TIA from stroke, and detect high-risk pathologies that require immediate intervention and admission.

Hemodynamically stable patients needing transfusions are appropriate for placement in an observation unit. Transfusions of red blood cells (RBCs), platelets, and platelet products: fresh frozen plasma (FFP), cryoprecipitate, and factors including von Willebrand factor (vWF), and factors VIII and IX, can be done in selected patients in the observation unit (OU). Administration of drugs such as DDAVP and TXA (tranexamic acid) can be used to treat bleeding. Patients with anemia, sickle cell disease, hemophilia, and von Willebrand’s disease are among those patients with hematologic and/or bleeding disorders who, if stable, might be treated in an OU instead of as an inpatient. In the OU, transfusions can be given over hours when indicated and patients can be monitored for transfusion reactions.

Patients with alterations in mental status must receive an appropriate medical diagnostic workup. Any abnormal vital signs must be addressed and should normalize within a 24-hour stay if due to anxiety. History and physical examination is critical, including medication history. Testing should be guided by the history and physical examination findings. No single battery of tests will pick up every metabolic or structural abnormality that might affect patient behavior. Universal laboratory and toxicologic screening of all patients with psychiatric complaints has a low yield and generally does not affect care. It is desirable to coordinate protocols for screening with the desires and needs of one’s psychiatric service. The term “medical clearance” cannot ensure that a patient is indeed clear of all medical conditions. Some have argued against using the phrase “medically clear” as this can minimize the presence of underlying medical problems. Instead the American Association for Emergency Psychiatry advocates for stating patients are “medically stable,” which implies the patient has received a thorough medical examination and their current behavior disturbance is not likely due to a medical or traumatic cause.

Goals and objectives

1. To recognize the patterns of geriatric abuse that exist

2. To learn how to screen and identify geriatric abuse

3. To learn to treat and refer victims of geriatric abuse

Introduction and overview

Elder abuse and neglect has been recognized as a growing problem in the United States. All 50 states have reporting requirements for elder abuse and neglect, although there is no federal policy requiring reporting of elder abuse. Literature suggests that the abusers appear most frequently to be family members and caretakers of the elderly. The responsibility for identifying elder mistreatment often falls on emergency care providers.

There are 45 million people over the age of 60 in the United States, and 3 million over the age of 85. Those over 85 represent the fastest growing segment of the elderly population; it is estimated that the number of persons over the age of 85 will be seven times higher in 2050 than it was in 1980.

Modern reports of elder abuse in the medical literature date from 1975 when the British Medical Journal published a report of “granny battering.” In the United States, reports of abuse and neglect in nursing homes in the 1970s led to a systematic study of elder mistreatment by the United States Senate Special Committee on Aging. Since that time, under the auspices of the Department of Health and Human Services, there has been the creation of the National Institute on Elder Abuse.