Care Protocols for the Injured Older Adult

Original Date: 8/2024 | Location: MH Katy | Go Live: 7/1/25

Identification of Vulnerable Geriatric Patients

  • Frailty syndrome assessment and management
    • Focus on optimization of comorbid medical conditions
    • Delirium Prevention Bundle (see below)
    • Nutrition consult and evaluation
    • Social Worker evaluation of social support network
    • Physical/Occupational Therapy consult and evaluation

 Identification of patients who will benefit from the input of a health care provider with geriatric experience

  • Geriatric trauma patients (≥65 years) with isolated injuries may be admitted to a Hospitalist with a surgical consult.

Prevention, identification, and management of dementia, depression, and delirium

  • Delirium Prevention Bundle EPIC Order Set
  • Recurrent nursing education – B-CAM, sleep hygiene, pain management strategies
  • Trauma and Depression Screening (PTSD5) completed by nursing on admission, weekly, and at time of discharge

 Process to capture and document what matters to patients, including preferences and goals of care, code status, advanced directives, and identification of a proxy decision maker

  • Social worker addresses MPOA and the presence of advanced directives
  • Hospitalist service consult to discuss preferences, goals of care, and code status

Medication reconciliation and avoidance of inappropriate medications

  • Delirium Prevention (Non-ICU) EPIC Order set
  • Geriatric Multimodal Acute Pain Management EPIC Order set
  • Pharmacist consult for medication reconciliation form and review
  • Minimization of nighttime awakening for medication administration
  • Hospitalist consult to review home medication list for potentially inappropriate medications

Screening for mobility limitations and assurance of early, frequent, and safe mobility

  • Physical/Occupational therapy consult are automatic for geriatric patients (included in Trauma admission order set and Delirium Prevention Bundle)

Implementation of safe transitions to home or other healthcare facility

  • Social worker and case manager evaluation are automatic for geriatric patients (included in Trauma admission order set)