{"id":495,"date":"2023-04-22T08:35:45","date_gmt":"2023-04-22T05:35:45","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=495"},"modified":"2023-04-22T08:35:47","modified_gmt":"2023-04-22T05:35:47","slug":"geriatrik-hastanin-acil-bakim-kalitesi","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/geriatrik-hastanin-acil-bakim-kalitesi\/","title":{"rendered":"Geriatrik Hastan\u0131n Acil Bak\u0131m Kalitesi\u00a0"},"content":{"rendered":"\n

Acil serviste baz\u0131 hasta gruplar\u0131 \u00f6zellik arz eder. Gebeler, \u00e7ocuklar, geriatrik ve onkolojik hastalar acil serviste de\u011ferlendirilirken daha fazla dikkat gerektirmektedir. 65 ya\u015f \u00fcst\u00fc geriatrik hasta pop\u00fclasyonunun acil servislere ba\u015fvurular\u0131 giderek artmaktad\u0131r.\u00a0T\u00fcrkiye\u2019de 65 ya\u015f ve \u00fcst\u00fc\u00a0n\u00fcfusun 2014 y\u0131l\u0131nda %8\u2019i, 2023 y\u0131l\u0131nda %10,2, 2050 y\u0131l\u0131nda %20,8, 2075 y\u0131l\u0131nda ise %27,7\u2019ye ula\u015faca\u011f\u0131 \u00f6ng\u00f6r\u00fclmektedir.\u00a0Son y\u0131llarda acil servise ba\u015fvuran her be\u015f hastadan biri geriatrik hasta grubunu olu\u015fturur hale gelmi\u015ftir.\u00a0<\/p>\n\n\n\n

Bu hastalar acil servise \u00e7ok farkl\u0131 \u015fikayetlerle, aileleri veya hasta bak\u0131m personeli taraf\u0131ndan getirilirler. \u0130leti\u015fim problemleri, hasta yak\u0131nlar\u0131ndan ayr\u0131nt\u0131l\u0131 anamnez al\u0131namamas\u0131, acil serviste te\u015fhis i\u00e7in \u00e7ok fazla tetkik istenmesi, acil servisten hastaneye yat\u0131r\u0131lmas\u0131ndaki zorluklar, geriatrik hastaya yakla\u015f\u0131mda personelin e\u011fitiminin eksiklikleri, hasta yak\u0131nlar\u0131n\u0131n hastaneye yat\u0131rma bask\u0131s\u0131 veya m\u00fcdahale onay\u0131 vermemesi, <\/strong>muayeneye kar\u015f\u0131 uyumsuzluklar, \u00e7oklu ila\u00e7 kullan\u0131m\u0131 ve d\u00fc\u015fme riskinden dolay\u0131 bu hastalar\u0131n y\u00f6netimi acil doktorunu zorlar.<\/p>\n\n\n\n

2014 geriatrik hastalar\u0131n acil servis y\u00f6netimi k\u0131lavuzuna g\u00f6re;<\/strong><\/p>\n\n\n\n

    \n
  1. Geriatrik hastalar\u0131n risk a\u00e7\u0131s\u0131ndan taranmas\u0131,<\/li>\n\n\n\n
  2. \u0130drar kateterlerinin kullan\u0131m durumu, <\/li>\n\n\n\n
  3. Geriatrik ila\u00e7 y\u00f6netimi,<\/li>\n\n\n\n
  4. Geriatrik d\u00fc\u015fme de\u011ferlendirmesi,<\/li>\n\n\n\n
  5. Deliryum ve demans tan\u0131nmas\u0131, <\/li>\n\n\n\n
  6. Palyatif bak\u0131m gerekliliklerinin de\u011ferlendirilmesini \u00f6nermektedir. <\/li>\n<\/ol>\n\n\n\n

    A- Riskli hasta grubunun belirlenmesi<\/strong><\/p>\n\n\n\n

    S\u00fcrekli yard\u0131ma ihtiya\u00e7 duyuyor mu? Acile getirilmeden \u00f6nce daha fazla yard\u0131ma ihtiya\u00e7 duyuyor mu? Son 6 ayda, \u22651 gece hastane yat\u0131\u015f\u0131 oldu mu? G\u00f6rme problemi var m\u0131? Haf\u0131za problemi var m\u0131? G\u00fcnde \u22653 ila\u00e7 kullan\u0131m\u0131 mevcut mu? T\u00fcm bu sorular\u0131n yan\u0131tlar\u0131 birden fazla evet ise y\u00fcksek riskli <\/strong>olarak kabul edilir.<\/p>\n\n\n\n

    B- \u0130drar kateteri kullan\u0131m\u0131n\u0131n de\u011ferlendirilmesi<\/strong><\/p>\n\n\n\n

    \u0130drar kateteri do\u011fru endikasyonda kullan\u0131m\u0131 de\u011ferlendirilmelidir. Gereksiz kullan\u0131mlar derhal sonland\u0131r\u0131lmal\u0131d\u0131r. \u0130drar yolu enfeksiyonlar\u0131 kontrol edilmelidir.<\/p>\n\n\n\n

    C- Kullan\u0131lan ila\u00e7lar\u0131n g\u00f6zden ge\u00e7irilmesi<\/strong><\/p>\n\n\n\n

    Antikoag\u00fclanlar, antitrombositerler, diyabet ila\u00e7lar\u0131, digoxin, beta blokerler, kalsiyum kanal blokerleri, amiodaron, di\u00fcretikler, antipsikotik, immunsuprese ila\u00e7lar ve narkotikler \u00f6zellikle sorgulanmas\u0131 gereken ila\u00e7 gruplar\u0131d\u0131r. Geriatrik hastalarda kronik hastal\u0131klar\u0131n \u00e7oklu\u011fu g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda \u00e7oklu ila\u00e7 kullan\u0131mlar\u0131 s\u0131kt\u0131r. \u00c7oklu ila\u00e7lar\u0131n birbirleriyle etkile\u015fimlerine dikkat etmek gerekir. Demans, antipisikotik ve antiparkinson ila\u00e7lar\u0131n beraber kullan\u0131mlar\u0131nda antikolinerjik y\u00fcke dikkat edilmelidir. \u00d6zellikle kardiyak ila\u00e7lar\u0131n do\u011fru dozlarda kullan\u0131lmas\u0131 \u00f6zellik arz eder. Hipotansiyona ba\u011fl\u0131 geli\u015fen senkop ve sonras\u0131nda d\u00fc\u015fme riski g\u00f6zden ge\u00e7irilmelidir. V\u00fccut ya\u011f oran\u0131n\u0131n etkilenmesi ve dehitratasyon ila\u00e7lar\u0131n biyoyararlan\u0131mlar\u0131n\u0131 etkiler ve istenmeyen sonu\u00e7lar g\u00f6zlenebilir.<\/p>\n\n\n\n

    D- D\u00fc\u015fme y\u00f6netimi<\/strong><\/p>\n\n\n\n

    Bilin\u00e7 kayb\u0131, daha \u00f6nce d\u00fc\u015fme \u00f6yk\u00fcs\u00fc, y\u00fcr\u00fcme ve denge problemi, melena, kardiyak problemler, g\u00f6rme ve n\u00f6rolojik bozukluklar, \u00e7oklu ila\u00e7 kullan\u0131m\u0131 ve alkol d\u00fc\u015fme riskini art\u0131r\u0131r. Tekrarlayan d\u00fc\u015fmeler \u00fczerinde olas\u0131 nedenler g\u00f6zden ge\u00e7irilerek \u00f6nlenebilir durumlar ortadan kald\u0131r\u0131lmal\u0131d\u0131r. Daha \u00f6nce g\u00fcnl\u00fck aktivitelerinde problem ya\u015famayan geriatrik hasta acil servise d\u00fc\u015fme ile geldi\u011finde kas iskelet sistemine mi ba\u011fl\u0131, yoksa sistemik bir olaya m\u0131 ba\u011fl\u0131 oldu\u011fu g\u00f6zden ge\u00e7irilmelidir. \u00d6rne\u011fin yeni geli\u015fen melena, gastrointestinal sistem kanamas\u0131na ba\u011fl\u0131 hipotansiyona ba\u011fl\u0131 ba\u015f d\u00f6nmesi veya senkop nedenli bir d\u00fc\u015fme olabilir.<\/p>\n\n\n\n

    E- Deliryumun tan\u0131nmas\u0131<\/strong><\/p>\n\n\n\n

    Deliryum akut ba\u015flang\u0131\u00e7l\u0131 bili\u015fsel fonksiyonlar\u0131 etkileyen, da\u011f\u0131n\u0131k d\u00fc\u015f\u00fcnce yap\u0131s\u0131, haf\u0131zada bozulma, oryantasyon kayb\u0131, dikkat eksikli\u011fi ve alg\u0131 bozuklu\u011fu ile karakterize bir durumdur. Geriatrik hastalarda akut geli\u015fen bir deliryum tablosu mortaliteyi art\u0131rabilir. Acil serviste deliryum erken tan\u0131nmal\u0131d\u0131r.<\/p>\n\n\n\n

    F- Palyatif bak\u0131m<\/strong><\/p>\n\n\n\n

    Geriatrik hastalar\u0131n \u00f6z bak\u0131mlar\u0131 acil serviste de\u011ferlendirilmelidir. Beslenme durumlar\u0131, ila\u00e7lar\u0131n\u0131 d\u00fczenli kullan\u0131p-kullanmad\u0131\u011f\u0131, a\u011fr\u0131 y\u00f6netimi, a\u011fr\u0131 d\u0131\u015f\u0131 semptomlar\u0131n y\u00f6netimi, ya\u015fl\u0131 bak\u0131m\u0131 ve dehidratasyon gibi durumlar g\u00f6zden ge\u00e7irilmelidir.<\/p>\n\n\n\n

    \u015eimdiye kadar geriatrik hastalar\u0131n acil bak\u0131m\u0131nda g\u00f6zden ge\u00e7irmemiz gereken fakt\u00f6rlerden bahsettik. Peki, hangi kriterler geriatrik hastan\u0131n acil bak\u0131m kalitesini de\u011ferlendirmemizde yard\u0131mc\u0131 olur? Yani bu hasta grubunu de\u011ferlendirirken hangi parametreleri g\u00f6zden ge\u00e7irirsek acil serviste kaliteli bir bak\u0131m sa\u011flam\u0131\u015f oluruz. Bunun i\u00e7in German Society of Emergency Medicine, The German Society of Geriatrics, The German Society of Gerontology and Geriatrics, The Austrian Society of Geriatrics and Gerontology, The Swiss Society for Gegiatrics \u00e7al\u0131\u015fma gruplar\u0131n\u0131n olu\u015fturdu\u011fu komisyonda; 3 acil hekimi, 1 \u00f6zel e\u011fitimli hem\u015fire, 1 Geriatrist , 1 farmakolog, 1 sa\u011fl\u0131k ekonomistive 2 ya\u015fl\u0131 vatanda\u015f yer almaktad\u0131r. S\u00f6z konusu komisyon kaliteli bak\u0131m esaslar\u0131n\u0131 5 ba\u015fl\u0131kta ortaya koymaktad\u0131r.<\/p>\n\n\n\n

    GeriQ-ED\u00a9 TOP 5 (1)<\/strong><\/p>\n\n\n\n

      \n
    1. Deliryumun tan\u0131nmas\u0131.<\/li>\n\n\n\n
    2. Tam bir ila\u00e7 \u00f6yk\u00fcs\u00fc almak ve endikasyonlar\u0131n de\u011ferlendirilmesi.<\/li>\n\n\n\n
    3. Acil ekibinin geriatri bilgi ve becerilerinin e\u011fitimi.<\/li>\n\n\n\n
    4. Geriatrik ihtiya\u00e7lar\u0131 olan hastalar i\u00e7in tarama.<\/li>\n\n\n\n
    5. D\u00fc\u015fme riski olan hastalar\u0131n belirlenmesi\/ tekrarlayan d\u00fc\u015fmeler. <\/li>\n<\/ol>\n\n\n\n

      Dilerseniz bu fakt\u00f6rleri g\u00f6zden ge\u00e7irelim;<\/p>\n\n\n\n

      1. Deliryum tan\u0131nmas\u0131: <\/strong>\u00c7al\u0131\u015fmalar deliryum s\u00fcresi ile mortalite aras\u0131nda g\u00fc\u00e7l\u00fc bir ili\u015fki oldu\u011funu g\u00f6stermi\u015ftir. Dolay\u0131s\u0131 ile deliryumun erken tan\u0131s\u0131 acil bak\u0131m ortam\u0131nda esast\u0131r. GeriQ-ED\u00a9’ye g\u00f6re, standartla\u015ft\u0131r\u0131lm\u0131\u015f bir tarama testi acil serviste deliryumu olan ve deliryum riski ta\u015f\u0131yan hastalar i\u00e7in uygulanmal\u0131d\u0131r. Acil serviste kullan\u0131m\u0131 \u00f6nerilen iki skala vard\u0131r (2, 3).<\/p>\n\n\n\n

        \n
      1. Confusion Assessment Method (CAM) (\u015eekil-1).<\/li>\n\n\n\n
      2. Modifiye Confusion Assessment Method (mCAMED) (\u015eekil-2).<\/li>\n<\/ol>\n\n\n\n

        K\u0131saca \u00f6zetleyecek olursak, geriatrik hasta acil servise geldi\u011finde deliryum a\u00e7\u0131s\u0131ndan taranmal\u0131 ve \u015fu parametreler g\u00f6zden ge\u00e7irilmelidir;<\/p>\n\n\n\n

        1. Hastan\u0131n ba\u015flang\u0131\u00e7 durumuna g\u00f6re mental durumunda akut bir de\u011fi\u015fiklik oldu\u011funa dair kan\u0131t var m\u0131?<\/p>\n\n\n\n

        2A. Hasta dikkatini odaklamakta g\u00fc\u00e7l\u00fck \u00e7ekiyor mu? \u00d6rne\u011fin, dikkati kolayca da\u011f\u0131l\u0131yor mu veya dikkatini toplamakta g\u00fc\u00e7l\u00fck \u00e7ekiyor mu? S\u00f6ylenenleri takip edebiliyor mu?<\/p>\n\n\n\n

        2B. Bu davran\u0131\u015f g\u00f6r\u00fc\u015fme s\u0131ras\u0131nda dalgaland\u0131 m\u0131? Yani gelip gitme veya artma e\u011filiminde oldu mu? \u015eiddetinde azalma var m\u0131?<\/p>\n\n\n\n

        3. Hastan\u0131n d\u00fc\u015f\u00fcnceleri da\u011f\u0131n\u0131k veya tutars\u0131z m\u0131? \u00d6rne\u011fin, ba\u015f\u0131bo\u015f veya alakas\u0131z konu\u015fma, belirsiz veya mant\u0131ks\u0131z fikir ak\u0131\u015f\u0131 veya konudan konuya \u00f6ng\u00f6r\u00fclemeyen ge\u00e7i\u015f var m\u0131?<\/p>\n\n\n\n

        4. Genel olarak bu hastan\u0131n bilin\u00e7 d\u00fczeyini nas\u0131l de\u011ferlendirirsiniz?<\/p>\n\n\n\n

        Uyar\u0131 [normal]; Tetikte [a\u015f\u0131r\u0131 uyan\u0131k, \u00e7evresel uyaranlara a\u015f\u0131r\u0131 duyarl\u0131, \u00e7ok kolay irkiliyor], Letarjik [uykulu, kolayca uyan\u0131yor]; sersemlik [zor uyand\u0131r\u0131l\u0131yor]; Koma; [uyand\u0131r\u0131lamaz]; belirsiz).<\/p>\n\n\n\n

        5. Oryantasyon kayb\u0131; g\u00f6r\u00fc\u015fme s\u0131ras\u0131nda herhangi bir zamanda (\u00f6rne\u011fin, kendisinin ba\u015fka bir yerde oldu\u011funu d\u00fc\u015f\u00fcnmek gibi) hasta y\u00f6n\u00fcn\u00fc \u015fa\u015f\u0131rm\u0131\u015f m\u0131yd\u0131? Hastane d\u0131\u015f\u0131nda, yanl\u0131\u015f yata\u011f\u0131 kullanmak ya da g\u00fcn\u00fcn saatini yanl\u0131\u015f de\u011ferlendirme var m\u0131?<\/p>\n\n\n\n

        6. Haf\u0131za bozuklu\u011fu; hasta g\u00f6r\u00fc\u015fme s\u0131ras\u0131nda herhangi bir haf\u0131za sorunu g\u00f6sterdi mi? \u00d6rne\u011fin,<\/p>\n\n\n\n

        hastanede ki olaylar\u0131 hat\u0131rl\u0131yor mu veya talimatlar\u0131 hat\u0131rlamakta zorlan\u0131yor mu?<\/p>\n\n\n\n

        7. Alg\u0131sal bozukluklar; hastan\u0131n herhangi bir alg\u0131sal rahats\u0131zl\u0131k kan\u0131t\u0131 var m\u0131? \u00d6rne\u011fin, hal\u00fcsinasyonlar, ill\u00fczyonlar veya yanl\u0131\u015f yorumlamalar gibi.<\/p>\n\n\n\n

        8A. Psikomotor ajitasyon var m\u0131? G\u00f6r\u00fc\u015fme s\u0131ras\u0131nda herhangi bir zamanda hastada al\u0131\u015f\u0131lmad\u0131k \u015fekilde artan bir motor ajitasyon d\u00fczeyi oldu mu? Huzursuzluk, yatak \u00f6rt\u00fclerini kar\u0131\u015ft\u0131rmak, parmaklar\u0131 hafif\u00e7e vurmak veya s\u0131k s\u0131k ani pozisyon de\u011fi\u015fiklikleri yapmak gibi aktiviteler var m\u0131?<\/p>\n\n\n\n

        8B. Psikomotor retardasyon; g\u00f6r\u00fc\u015fme s\u0131ras\u0131nda herhangi bir zamanda hastan\u0131n motor becerilerinde al\u0131\u015f\u0131lmad\u0131k derecede azalma oldu mu? Uyu\u015fukluk, bo\u015flu\u011fa bakmak, uzun s\u00fcre ayn\u0131 pozisyonda kalmak veya \u00e7ok yava\u015f hareket etmek gibi aktiviteleri var m\u0131?<\/p>\n\n\n\n

        9. Uyku-uyan\u0131kl\u0131k d\u00f6ng\u00fcs\u00fcnde de\u011fi\u015fiklik; hastada g\u00fcnd\u00fcz vakti a\u015f\u0131r\u0131 uyku-uyan\u0131kl\u0131k d\u00f6ng\u00fcs\u00fcnde bozulma oldu\u011funa dair kan\u0131t var m\u0131?<\/p>\n\n\n\n

        2. Geriatrik hastan\u0131n kulland\u0131\u011f\u0131 ila\u00e7lar:<\/strong> \u00c7oklu ila\u00e7 kullan\u0131m\u0131 geriatrik hastalar aras\u0131nda yayg\u0131nd\u0131r. \u0130la\u00e7 say\u0131s\u0131 artt\u0131k\u00e7a advers ila\u00e7 reaksiyonlar\u0131 veya ila\u00e7 kullan\u0131m hatalar\u0131 da artmaktad\u0131r. Ara\u015ft\u0131rmalar, t\u00fcm advers ila\u00e7 reaksiyonlar\u0131n\u0131n %60’\u0131n\u0131n potansiyel olarak \u00f6nlenebilir oldu\u011funu g\u00f6stermi\u015ftir. Antikoag\u00fclanlar, benzodiazepinler, steroid olmayan antienflamatuvar ila\u00e7lar, di\u00fcretikler ve antidepresanlar\u0131n kullan\u0131m\u0131na \u00f6zel dikkat g\u00f6sterilmelidir (4). Al\u0131nan ila\u00e7lar\u0131n endikasyonlar\u0131 do\u011frulanmal\u0131d\u0131r.<\/p>\n\n\n\n

        \"\"<\/figure>\n\n\n\n
        \"\"<\/figure>\n\n\n\n
        \"\"<\/figure>\n\n\n\n

        \u015eekil-1:<\/strong> Confusion Assessment Method (CAM).<\/p>\n\n\n\n

        \"\"<\/figure>\n\n\n\n
        \"\"<\/figure>\n\n\n\n
        \"\"<\/figure>\n\n\n\n

        \u015eekil-2:<\/strong> Modifiye Confusion Assessment Method (mCAMED).<\/p>\n\n\n\n

        3. Geriatri bilgi ve becerileri konusunda personel e\u011fitimi<\/strong>:<\/strong> 2015 y\u0131l\u0131nda The Geriatric Section of the European Society for Emergency Medicine (EUSEM) ve European Geriatric Medicine Society (EUGMS) geriatrik hastalar\u0131n acil servis bak\u0131m\u0131 i\u00e7in haz\u0131rlad\u0131\u011f\u0131 m\u00fcfredat; <\/p>\n\n\n\n

        1-Ya\u015flanman\u0131n fizyolojisi,<\/p>\n\n\n\n

        2-Yayg\u0131n ve atipik \u015fikayetler,<\/p>\n\n\n\n

        3-Geriatrik sendromlar\u0131n tan\u0131mlanmas\u0131,<\/p>\n\n\n\n

        4-Geriatrik hastalar\u0131n psikiyatrik ihtiya\u00e7lar\u0131n\u0131n belirlenmesi, gibi konular\u0131 i\u00e7ermektedir.<\/p>\n\n\n\n

        Acil servis \u00e7al\u0131\u015fan\u0131 doktor ve hem\u015firelerin en az %60\u2019\u0131n\u0131n her y\u0131l bu e\u011fitimi almas\u0131n\u0131 \u00f6nerilmi\u015ftir (5).<\/p>\n\n\n\n

        4.<\/strong> <\/strong>Geriatrik ihtiya\u00e7lar\u0131 olan hastalar i\u00e7in tarama: <\/strong>Ya\u015fl\u0131 acil servis hastalar\u0131 i\u00e7in olumsuz sonu\u00e7lar\u0131 tahmin etmede \u00e7e\u015fitli risk fakt\u00f6rleri ve tarama ara\u00e7lar\u0131 kullan\u0131lmal\u0131d\u0131r. Beklenmeyen acil servise geri d\u00f6n\u00fc\u015fler, hastaneye yeniden yat\u0131\u015flar, fonksiyonel d\u00fc\u015f\u00fc\u015f varsa dikkatle irdelenmelidir. Taramalar, \u00f6l\u00fcm gibi k\u0131sa vadeli olumsuz sonu\u00e7lar ya\u015fama olas\u0131l\u0131\u011f\u0131 az veya \u00e7ok olan hastalar\u0131 ay\u0131rt etmek i\u00e7in bireysel risk fakt\u00f6rlerinin ve acil servis taraf\u0131ndan do\u011frulanm\u0131\u015f tarama ara\u00e7lar\u0131n\u0131n prognostik do\u011frulu\u011funu \u00f6l\u00e7mektedir (6).<\/p>\n\n\n\n

        5. <\/strong>D\u00fc\u015fme riski olan geriatrik hastalar\u0131n belirlenmesi\/ tekrarlayan d\u00fc\u015fmeler<\/strong>: <\/strong>Travma de\u011ferlendirmesi ve ayn\u0131 zamanda potansiyel nedenlerin g\u00f6zden ge\u00e7irilmesini i\u00e7erir. D\u00fc\u015fme \u00f6yk\u00fcs\u00fc, y\u00fcr\u00fcme yard\u0131mc\u0131lar\u0131n\u0131n kullan\u0131m\u0131, depresyon, bili\u015fsel bozukluk ve alt\u0131dan fazla farkl\u0131 ilac\u0131n uzun s\u00fcreli kullan\u0131m\u0131 gibi risk fakt\u00f6rlerinin de\u011ferlendirilmesini \u00f6nerir. Kald\u0131\u011f\u0131 ortamda d\u00fc\u015fmeye kar\u015f\u0131 riskler belirlenerek, uygun ortamlar\u0131n haz\u0131rlanmas\u0131 tavsiye edilmelidir. Hastada d\u00fc\u015fmeye ba\u011fl\u0131 zararlar ortaya konmal\u0131, tespit edilmeli ve m\u00fcdahalesi yap\u0131lmal\u0131d\u0131r. Acil hem\u015firelerin %80’inden fazlas\u0131 d\u00fc\u015fme fakt\u00f6rleri risk konusunda e\u011fitilmelidir.<\/p>\n\n\n\n

        Kaynaklar <\/strong><\/p>\n\n\n\n

          \n
        1. Quality indicators for a geriatric emergency care (GeriQ-ED) \u2013 an evidence-based delphi consensus <\/strong>approach to improve the care of geriatric patients in the emergency department Schuster et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2020) 28:68.<\/li>\n\n\n\n
        2. Schnitker LM, Martin-Khan M, Burkett E, Brand CA, Beattie ER, Jones RN, Gray LC. Structural quality indicators to support quality of care for older people with cognitive impairment in emergency departments. Acad Emerg Med. 2015;22:273\u201384.<\/li>\n\n\n\n
        3. Pisani MA, Kong SYJ, Kasl SV, Murphy TE, Araujo K, Van Ness PH. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med. 2009;180(11):1092\u20137.<\/li>\n\n\n\n
        4. Schurig AM, B\u00f6hme M, Just KS, Scholl C, Dormann H, Plank-Kiegele B, et al. Adverse Drug Reactions (ADR) and Emergencies: The Prevalence of Suspected ADR in Four Emergency Departments in Germany. Dtsch Arztebl Int. 2018;115(15):251.<\/li>\n\n\n\n
        5. Conroy S, Nickel CH, J\u00f3nsd\u00f3ttir AB, Fernandez M, Banerjee J, Mooijaart S, et al. The development of a European curriculum in Geriatric Emergency Medicine. Eur Geriatr Med. 2016;7(4):315\u201321.<\/li>\n\n\n\n
        6. Carpenter CR, Shelton E, Fowler S, Suffoletto B, Platts-Mills TF, Rothman RE, Hogan TM. Risk factors and screening instruments to predict adverse outcomes for undifferentiated older emergency department patients: asystematic review and meta-analysis. Acad Emerg Med. 2015;22(1):1\u201321.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

          Acil serviste baz\u0131 hasta gruplar\u0131 \u00f6zellik arz eder. Gebeler, \u00e7ocuklar, geriatrik ve onkolojik hastalar acil serviste de\u011ferlendirilirken daha fazla dikkat gerektirmektedir. 65…<\/p>\n","protected":false},"author":1185,"featured_media":496,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10014],"tags":[10036,10020,10018],"class_list":["post-495","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","tag-acil-bakim","tag-acil-tip","tag-geriatri"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/495","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=495"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/495\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/496"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=495"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=495"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=495"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}