Chapter 30. Geriatric Evaluation and Management Units for Hospitalized Patients

Inpatient care of elders with multiple co-morbidities requires close attention to the special needs and geriatric syndromes that arise in this vulnerable population. One strategy to address the risks of hospitalization is to provide care by a multidisciplinary team in a dedicated geriatric unit, principally Geriatric Evaluation and Management (GEM) Units. This model of care, in many ways similar to coordinated stroke units, may improve mortality and other clinically relevant outcomes compared with outcomes achieved on a general medical ward. An alternative strategy, reviewed elsewhere in this Report, is the comprehensive geriatric consultation service, analogous to a typical medical consultation team (see Chapter 29). In a GEM unit, a multidisciplinary team provides comprehensive geriatric assessment, detailed treatment plans, and attention to the rehabilitative needs of older patients. A typical team is composed of a geriatrician, clinical nurse specialist, social worker, and specialists from such fields as occupational and physical therapy, nutrition, pharmacy, audiology, and psychology. GEM units are typically separate hospital wards that have been redesigned to facilitate care of the geriatric patient. Multidisciplinary team rounds and patient-centered team conferences are hallmarks of care on these units, which, in contrast to geriatric consultation services, have direct control over the implementation of team recommendations.