The domain management model--a tool for teaching and management of older adults in emergency departments

Older adults in emergency departments (EDs) can have complicated health problems that defy straightforward diagnosis and management. Implementation of the 11 core principles in the geriatric emergency care model requires changes in care processes. The Domain Management Model (DMM) is one solution to organize care efficiently using a standard language. Its use is consistent with the geriatric model. Patients' problems are organized into one of four domains: I. Medical/Surgical Issues; II. Mental Status/Emotions/Coping; III. Physical Function; and IV. Living Environment (A. Physical, B. Social, and C. Financial). Specific geriatric cases illustrate improved communication using these standard domains. This model can educate health care staff, facilitate team care, improve flow of relevant information, improve decision making, and facilitate more meaningful interactions with patients.