2024 GEMSSTAR for Emergency Medicine Supplemental Funding Program - $25,000

"Risk Factors and Time Course of Incident Delirium Among Older Adults in the Emergency Department (ED)"

Delirium, an acute, fluctuating change in cognition with significant downstream consequences, is present in up to 35% of older adults in the emergency department (ED), but the incidence (number of patients developing delirium in the ED, versus those with delirium prior to ED visit) and time course are currently unknown. Prevention is the only effective treatment for delirium, requiring early identification of patients at risk of developing delirium in the ED, but up to 83% of ED providers fail to recognize delirium cases, often due to lack of screening. We propose to tackle the first steps towards developing preventive and management strategies for delirium in the ED — that is, determining its incidence and time course, identifying the most relevant risk factors, and evaluating geriatric risk assessment instruments for ED delirium. 


  • Rachel M. Skains, MD, MSPH

    University of Alabama at Birmingham

    "Risk Factors and Time Course of Incident Delirium Among Older Adults in the Emergency Department (ED)"

    Dr. Skains is an assistant professor in the department of emergency medicine (EM) at the University of Alabama at Birmingham (UAB) with a joint faculty position at the Birmingham VA Medical Center (BVAMC). Dr. Skains is an early-stage investigator focused on improving medication safety and cognitive impairment management in the acute care of older adults through patient-centered outcomes research. Dr. Skains’ interest in cognition and aging stems from her undergraduate training in neuroscience, working as a clinical research coordinator at Carolinas Neuromuscular/MDA-ALS Center, and serving as a NC Albert Schweitzer Fellow. After graduating from Wake Forest School of Medicine (2016), she completed her EM residency at UAB (2019) followed by a clinical research fellowship focused on geriatric EM while pursuing a master's degree in public health in clinical and translational science from the UAB School of Public Health (2021). 

    Dr. Skains was awarded the AHRQ NRSA T32 Postdoctoral Scholar Fellowship in the UAB Health Services Research Training Program (2020-2022), in addition to funding through the UAB Integrative Center for Aging Research (ICAR) and Geriatric Emergency Care Applied Research (GEAR) 1.0 pilot grant programs. She has recently been awarded two NIA awards: Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR) R03 (2023-2025) to evaluate the risk factors and time course of incident delirium among older adults in the ED and Exploratory/Developmental Grant R21 (2023-2025) for comprehensive assessment of delirium risk due to medications, in addition to the GEMSSTAR for EM Supplemental Funding Program through SAEMF/EMF. Furthermore, Dr. Skains is an ED physician champion for the UAB – Highlands and BVAMC Geriatric ED committees, which received Level 1 (2021) and Level 3 (2023) accreditations respectively, completed the UAB Geriatric Scholar Interprofessional Program (2019-2021), served as fellow board member for the GEM Section of ACEP (2021-2023), and currently chair of the AGEM Grants & Awards subcommittee (2023-Present). Dr. Skains is also leader of the medication safety committee to update the national Geriatric ED Guidelines, leader of the ACEP quality measure group to develop a geriatric high-risk ED prescription list, Level 3 Geriatric ED accreditation reviewer, and committee member for UAB’s Department of Inter-professional Practice and Training (DIPT), What Matters Advisory Group, and AGEM Grant and Awards Subcommittee. Finally, she was recently the recipient of the 2023 Academy of Geriatric Emergency Medicine Early Career Achievement Award and the UAB Department of EM Outstanding Researcher of the Year 2023.