Geriatric emergency departments on the rise

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Emergency rooms are intimidating for people of all ages, but they can be even more daunting for patients older than 65.

Now, innovative emergency departments around the country are taking the lead and offering specialized care to elderly patients.

Ninety-four-year-old Harry Shank is happy living on his own, even if it worries his son Gary.

"When they get older, they get kind of stubborn," Gary Shank said.

Harry Shank has fallen several times with multiple trips to the emergency department. The last time, he broke three ribs.

"As he gets older, it's more and more of a concern. So, it's a dilemma," Gary Shank said.

ED doctors are facing a dilemma of their own. By 2060, there will be more than 100 million people older than 65.

"The older adults often don't come with one problem, and often the problem they come with is not the most life-threatening problem that's in front of them," Dr. Christopher Carpenter said.

Forward-thinking emergency departments around the nation are adopting new guidelines to get accredited as geriatric emergency departments. Missouri Baptist Medical Center is one of them.

"We need to get prepared. And we want to be prepared to help those patients," said Dr. Joseph Galkowski, a physician there.

Nonstick floors, large-faced clocks, dimmable lights, windows to orient patients to the time of day, specially trained staff, testing for dementia and fall risk, immediate follow-up care at home – all these steps cater to an older population.

"I think the patients notice the difference when they are in a geriatric-friendly emergency department versus one that treats the geriatric patient like the pediatric patient," Carpenter said.

The comprehensive care Harry Shank gets at the ED gives him and his son an extra layer of security.

"He's the greatest dad I could ever hope for," Gary Shank said.

As of September 2019, there are 85 hospitals across the United States with accredited geriatric emergency departments. Early studies show elderly patients treated at geriatric EDs are less likely to be admitted to the hospital.

ED doctors are hopeful the accreditation program will serve as a motivator for ED departments across the country to adopt the guidelines and better care for our aging population.

RESEARCH SUMMARY
GERIATRIC EMERGENCY DEPARTMENTS ON THE RISE
REPORT #2679

BACKGROUND: Annually, there is nearly one emergency department (ED) visit for every two older Americans. ED environments, which are often characterized by bright lights, fast pace of activity, and loud noises, can be disorienting to older adults and potentially interfere with the effectiveness of care. Complexity of care also rises with age. Older patients are more likely to have several conditions such as heart disorders and chronic obstructive pulmonary disease, or COPD. Many patients who are on multiple prescribed medications might benefit most from having their drug regimens trimmed. Instead, they may receive new drugs in the ER that can cause side effects and possibly interact with drugs they're already taking. Geriatric emergency departments incorporate specially trained staff to assess older patients in a more comprehensive way and take steps to make the experience more comfortable and less intimidating. (Source: https://www.americangeriatrics.org/programs/geriatrics-emergency-department-collaborative and https://health.usnews.com/health-care/patient-advice/articles/2018-09-28/what-is-a-geriatric-emergency-department)

COMPONENTS THAT SET APART GEDs: Structure is a feature that sets apart a geriatric emergency department. "It should be quieter," Kevin Biese, MD, an emergency medicine physician with University of North Carolina Hospitals, says. "You shouldn't be in the hallway. You should be in a more comfortable bed or cot, not a thin cot that's going to cause skin breakdown in older adults. The lights should dim at night. There should be some nonstick flooring to minimize falls within the department." Another feature is a variety of screening tools that can quickly uncover physical or mental health risks that are more common in older adults. Nurses and doctors receive additional education in geriatrics, above and beyond what they learned about caring for older adults during emergency medical training. An emergency department visit doesn't always need to lead to hospitalization for older patients. "Rather, you might have an opportunity to connect with your community, figure out what your needs are and see whether those can be met at your house," Biese says. Team members can reach out to the local Agency on Aging, services like Meals on Wheels, physical therapy providers and home health agencies. (Source: https://health.usnews.com/health-care/patient-advice/articles/2018-09-28/what-is-a-geriatric-emergency-department)

CHANGES COME TO GEDs: Mount Sinai's Geriatric Emergency Department (Geri ED) has a team assigned to anyone over 65 which includes doctors, nurses, case managers, social workers, pharmacists and even physical therapists. "The elderly often present with atypical symptoms," says Denise Nassisi, MD, head of Mount Sinai's Geri ED. They also better handle the host of comorbidities that can make a diagnosis even more confounding. "Because of the wonders of modern medicine, people are surviving longer, so they have extensive medical histories that can include diabetes and stroke and hypertension. And you must stop for a second and figure out what brought them here," Nassisi says. Mount Sinai is the first in New York state to specialize in emergency geriatric medicine and one of nine medical centers nationwide accredited for geriatric care by the American College of Emergency Physicians. Nonslip floors and a lighting system designed to help fight delirium are part of the hospital. (Source: https://www.aarp.org/health/conditions-treatments/info-2019/geriatric-emergency-rooms.html)