Components of an Effective Geriatric Emergency Department

Abstract

Emergency department (ED) visits by older adults are increasing as the worldwide population ages, and health systems struggle to meet the increased health-care needs of older adults. Additionally, the environment in the ED with its focus on rapid diagnostics and stabilization often leads to suboptimal care for older adults in the ED increasing their likelihood of hospitalization, delirium, infections, falls, and other poor outcomes. To improve care for older adults, ED programs across the world have been developed to better address the health-care needs of older adults. These programs seek to provide accessible, integrated, people-centered health services for older adults by identifying and responding to underlying health-related needs such as impaired functional status, multi-morbidity, lack of social support, cognitive impairment, or depression. To address these needs, guidelines for geriatric ED care have been developed in the United States, Australia, Great Britain, and other countries around the world. These guidelines recommend use of a multidisciplinary team in the ED to help address underlying health-related needs of older adults. This team may involve specialized nurses such as transitional care nurses, pharmacists, social workers, geriatric consultants, physical therapists, and occupational therapists. These multidisciplinary teams work to address concerns such as medication risk, falls, functional decline, delirium, dementia, elder abuse, and palliative care needs. Based on hospital and local resources, the teams and protocols in a given geriatric ED will vary; however, the focus always should be on providing high-quality, accessible, integrated, people-centered health services for older adults. When this goal is achieved, patients will benefit from fewer hospitalizations, falls, adverse drug events, delirium, and functional decline and better overall quality of life.