There's a new movement afoot in our nation’s hospitals that could shape how older Americans receive emergency care in the future.
We may soon see ERs specifically designed for the care of older people. It's a novel idea, and one that could greatly improve outcomes of geriatric cases where the decisions made in the first hours of medical intervention are usually the most critical. These early decisions can be the difference between life and death, and they can dictate how future care will proceed once a person leaves the hospital.
Overall, geriatric emergency care is more involved than standard ER care.
Currently, the average length of an ER stay is 20% longer for older patients, often requiring up to 50% more diagnostic services than younger patients. Many seniors will present to the emergency room physician with unstable vital signs—symptoms that may be unknown to them prior to arrival.
Because of this, some physicians will automatically order an EKG for any patient over 65 or 70 years of age, regardless of the patient's chief complaint. And many times underlying heart conditions — like a-fib or congestive heart failure — are detected by these tests, and they require follow-up.
A visit for a simple twisted ankle can quickly turn into an admission to a telemetry unit and months of appointments with a heart doctor.
In addition, seniors require more social service intervention than younger patients. Once at the hospital, doctors may determine that it is no longer safe for a senior to live on their own, whether due to illness, overall physical condition, changes in mental status, or other debilitating circumstances. And ER stays can become quite lengthy while social workers seek appropriate post-discharge placement.
Though these ancillary services can be lifesaving, they require two things that many ERs are short on: time and manpower.
Luckily, the delivery of emergency care seems to be changing to meet seniors’ needs
Geriatric ER patients already make up approximately 43% of acute admissions nationwide. With the percentage of Americans over the age of 65 at its highest than at any previous point — and predicted to grow as the Baby Boom reaches retirement age — emergency physicians knew they needed to change protocols, make procedures safer, and improve outcomes for vulnerable geriatric patients.
This year, a team of interdisciplinary experts from American College of Emergency Physicians, the American Geriatrics Society, the Emergency Nurses Association, and the Society for Academic Emergency Medicine published a new set of emergency guidelines specifically for the treatment of older people. Among the panel’s recommendations is a call for providers to operate geriatric-specific emergency rooms. There is precedent for age-specific emergency medicine: children have different medical concerns and needs than adults, and so we see pediatric emergency rooms. Why shouldn’t the oldest among us also benefit from dual-specialty care?
According to the panel’s recommendations, senior care ERs would feature:
- Clinical staff specially trained to provide emergency care to older people.
- Revised treatment protocols for the field and for the emergency ward, designed to minimize the negative, unintended outcomes most common to senior emergency patients.
- Additional lab and imaging equipment and staff to expedite ER care and enable doctors to make faster life-saving interventions.
- Higher staffing levels than a “normal” ER, to reflect the additional procedures and face time that these patients require.
- Close coordination with ICU, telemetry, neurosurgical and psychiatric units, to better facilitate admissions and decrease the time spent waiting for life-saving care.
- Additional social service staff.
Well-developed relationships with long-term acute care hospitals, skilled nursing facilities, in-home care providers and community services to ease a patient’s progression of care, ensure compliance and reduce dangerous lapses in medical follow-up.
Geriatric emergency rooms first started to appear in 2008 in the United States, and they are expected to become increasingly more common. With new guidelines in place, future care for older ER patients may look very different in just a few short years.
If all goes smoothly, seniors should see significant improvement in care.