Increasingly, long-term care residents and other seniors seen in hospital emergency departments (EDs) are being treated in facilities designed with their specific needs in mind. In response to this phenomenon, several organizations representing those caring for seniors in emergency situations have issued guidelines covering staffing, education and aging-related issues.
“Geriatric [EDs] first appeared in 2008, but this is the first time there has been a standardized template for how they should be set up and how care for older patients should be delivered,” says Alex Rosenau, DO, president of the American College of Emergency Physicians (ACEP), one of the groups developing the guidelines over a two-year period. “It is important that the special needs of these vulnerable patients are met appropriately in the emergency setting. As of 2010, there were 40 million people in this age group, and many of them will be emergency patients at some point.”
In addition to the ACEP, the American Geriatrics Society, the Emergency Nurses Association and the Society for Academic Emergency Medicine devised the recommendations, which relate to staffing; follow-up care; education; quality improvement; equipment and supplies; policies, procedures and protocols; the use of urinary catheters; medication management; fall assessment; delirium and dementia; and palliative care. Widespread adoption of the guidelines will more effectively allocate healthcare resources and improve patient care, according to the organizations. Similar programs designed for other age groups (such as children) or specific diseases (such as myocardial infarction, stroke and trauma) have improved care both in individual EDs and system-wide, resulting in better, more cost-effective care and better patient outcomes, they add.
Geriatric emergency patients represent 43 percent of hospital admissions. On average, they stay longer in the ED, use more resources and are significantly more likely to require social services, the groups note.
“Our advice to healthcare systems with limited resources is to make the entire [ED] a geriatric [ED],” says Mark Rosenberg, DO, the geriatric emergency medicine chief at St. Joseph’s Healthcare System in Paterson, N.J., and chairman of the ACEP task force working on the guidelines. “If the [ED] is designed for the most frail and vulnerable, it will work for the strongest patients as well.”