The geriatric-focused emergency department: opportunities and challenges
Emergency departments are an important site of medical care for older persons and serve as a gateway to hospital entry. In the United States, persons aged 65 years and older comprise 18% of emergency department visits and a whopping 40% of emergency department-to-hospital admissions. The primary focus of emergency departments is acute, potentially life-threatening conditions, which has led these settings to be characterized by a restive staff mindset, limited history taking, extensive use of laboratory and radiologic tests, and a focus on rapid decision making and patient disposition. This approach is in many ways antithetical to care of older persons, for which the key elements of quality include concern for comfort and homeostasis, understanding of the patient’s complex medical and psychosocial history, avoidance of unnecessary interventions, and observation over time. In the emergency department setting, it is not uncommon for older persons and their family caregivers to report less-than-satisfactory experiences, citing unpleasant waiting conditions, unhelpful staff attitudes toward patients, lack of communication, and inattention to privacy and personal care.2,3 In addition, the lack of attention among emergency departments to the peculiarities of older patients has been associated with such negative outcomes as overdiagnosis of urinary infection and unnecessary hospitalization, and these have been linked to insufficient provider knowledge, negative attitudes, health system deficiencies, and suboptimal communication.4,5
Sloane PD. The Geriatric-Focused Emergency Department: Opportunities and Challenges. J Am Med Dir Assoc. 2022 Aug;23(8):1288-1290. doi: 10.1016/j.jamda.2022.06.017. PMID: 35940680.