There was a time when it was rare to see a patient over the age of 85 in an emergency room.
But on one recent day, Dr. David John had five 95-year-olds in his Connecticut emergency department — at one time.
Hospitals across the country are adding geriatric emergency departments or bringing their emergency rooms in compliance with elder care guidelines.
The goal is to better serve the aging U.S. population and meet the demands of a rapidly growing demographic.
But the move isn’t completely altruistic. Better geriatric care means a less likely chance of readmission, which can save health networks and hospitals money.
One of the statistics driving the addition of geriatric emergency departments is that the number of people over the age of 85 has quadrupled in the past 10 years, said John, a spokesman for the American College of Emergency Physicians.
“And it’s going to quadruple again in the next 10 years,” he said.
Some estimates put the number of Americans over the age of 65 years at 89 million in 2050.
Older Patients Are Now Common
The days when seeing a patient over the age of 85 was a quotable moment are long gone.
“Now, it’s routine if we see people in their 90s and it’s not even a shocker to see someone over 100,” John said.
A big push for geriatric emergency departments or emergency rooms brought into compliance with geriatric care standards occurred in years leading up to 2011, when the first baby boomers hit 65.
“You had the biggest chunk of the population in the United States post-World War II aging,” John said. “And older people tend to use hospital services more than younger people.”
The same ailment can often have a much stronger impact on a geriatric patient than a younger patient.
“You have to treat older people different than a young kid,” John said.
Some of the differences in senior emergency departments are simple.
The lights are softer than the usual glaring fluorescent white light of an emergency room. The clocks feature large, easy-to-read numbers, floors are quick-drying and non-slip, toilets are at patient bedsides to prevent falls, and the mattresses are thicker.
However, other differences are more medical in nature.
For example, if a youth falls and breaks an arm, chances are they will heal with a cast. With an older patient, if a doctor just patches them up and sends them home, there’s a higher chance they’ll come back a day or two later because the fall was actually the result of something else. Perhaps a silent heart attack or a urinary tract infection or an electrolyte balance.
Geriatric patients require much more intense workups, John said, and for hospitals that are implementing geriatric emergency departments, that extra attention to detail is reducing readmission.
“What we are looking at is coming up with a way to keep people out in the community, which is cheaper in the long run and much more satisfying for the patient,” John said. “The idea is to provide people care in their home.”
Setting Up the Guidelines
John was part of the team that introduced multidisciplinary geriatric emergency department guidelines for hospitals and health networks, a joint effort from his organization, the American Geriatrics Society, the Emergency Nurses Association, and the Society for Academic Emergency Medicine.
The guidelines are made up of 40 specific recommendations in six general categories. They are staffing, transitions of care, education, quality improvement, equipment and supplies, and policies, procedures, and protocols.
Geriatric emergency departments, in providing greater comfort for elders, screening for common complications, and selectively working with social workers and outside care providers are noticeably decreasing rates of admission, according to a study published in May 2014.
“Older people are different than the people that preceded them and we can provide better care,” John said.