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Remaking Emergency Rooms for Older Adults

February 24, 2020

In another sign of our country’s aging demographic, emergency rooms are being created or renovated to better care for older adults. The issue is that the traditional ERs we’ve come to know, or seen on TV, wasn’t designed for frail, older adults. They were designed for people suffering from heart attacks, gunshot wounds, car crashes and the like. For many seniors, going to the ER can be a traumatic, even dangerous affair. They may have to endure long waits, uncomfortable beds, germ-filled surroundings, and a loud and hectic pace that can be overwhelming. Yet, between 2005 and 2016, the number of people over age 65 visiting ERs rose by more than 27 percent, according to the Centers for Disease Control and Prevention. And, according to a Rand Health study, nearly two-thirds of all Medicare patients are admitted to the hospital through the emergency room. With our aging population, those numbers will undoubtedly increase. Seniors, however, enter ERs with different types of conditions. They often have multiple chronic conditions like diabetes and heart failure and injuries from falls. Or they have atypical symptoms. For instance, if they’re having angina, they may not have chest pain. If they have an infection, they may not have a high fever or an elevated white blood cell count. It makes having a collaborative team approach in the ER important. Enter the American College of Emergency Physicians (ACEP), which developed a Geriatric Emergency Department Accreditation (GEDA) program to improve and standardize emergency care for seniors. This emergency department may include a separate space or integrated features designed for older patients, screenings for high-risk conditions specific to older patients, processes, protocol or procedures designed to enhance care for older patients or designated and specially trained staff. These facilities may also have additional resources, food, or equipment such as furniture, mobility aids, hearing assists, clocks or enhanced lighting, all of which are designed to meet the needs of older patients and play an important part in enhancing treatment and transition of care, either in or out of the ER. There are three levels of accreditation, each requiring an increasing number of features, policies, and practices. It isn’t necessary to create a separate ER, for example. Existing ERs can be accredited by following certain processes and policies, such as hiring geriatric specialists or using screening tools for problems like depression and dementia. Examples of some of the unique features of these ERs are (each ER may not have all):
  • A separate space with sound-absorbing walls, a lighting system that orients patients to the time of day to combat delirium—a common condition for older adults in hospitals—and nonslip flooring to protect against falls.
  • Providing comfortable seating for family and 24/7 access to food and drinks.
  • Large-button remote controls and phones.
  • Goal to have no patient wait longer than 14 minutes to be seen. Care providers have geriatric training and conduct risk assessments for factors like dementia and dietary problems that might worsen patients’ health problems.
  • Thicker mattresses for frail bodies, and pleasant lighting. Comforts such as aromatherapy and books.
So far, more than 50 geriatric emergency departments have earned the Geriatric Emergency Department Accreditation or GEDA, and more than 100 are in the process of getting accredited nationwide.