For most of the 20th century, the over-65 age group outpaced the growth of all other age groups in the U.S., and by 2030 one in five Americans will be over 65 years old. Patients over age 65 are the highest users of healthcare services. They will have six to seven healthcare encounters a year, compared with younger adults, who average only two such visits. As people age, their need for acute healthcare services increases exponentially. Although the "graying of America" will affect all areas of healthcare, the emergency department will be impacted disproportionately.
Better Medicine: Creating a geriatric ED helps gives seniors better care
Once in the ED, the elderly are more likely to have urgent or emergent conditions, to be admitted and to require critical care. Senior citizens will require more diagnostic testing and therapeutic interventions and their ED charges will be higher than those of younger persons. Another study found that 27% of elderly patients seen in the ED and discharged will revisit the ED, be admitted or die in the three months that follow the visit. Indeed, an ED visit by an elderly patient may in and of itself be a sentinel event and impossible to force into the rapid-throughput model established for other ED patients. Gearing up for the baby boomers, the largest cohort of healthcare consumers this country has ever seen, may wisely include the emergence of the specialty ED for seniors.
In 2008, Holy Cross Hospital in Silver Spring, Md., opened the first geriatric emergency department. More emergency departments are following suit by either building a separate emergency department designed for senior citizens or by allocating space in the existing ED for seniors. In Houston, Park Plaza Hospital and Medical Center opened a geriatric ED in October of 2010. In Michigan, St Joseph Mercy Health System is spending 1.4 million to open senior emergency departments in eight of its hospitals.
The geriatric ED should be different from other healthcare settings in terms of physical space: Nonglare lighting, large-print information dispensation, nonskid flooring, guard rails and hand rails are all features of facility design that are adaptive to senior citizens. Efforts at noise control (it is harder for the elderly to hear when the ambient noise level is high) is also a key feature of an emergency department catering to elderly patients. Because elderly patients will require longer lengths of stay in the ED to sort out their increasingly complex healthcare needs, an ED designed for seniors should have rooms more like inpatient suites with real beds instead of stretchers and space for family members to sit comfortably. In addition, the geriatric ED should have work space for case managers, social workers and other ancillary personnel who will provide support services that will be critical to keeping patients out of the hospital.
Moreover, the geriatric ED should be operationally different from the traditional ED. At Holy Cross, half of the patients presenting to the ED have fall-related injuries. In the traditional ED, efforts would be made to get the patient through quickly with a superficial and focused evaluation of the patient. In the geriatric ED, attention would be paid to underlying co-morbid conditions that may have contributed to the fall. Medication interactions are also a focus in the geriatric ED, given that patients taking more than seven medications at once (and this is increasingly common among elderly patients) have an almost 90% chance of an adverse drug interaction. Early data suggests that the geriatric ED and its approach to the healthcare needs of seniors is effective: Holy Cross has reduced its 30-day re-admission rate from 10.9% to 5.2%.
Dr. Shari WelchUtah Emergency PhysiciansSalt Lake CityPresidentQuality Matters Consulting
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