13 -The Geriatric Emergency Department
Shari Welch, MD, FACEP
Intermountain Institute for
Health Care Delivery Research
Salt Lake City, UT
For most of the past century the over 65 years 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 aged 65 are the highest utilizers of health care services: They will have 6 to 7 healthcare encounters per year, compared with younger adults having only 2. As people age their need for acute health care services increases exponentially and the emergency department (ED) will be impacted disproportionately. Once in the emergency department the elderly are more likely to have urgent or emergent conditions, to be admitted and to require critical care. 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.
The Geriatric ED should be different from other healthcare settings in terms of physical space: Non-glare lighting, large print information dispensation, non-skid 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 and seniors are more comfortable in rooms with higher ambient temperatures. Since 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 that will provide support services which will be critical to keeping patients out of the hospital.
Borrowing from successful interventions on the inpatient side, some authors have dubbed senior friendly modifications to the ED environment as GEDI’s: Geriatric Emergency Department Interventions. Some of these include recliners in lieu of stretchers (which can cause pressure ulcers in patients forced to lay on them for many hours), hearing amplification devices, magnifying glasses, telephones with large numbers, clocks and signage with large lettering, aisle lighting, warmer room temperatures, soundproof drapes, egg crate bed padding, and non-skid rubber mats for the patient’s bedside. Some departments are looking at “GEDI packs” distributed in triage to seniors with many of these items in them.
Many EDs already use patient segmentation to separate pediatric patients, psychiatric patients and minor injury patients from the rest of the mix in the ED. The special needs of seniors and the new reform models on the horizon are combining to make the development of the Geriatric ED an operational imperative. Shouldn’t this be an option worth considering by your healthcare organization?