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Could having separate geriatric emergency rooms improve ER outcomes?

America’s population is aging. People are living longer while Americans have fewer children. There is just a greater proportion of people 65 and over in the population than there ever was before.

With that in mind, it may be time to re-think how we provide emergency medical services in this country. With more older people using emergency departments, hospitals need to recognize that these patients have somewhat different needs than younger ones, along with additional frailties.

“Emergency room practices have changed,” says Lillian Banchero. In the past, “it didn’t matter what you had, when you came in the door, you got IVs and a full catheter, maybe some anti-anxiety medication,” she told nextavenue.com. “We’re just not doing that anymore.”

It’s never a good idea to provide possibly unnecessary care to anyone, but it could be catastrophic for seniors. They may not be able to tolerate interventions that younger people could take in stride. Moreover, their illnesses and injuries often present differently, so they require an individualized assessment performed by a doctor who knows those differences.

What else could older people benefit from in the ER? It could be a lot of things. Older people most often come to the ER for a chronic condition, and they may not always be looking for a cure. They may be seeking palliative care or looking for short-term improvement. When they are injured in falls, older people may benefit from learning fall prevention strategies.

Separate ERs or separate policies for elderly patients could both work

The Anne Arundel Medical Center in Annapolis, Maryland, has been working to change how it treats geriatric ER patients.

“Up until two years ago, we weren’t focused on screening for delirium,” says Banchero, who directs the medical center’s Institute for Healthy Aging. “Yet it’s present in almost sixty percent of our patients.”

Now, its geriatric ER not only screens for delirium but provides early intervention to prevent “sundowner” syndrome. And, it offers “delirium carts” with reading glasses, hearing amplifiers, phone chargers and crossword puzzles to help combat delirium and keep patients from getting too bored, which increases the risk.

Doctors at the geriatric-centered ER work more closely with family and caregivers than they would in a classic emergency department. They talk more with the patients about their lives, their goals and their plans for the rest of those lives. Not only does this promote a more effective plan of care, but it also helps ensure the person leaves the ER with a workable home care plan.

Geriatric ERs like the one at Anne Arundel Medical Center can offer age-appropriate services like dementia screening, fall prevention, medication reconciliation and evaluations of delirium. They can bring in specialists, such as geriatric physical therapists and social workers who can help get patients back on track to go home instead of being admitted to the hospital.

The completely separate geriatric emergency department could work as a model, just as dedicated pediatric ERs serve the needs of young patients. However, experts think more general ERs could also adopt special policies geared toward older people and their needs.

Certifications and cost savings could spread these practices

The hospital, which has a bronze certification from the American College of Emergency Physicians (ACEP), hired a full-time geriatrician last year. The certification requires at least one doctor and nurse to be trained in geriatric emergency medicine, along with other geriatric-friendly amenities. Silver and gold certifications are also available, with each level requiring additional policies, staff and age-specific protocols.

Currently, there are over 280 geriatric ERs accredited in 41 states and four countries, according to ACEP. However, there are around 5,000 ERs in the United States.

There is even some evidence that the holistic way a geriatric ER treats a patient is less expensive than traditional care. A recent study found that, when Medicare patients were treated by social workers or transitional care nurses in the ER, their cases cost about $3,000 less than when they were treated in standard emergency departments.

Any ER could benefit from better information and training specific to older people. These initiatives have the potential for improving overall outcomes for older patients and returning them home better equipped to avoid another emergency.