'They need more': 3 geriatric emergency department leaders on why specialization is essential

Geriatric emergency departments are being added to hospitals nationwide as COVID-19 and a rapidly aging population illuminate these patients' vulnerability and distinct needs. 

An estimated 10,000 baby boomers turn 65 every day, according to the American College of Emergency Physicians. These patients, at a higher risk of falling and developing chronic or sudden illness, frequently visit emergency departments: The National Center for Health Statistics' most recent data on geriatric patients found that from 2014 to 2017, 43 of every 100 people older than 60 visited an emergency department. This number doubled in people 90 and older. 

COVID-19 has furthered the need for geriatric emergency care, as its severity deepens in older populations. Though only 16.5 percent of the U.S. population is 65 or older, this age group accounts for 75.2 percent of COVID-19 deaths, Statista reported Aug. 30.

Although emergency departments' patients often are older adults, most facilities are not built with their needs in mind. There are approximately 5,000 emergency departments in the United States but only 280 accredited geriatic departments, Dr. Kevin Biese, MD, chair of ACEP's geriatric accreditation board of governors, told PBS' Next Avenue in January. 

As the geriatric population's reliance on health systems heightens, more emergency departments are gaining geriatric accreditation by building separate spaces for geriatric patients or adding features to the emergency departments they already have. 

 

Leaders of three health systems placing an emphasis on geriatric emergency medicine spoke with Becker's about the needs they have seen and the steps being taken to address them: 

 

Mount Sinai (New York, N.Y.): Mount Sinai was ranked first in U.S. News & World Report's "Best Hospitals for Geriatrics" list this year. In 2012, the hospital opened New York's first ED for patients 65 and older, and in 2018 it became the first hospital in the state to receive emergency geriatric accreditation. 

Martine Sanon, MD, director of inpatient geriatric medicine clinical services at Mount Sinai, said it was clear its urban, academic ED — facing long wait times, overcrowding and challenges addressing comprehensive care — was not suitable for older adults.

"The greatest concerns were patients coming to the ED for one issue and unfortunately developing complications, such as confusion, delirium, pressure sores, or given potentially inappropriate medications — complications not related to their presentation, but we know older adults are at greater risk for developing," Dr. Sanon told Becker's. 

Mount Sinai received a CMS grant to develop and test the geriatric ED, according to Dr. Sanon. 

"At our institution, [developing a geriatric ED] included new roles for emergency department medical and nursing personnel, social workers and pharmacists; information technology-enabled clinical decision support and care coordination; and changes to the physical setting to improve care for older adults while decreasing adverse events (e.g. falls, medication errors and delirium), hospitalizations, re-hospitalizations and repeat emergency visits," Dr. Sanon said. 

 

Cleveland Clinic: Cleveland Clinic was ranked second in U.S. News & World Report's "Best Hospitals for Geriatrics" list this year. Its geriatric emergency department, which first opened in 2019, provides specialized care within the clinic's existing emergency unit. 

According to Dr. Saket Saxena, who helps lead the geriatric-focused ED at Cleveland Clinic, a multidisciplinary approach is required to address the specific, multifaceted conditions of many geriatric patients. Whether a patient struggles to manage multiple medications, communicate effectively or handle depression, cross-departmental collaboration allows the geriatric ED to address those needs, Dr. Saxena told Becker's. 

"When complex older adults come to the emergency room, they need more. They want more," Dr. Saxena said. 

 

Scripps Health (San Diego): In October, Scripps Health received geriatric accreditation at all four of its emergency departments, although the system aims to keep older patients living independently in their homes for as long as possible, according to Andrew Accardi, MD, the health system's emergency department careline director. 

"In our emergency departments we use a special screening tool that identifies patients with elevated risks of falling. That allows us to use resources, such as case managers and social workers, to provide those patients with walkers, better lighting at home, rug and furniture rearrangement, and education that can lower that risk," Dr. Accardi told Becker's. "Our geriatric emergency department program also provides patients with extra access to home health and outpatient services."

When geriatric patients stay in an ED for observation, Scripps aims to keep them in areas with less noise, more natural light and more room for family members, Dr. Accardi said. 

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