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Geriatric Emergency Medicine Guidelines: rationale

Geriatric Emergency Medicine Guidelines

After two years of consensus-based work, the American College of Emergency Physicians (ACEP), the Society for Academic Emergency Medicine (SAEM), the American Geriatrics Society (AGS), and the Emergency Nurses Association (ENA)  published in 2013 this well-developed document to guide the creation of either free-standing Geriatric Emergency Departments or general Emergency Departments that strive to be more age-appropriate or “senior-friendly”.

What motivated this project?

  • An aging demographic of most populations around the world;
  • Emergence of so-called geriatric emergency departments but without any standard to guide them;
  • Lack of definition of what a Senior-Friendly ED should be;
  • An awareness that the ED is an important site of care for many older people

In Ontario, people 65 years and older account for 42% of hospitalizations, and 59% of total hospital days as their length of stay in hospital are longer (8.9 days vs 6.3 days for the population in general). Despite the fact that they account for 12-14% of the population, they represent almost 60% of the health care system budget.

This does not mean that all people over 65 years old are heavy users of EDs. According to a study done in the 1990s, only 10% of them are frequent ED users. Three specifics features characterize them: multiple comorbidities, impaired functional status and social fragility.

The guidelines suggest that there are areas of ED models of care that can be changed to provide better care to older patients.

This is what traditional EDs are good at:

A single chief complaint
Acute
Specific diagnosis and Treatment plan
Rapid discharge decision

 

This is a what typical older adults in the ED have:

Multiples medical, functional and social issues
Multiple chronic and subacute and acute issues
An interest in symptom management and maximizing quality of life
Complex transitions of care

 

There is a significant discrepancy between traditional ED competencies and older adult needs.

This is why enhancing ED models of care is so important in the continuum of care for older adults. The Geriatric ED Guidelines, provide support and direction for addressing those models of care.  It is a long and comprehensive document, with a solid base of evidence-based recommendation statements but few examples of how to practically implement them.

This section summarizes the six domains identified as important components of a Geriatric ED or a Senior-Friendly ED:

  1. Staffing and Administration (new job descriptions and an interdisciplinary team)
  2. Follow up and Transition of Care 
  3. Education
  4. Quality improvement 
  5. Equipment and supplies
  6. Policies, Procedures, and Protocols

 

References and Resources

  • American College of Emergency P, American Geriatrics S, Emergency Nurses A, Society for Academic Emergency M, Geriatric Emergency Department Guidelines Task F. Geriatric emergency department guidelines. Annals of emergency medicine. 2014 May;63(5):e7-25. PubMed PMID: 24746437.
  • Adams JG, Gerson LW. A new model for emergency care of geriatric patients. Acad Emerg Med. 2003;10: 271-274. 7.
  • Hwang U, Morrison RS. The geriatric emergency department. J Am Geratr Soc. 2007;55: 1873-1876.
  • Carpenter CR, Platts-Mills TF. Evolving prehospital, emergency department, and “inpatient” management models for geriatric emergencies. Clin Geriatr Med. 2013;29: 31-47.
  • Fitzgerald RT. White Paper: The Future of Geriatric Care in Our Nation’s Emergency Departments: Impact and Implications. in. Dallas TX, American College of Emergency Physicians; 2008.
  • Jayadevappa R. Quality of Emergency Department Care for Elderly. Emerg Med. 2011;1: e107.
  • Ryan D, Liu B, Awad M, et al. Improving older patients’ experience in the emergency room: the senior-friendly emergency room. Aging Health. 2011;7: 901-909.
  • Banerjee B, Conroy S, Cooke MW. Quality care for older people with urgent and emergency care needs in UK emergency departments. Emerg Med J. 2013;30: 699-700.
  • Baum SA, Rubenstein LZ. Old people in the emergency room: age-related differences in emergency department use and care. J Am Geriatr Soc. 1987;35: 398-404.
  • Gruneir A, Silver MJ, Rochon PA. Emergency department use by older adults: a literature review on trends, appropriateness, and consequences of unmet health care needs. Med Care Res Rev. 2011;68: 131-155.
  • Wilber ST, Gerson LW, Terrell KM, et al. Geriatric emergency medicine and the 2006 Institute of Medicine reports from the Committee on the Future of Emergency Care in the U.S. Health System. Acad Emerg Med. 2006;13: 1345-1351.

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Profile photo of Audrey-Anne Brousseau
I graduated as an Emergency Physician from Université Laval in 2016 and I completed a Fellowship in Geriatric Emergency Medicine at Mount Sinai Hospital in Toronto in 2017. My specific interests are in teaching, research and management of the ED with one objective: Providing the best care for older adults in the Emergency Department.

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