The geriatric emergency department

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Introduction: Our Aging Population and the Disconnect with Emergency Care An aging society presents unique emergency management challenges for providing prompt, thorough clinical care worldwide. Optimal outcomes for medical illness and surgical trauma depend on accurate diagnoses and timely consultation, but older adults often display atypical symptoms clouded by the complexities of comorbid disease, including age-related physiologic changes and undiagnosed organ dysfunction. The contemporary emergency department (ED) was designed to manage acute medical issues in populations of all ages, but the time-intensiveness and complexity of geriatric evaluations has traditionally been relegated to inpatient settings. Concerns about healthcare costs and efficacy have produced a policy environment in which inpatient access is increasingly being constrained by payers because of escalating costs, so the onus is on emergency medicine to transform itself and develop protocols that provide more intensive, yet efficient, geriatric evaluations in the future. It is projected that older adults (age 65+) will utilize the ED more than any other age group. Once in the ED, they are more likely to have testing, longer lengths of stay in the ED, higher ED charges, and to be admitted (specifically to the intensive care unit). Despite this high volume of care, older adults often receive a lower quality of care than younger patients. They are at greater risk for iatrogenic injuries, including adverse drug events and catheter-associated urinary tract infections, and have poorer post-ED discharge outcomes, including ED revisits, hospitalizations, and death. Emergency medicine seeks to promote health, accelerate recovery from disease and injury, and ease the end-of-life process. However, the complexity of older adult emergencies, combined with an amalgamated healthcare web leading to challenging gaps in care transitions, leave modern EDs to contribute at times to unsatisfactory outcomes for the aged. It is not uncommon for dementia and delirium to be unrecognized; fall victims to not receive guideline-appropriate management; acute pain to be undertreated; and palliative care resources to be underutilized. These deficiencies occur across healthcare systems internationally, providing an extraordinary opportunity to advance the science and humanism of emergency medicine for older adults around the world.

Original languageEnglish
Title of host publicationValue and Quality Innovations in Acute and Emergency Care
PublisherCambridge University Press
Pages82-90
Number of pages9
ISBN (Electronic)9781316779965
ISBN (Print)9781316625637
DOIs
StatePublished - Jan 1 2017

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    Hwang, U., & Carpenter, C. R. (2017). The geriatric emergency department. In Value and Quality Innovations in Acute and Emergency Care (pp. 82-90). Cambridge University Press. https://doi.org/10.1017/9781316779965.011