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Jan. 25, 2022, 1:35 p.m. EST

Why ERs for seniors could be a game-changer in healthcare

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By Nora Macaluso

This article is reprinted by permission from  .

A hospital’s emergency department is not always the best place for older people. The problems that bring these patients in may be complicated or made worse by long waits, lack of food and even some standard procedures, doctors say.

While younger people generally go to the emergency department after one-time crises, older adults more often show up because of exacerbating events related to underlying conditions, such as a frailty-related fall or shortness of breath due to congestive heart failure, said Dr. Ula Hwang, professor of emergency medicine at Yale School of Medicine and a key researcher in geriatric emergency medicine.

“It’s not like we’re going to fix [the condition] and they’re never going to have it again,” Hwang said.

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Medical centers around the country are taking note, setting up separate emergency departments or instituting separate policies for emergency geriatric patients. It’s improving care and saving money, and the value will become even more evident as the population ages, hospital administrators say.

Anne Arundel Medical Center in Annapolis, Md. opened an acute care unit for older patients in 2013, said Lillian Banchero, senior director for the medical center’s Institute for Healthy Aging.

“In these few short years, we have gone from an average age of patients of sixty-five to an average age of eighty-five,” Banchero said. “Up to a hundred and two is not uncommon here.”

A collaborative for change

Anne Arundel is part of the Geriatric Emergency Department Collaborative, an initiative designed to better serve older Americans in the emergency department led by the American College of Emergency Physicians (ACEP), American Geriatrics Society, Emergency Nurses Association and Society for Academic Emergency Medicine. It’s supported by the John A. Hartford Foundation (a funder of Next Avenue), and the Gary and Mary West Health Institute.

Yale’s Hwang is also involved with the collaborative.

“Emergency room practices have changed,” Banchero said. 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 antianxiety medication,” she said. “We’re just not doing that anymore.”

Instead, patients are evaluated individually and there’s an effort to involve families and caregivers, she said.

The hospital last year hired its first geriatrician, which is “a dream come true,” Banchero said. Having that person on staff “will make all the difference,” she noted.

Geriatricians are “few and far between,” Banchero said, adding that it’s important to have someone who understands the unique needs of older adults, just as it’s important to have pediatricians to address the way children present symptoms and deal with the stress of being in the hospital.

“Over the years, we’ve developed policies, procedures and best practices about how to care for the elderly,” Banchero said. “Delirium is one thing we’ve worked hard on. Up until two years ago, we weren’t focused on screening for delirium. Yet it’s present in almost 60% of our patients.”

Read: We’re in our 60s, my husband plans to work until he ‘drops dead’ and our medical bills are overwhelming – how can we retire like this?

Education is key

Before the hospital started focusing on geriatric medicine, delirious patients were dismissed as “sundowners” (a dementia sufferer who is negatively affected after sunset) and not treated. Now, they get early intervention to prevent the syndrome, Banchero said.

Diversion activities keep patients occupied, preventing them from panicking or from falling as they try to get up, she added.

“The biggest thing we did was education,” Banchero said. That includes sending leaders to education courses and getting them certification through programs such as Nurses Improving Care for Healthsystems Elders, she said.

In the ER, the hospital puts together “delirium carts” for patients, with amenities like crossword puzzles, reading glasses, hearing amplifiers and phone chargers — “things that enhance their stay” — Banchero said. “Somebody comes in, they get Grandma into an ambulance, and she’s forgotten her glasses, her walker, or her charger. When they get [to the hospital], that’s what they want.”

Providers are also trained to talk to patients with more of an understanding of their lives, Banchero said.

Many patients “have already articulated what their plan for the rest of their life is,” she said. “We need to be present and talk to the patient about what they want,” whether it’s palliative care or more aggressive treatment.

For some people, the goal might be to make it to a grandchild’s wedding a week away, “so then you change the plan of care,” Banchero said.

Read : Dementia and Alzheimer’s disease: How to spot — and prevent — them

Accredited geriatric ERs

Anne Arundel’s Institute for Health Aging has Level 3, or bronze, certification from the American College of Emergency Physicians, meaning it has at least one doctor and one nurse trained in geriatric emergency medicine, provides access to mobility aids and round-the-clock food and drink, and has taken a “geriatric emergency care initiative” such as a catheterization policy.

Level 1, or gold, certification goes to hospitals with several specific policies and procedures in place, including at least 20 age-specific protocols and staffers dedicated to geriatric patients.

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