According to the U.S. Census Bureau’s national population projections, the number of Americans 65 years old or older will expand from 40 million to 54.6 million by 2020—an increase of 36%.1
When it comes to emergency services, seniors require a different type and delivery of care than other patients. Older patients typically present complex medical conditions, stay longer for more extensive diagnostic testing and treatment regimens, and require special needs during their visit, making rapid triage and diagnosis difficult in the traditional emergency department (ED) setting.
Experts have recommended making changes to adult EDs to better accommodate the needs of seniors for quite some time, but it has not been until recent years that hospitals have taken steps to do so. Now hospitals nationwide are redefining the ED experience for the elderly and responding to their special requirements by designing and building facilities dedicated solely to their needs.
With about a dozen geriatric emergency departments currently around the country, more are sure to follow with new and innovative ideas to meet the demands of an aging population.
In April 2009, St. Joseph’s Regional Medical Center in Paterson, New Jersey, opened its region’s first standalone Geriatric Emergency Center, also known as the senior ED (SrED). Treating patients age 65 and older, this new 14-bed SrED focuses on treating highly functional patients who do not require stabilization.
All patients are triaged in the adult emergency department and are transferred to the SrED if they meet the designated criteria. The unit is separated from the adult ED and staffed by specially trained and board-certified emergency physicians and nurses, and supported by other healthcare professionals—such as clinical pharmacists and case managers—who are trained in geriatric emergency medicine.
According to Dr. Mark Rosenberg, chairman of emergency services at St. Joseph’s, the hospital’s geriatric emergency program is built on eight basic tenants:
- Physical plant—creating a better facility for the most frail, which ultimately enhances the ED environment for all patients.
- Quality initiatives—being more comprehensive about dealing with the root cause of falls, carefully evaluating drug interactions, etc.
- Educating staff—retraining the emergency services staff to understand and respond to the special needs of the elderly.
- Operational enhancements—making next-day calls to all seniors who leave the ED to ensure they are getting the necessary follow-up care.
- Coordination of hospital resources—taking steps to ensure all the resources of the hospital are made available to elderly ED patients.
- Coordination with the community—interacting with local senior agencies to bring additional outside resources into the picture.
- Emergency services staff enhancements—adding a geriatric program coordinator to manage the overall effort.
- Patient satisfaction—taking whatever steps are necessary to ensure that geriatric patients are satisfied with the level of care.
“The success of St. Joseph’s SrED is evident by improved patient and family satisfaction, fewer readmissions, and better clinical outcomes,” Rosenberg says. “There is a real push nationwide to open new geriatric emergency departments, with as many as 50 being developed across the country. I think that within the next five years, we will see every major hospital establishing a geriatric ED.”
The Methodist Medical Center in Peoria, Illinois, has taken a somewhat different approach to accommodating the growing number of seniors visiting its emergency department. Since March 2011, it has offered five rooms in its existing emergency department designed especially for senior citizens.
Buttons on the phones are bigger, the television is closer, and there are speakers next to the pillows. Senior patients are also visited by a social worker to talk about programs in the community that can assist them after they get back into their own homes.