Patients older than age 65 constitute the most rapidly growing demographic segment of the US population. As the first Baby Boomers reached age 65 (in 2011), the tsunami of geriatric patients began entering the doors of emergency departments (EDs) in record numbers. The ED is a primary entry point to the healthcare system, particularly for seniors. Chronic illness, multiple comorbid conditions, and social or psychiatric problems are a few reasons that older adults utilize emergency services at a greater rate than younger patients. ED visits for the older adult has grown faster than any other age group.1 According to the Centers for Disease Control, in 2008, over 123 million people were seen in an ED.2 In 2005, geriatric patients comprised 15.5% of the emergency center population, with the majority age 75 and older.3
Over the past decade the demand for emergency services has continued to rise, while the number of EDs has declined.4 The current environment of care creates hurried assessments in overcrowded EDs with long wait times, a dangerous combination for an older adult. As the geriatric patient ages, sensory and physiologic changes occur that results in an atypical medical presentation of acute illness. Because of these differences and their implications for patient safety in the geriatric population, some emergency physician groups have developed specific risk reduction guidelines for the care of the geriatric patient (see Appendix 53-1 at the end of this chapter).
The rapid pace of triage and the need to obtain a quick history of present illness in the ED are not conducive to evaluating an older adult who may present with sensory losses, slower response times, complex medical and surgical histories, multiple medications as well as functional and cognitive impairments. When older adults present to an ED, they are more acutely ill, require longer lengths of stay, are more likely to be admitted to the hospital or have repeat ED visits, and experience more negative health outcomes.5-6
The need for specialized care has been recognized in the literature for several years7-8 and as is often quoted “ED care is not designed for older people.”9 The creation of the nation's first Seniors Emergency Center (SEC) was fully operationalized in 2008 when Holy Cross Hospital, a large not-for-profit, faith-based community and teaching hospital in suburban Washington DC opened their dedicated 8-bed Seniors Emergency Center.
The model of specialized ED care such as pediatrics has been in existence for over 30 years. The distinctive needs of the pediatric population require specialized environment, protocols, medications, and equipment to provide the best evidence-based care. Just as children are not “little adults,” geriatric patients are a unique population that exhibit different signs and symptoms of illness compared to younger adults. In addition to the physiologic effects on elderly patients' presentations (of acute medical and surgical emergencies), other concerns are the
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