The emergency department (ED) plays a unique and essential role in the care of the older adult. The ED is open 24 hours a day, seven days a week, 365 days a year. It provides access to the millions of people who have no other entry point for health care. It gives care to people who have no established community provider and acts as the gatekeeper between the community and the hospital.
The prevailing model of care in EDs has been established for over 40 years but does not conform well to the needs of the older adult. Based on principles proposed in 1962 by the Committee on Trauma of the American College of Surgeons (ACS), EDs are designed for rapid evaluation and treatment of the emergent and urgent needs of acutely ill and injured patients. ED care differs from care delivered in other settings. Typically, there is no preexisting relationship between the patient and the physician. The process rewards speed, the timeframe is immediate, and the focus is on the patient's complaint. It is not friendly to the older patient with complex needs who require thorough assessment and evaluation and whose care process is slow-moving.
In the 1990s, the Society for Academic Emergency Medicine (SAEM) Geriatric Task Force proposed a model of emergency care for older patients (Table 18-1). The model appreciates differences in disorders and diagnoses by age, atypical presentation of disease, altered physiology of aging, the complexity of diagnosis, and management of older patients, and the need to consider other issues beyond the presenting complaint. The Geriatric Task Force recognized that symptoms may be nonspecific, comorbidities are common, and response to therapy is often difficult to predict. The Task Force proposed a biopsychosocial model of emergency care for older patients. The model has evolved over time and reflects the current thinking about basic principles for emergency care of the older patient.
Table 18-1 Geriatric Emergency Care Model Developed by the Saem Geriatrics Task Force |Favorite Table|Download (.pdf)
Table 18-1 Geriatric Emergency Care Model Developed by the Saem Geriatrics Task Force
- The patient's presentation is frequently complex.
- Common diseases may present atypically.
- Comorbid conditions must be considered.
- Polypharmacy is common and may be a factor in presentation, diagnosis, and management.
- Cognitive impairment is possible and mental status should be evaluated.
- Standard values for diagnostic tests may not be applicable.
- With age comes decreased functional reserve and this must be anticipated.
- Social support systems are important in care of older patients and should be considered in planning for care.
- Knowledge of baseline functional status is essential in evaluating new complaints.
- Medical problems must be evaluated for psychosocial adjustment.
- The encounter is an opportunity to assess important conditions in the patient's personal life.
The ED plays a crucial role in care for seniors. Older people use the ED at higher rates than other populations, present ...