Emergency Rooms for the Elderly
March 18, 2011
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A recent Associated Press article describes a new trend in care for seniors; several hospitals are opening emergency rooms for the elderly. “Older people are not just wrinkly adults. They have totally different needs,” says David John, M.D., who runs the geriatric medicine division of the American College of Emergency Physicians.
The concept behind the senior ER is to place older patients in a calmer area not only to treat the problem that brought the person to the hospital, but also to discover any underlying problems. These problems include dementia, depression, and susceptibility to falls. Mark Rosenberg, M.D., emergency medicine chairman at St. Joseph’s Regional Medical Center in Paterson, New Jersey, says that his center makes day-after-discharge calls to see how the patient is doing. He has documented a large drop in the number of patients who make return visits since instituting the calls. St. Joseph’s has a 14-bed Senior Emergency Center, and it plans to open a larger one in the fall.
The first ER for seniors opened in Silver Spring, Maryland, in 2008. Trinity Health of Novi, Michigan, operates this ER, as well as eight others in Michigan. They plan to open two more in Iowa, followed by more in other states. Seniors still go through the main ER, where they are assessed to see if they have a life-threatening condition. If so, they will remain in the main ER. If not, the seniors have the option to go to the new special zone. There are doors instead of curtains to separate beds; this decreases the noise in the area and can help reduce anxiety and confusion. In some facilities, mattresses are thicker, and patients can wait in reclining chairs instead of lying flat, and the floors have nonskid surfaces to help prevent falls. The patient forms are printed in larger type to make them easier to read; this helps patients read their care instructions when they go home. While the seniors are in the ER, pharmacists check automatically to see if the patient’s routine medications could cause dangerous interactions. If other resources are needed, such as Meals on Wheels, then a geriatric social worker is available to arrange for those resources.
Michelle Moccia, who heads the senior ER at Trinity’s St. Mary Mercy Hospital in Livonia, Michigan, says that the biggest change as a result of the senior ER concept is that physicians and nurses are trained to dig deeper into the patients’ lives. Ms. Moccia says, “It’s a very nurturing environment.” While the patient is waiting for test results or treatment, the patient is checked for signs of dementia, depression or delirium. Dr. Rosenberg says that it doesn’t necessarily require opening a separate ER to improve care for older patients; better geriatric awareness is the key. It may take lengthy detective work to unravel the various ailments that send seniors to the ER. Older patients may not have the same symptoms as younger people. For example, a senior may be less likely to complain of vague symptoms such as dizziness or nausea, rather than chest pain, when they are experiencing a heart attack. Confusion may be caused by a urinary tract infection and could be mistaken for dementia. Seniors with cognitive impairment may not be able to accurately describe their symptoms or understand what they are supposed to do when they go home from the hospital.
Seniors make 17 million ER visits a year. With 1 in 5 Americans being age 65 years or older by 2030, the senior ER concept is likely to continue to grow, if hospitals have the money and space to accommodate them.
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