Doctors, nurses, and physician's assistants focused on managing the treatment of the constant stream of sick and injured people entering emergency room doors have neither the time nor the resources to handle the specific needs of older patients.
A Need for Change
Some institutions have recognized that, when it comes to emergency health care for the elderly, the status quo is no longer sufficient.
One of these institutions, Holy Cross Hospital of Silver Spring, Maryland, a member of the Trinity Health Care system, was the first hospital to implement a senior ER back in 2008.
Dr. William Thomas, a world-renowned geriatrician and professor who pioneered the concept of patient-centered care at nursing homes, spoke with AgingCare about the creation of the nation's first-ever elder-focused emergency room. "If you were to read the literature that's out there on what is good for emergency elder care, and then do the opposite, you would get the modern emergency room," he says.
He recounts how the push for a senior ER began when a Trinity Heath hospital CEO took an elderly relative to the emergency room. Witnessing the chaos that ensued, he knew things had to change.
A team of seniors, and experts, including Dr. Thomas and some of his colleagues from the Erickson School of Aging at the University of Maryland, Baltimore County, was assembled and tasked with discovering how to improve upon the current ER model of elder care. The result: the nation's first-ever senior ER.
Patient-Focused Process
The admissions process of a senior emergency room mostly mimics that of a normal ER. Elderly patients are triaged according to the severity of their health problem, after which around 75% of seniors will qualify for admittance into the elder-focused ER.
Once in the geriatric wing of the emergency room, a nurse specially-trained in senior health issues and care will assess the elderly person, determining the status of their mental and physical functioning. Working in tandem with the nurse are a geriatric social worker and a pharmacist. This team collaborates and decides on treatment and care options for the senior based on a comprehensive assessment of their entire mind-body condition.
Instead of focusing solely on the health problem that is immediately obvious, the staff of a senior emergency room works together to provide a more holistic approach to care with the hopes that it will prevent an elderly person from having to make repeat visits to the hospital.
Physical Changes
Aging alters symptoms and amplifies confusion.
Bearing this in mind, senior emergency rooms are designed to be as calming and comfortable as possible to the elderly, and to minimize their risk for injury.
Physically, senior emergency rooms offer:
- Floors with more traction and less glare
- Lighting that is gentler on elderly eyes
- Reclining chairs and mattresses designed to lessen pressure
- Personal rooms for patients
- Telephones, clocks and documents with larger print
- Blankets warmed in special ovens
- Machines that aid in hearing and communication between patient and health care professional
Bright Future for Specialized ERs
Senior emergency rooms are a burgeoning trend. There are approximately 15 elder-focused emergency rooms currently in operation around the country—with many more planning to open in the coming years.
Dr. Thomas is hopeful that more hospitals will begin adopting the trend. But, for those that may not have the resources, he suggests simply investing in more geriatric-specific training for emergency room staff to improve care for the elderly.
Though it's still early in the game, evidence is indicating that specialized emergency rooms are cutting down on unnecessary repeat hospital visits by seniors as well as increased family and patient satisfaction.
Caregiver Emergency Room Recommendations
Whether you are taking an elder to a senior ER or a regular emergency room, Dr. Thomas says there are a few things every caregiver can do to ensure that their loved one gets the care they need:
- Be clear with emergency room staff—tell them that your loved one has special needs.
- Inter-departmental patient transfer can be extremely stressful for an older person and this is often the time when serious problems can occur. Ask the staff to be especially careful when they move an elder from one department to another.
- Make sure that you have an up-to-date, comprehensive list of all the medications an elder is taking. Take an inventory before an emergency happens.
- Dr. Thomas cautions against believing the myth that all doctors have ready access to a patient's entire medical record. Especially in an emergency situation, there may not be time to compile the information, so it is essential to be prepared.