Good communication with older adults and their caregivers in the Emergency Department (ED) is important in delivering high-quality care. Effective, empathetic communication improves patient and family coping skills and creates a care plan that is consistent with the patient’s goals. It also improves the important metrics of patient satisfaction, patient safety, health outcomes, and cost of care.
ED clinicians play a crucial role in our health system for older adults with serious illness. In the US, 75% of older adults have at least one ED visit in the last six months of life, and 50% in the last month. Care plans created in the ED set the trajectory for the site and intensity of subsequent care.

Communication in the ED is challenging, and there is a gap between what providers say and what patients hear. It is often more difficult with older patients due to vision/hearing issues, cognitive impairment, and the inherently complex, multifactorial nature of their presentations. Clear, caring communication in the ED may be considered a procedure and, like any emergent procedure, is improved with training and repetition.

The Center for Medicare and Medicaid Services measures the quality of care at hospitals and emergency departments in part by asking patients to rate provider communication. For older adults with serious illness, caregiver communication is equally important, as caregivers may complete satisfaction surveys. For ED providers facing ongoing productivity and throughput pressure, increasing administrative focus on patient satisfaction and communication may be unwelcome. Here are some practical suggestions to efficiently improve communication with older adults, while also augmenting quality and goal-concordance.