Recent increases in Emergency Department (ED) volumes in most parts of America have resulted in long waiting room times, longer times receiving care in the ED, crowding in the waiting room and in the ED site, and longer times waiting for a hospital bed. In a rural community Emergency Department that had 15,000 encounters (all ages) from 10/2020 to 9/2021 there were 4674 encounters in those over the age of 65 (30.7%), and of those, 116 became boarders (waiting for a hospital bed). 45% of all boarders in this hospital Emergency Department are older adults (> 65 years old). (These statistics were obtained from administrative data from personal communication from Aaron Malsch, Advocate Aurora Health Care 12/2/2021.)

The ED rooms may be used for those who await Intensive Care Unit beds, hence may not be available for others. The hallway is used “to keep an eye on the older adults” while they await transfer to the general medical floor of the hospital. Some older adults may spend long periods in this setting. Older patients who are vulnerable may develop delirium during their care in the emergency department.¹ The chaotic setting of ED hallways can create an environment that is particularly difficult to provide care and may pose further risk for delirium.^2,3 For patients with cognitive impairment, the ED can be a disorienting experience which can lead to behavioral and psychological symptoms in response to stressors.

Several principles of care for older adults during disasters may be relevant to this situation.^4,5 The American Red Cross developed a White Paper which highlighted key principles on the care of vulnerable older adults during particularly distressing times or disasters. Many of the concepts apply to the context of care for older adults in the hallway of an ED.