Excellent emergency care does not happen by chance. The standard emergency approach that excels in the young, fails in older patients. Older adults experience unnecessary morbidity and excess mortality in our emergency departments. This article describes the pursuit of excellent emergency care in the historically challenging older adult population. A pivotal point occurred once emergency physicians recognized older patients as a distinct population in need of unique evaluation and treatment.

In the early 1990s, a group of geriatricians, philanthropists, and emergency physicians joined forces to improve older patient care. Geriatric Emergency Medicine (GEM) emerged as a subspecialty as these individuals systematically identified its distinctive knowledge, skills, competencies, literature, champions, research, fellowship programs, service lines, staffing, accredited geriatric emergency departments, and now its own journal. Early GEM advocates recognized that a legion of older patients would overwhelm providers lacking the training and resources to deliver adequate care for the aging population. They created education and grant programs, developed leaders, and overcame barriers of ageism, ignorance, and indifference. A review of this progress can inform new strategies and innovations providing a future of excellence in the emergency care of older adults.