Geriatric Emergency Care – An Evolution
The Geriatric Emergency Department (GED) movement is growing rapidly, reflecting a significant shift in how we care for older adults in emergency settings. There are now more than 500 accredited geriatric emergency departments through the Geriatric Emergency Department Accreditation (GEDA) program, and over 150 hospitals participating in the Geriatric Emergency Department Collaborative (GEDC). These numbers highlight the broad adoption of geriatric-specific care principles, which are reshaping the way emergency departments approach the unique needs of aging populations.
A key development in the evolution of geriatric care is the implementation of the CMS Age-Friendly Hospital Measure(link). This measure underscores the growing recognition of age-friendly principles in healthcare systems and holds hospitals accountable for delivering care that is in line with the specific needs of older adults. It looks at 5 important domains in geriatric care: eliciting patient healthcare goals; responsible medication management; frailty screening and intervention; social vulnerability; and age-friendly care leadership. The CMS Age-Friendly Hospital Measure supports the ongoing efforts of GEDA and GEDC by encouraging hospitals across the country to embed these critical principles into their emergency departments and beyond, ultimately setting a higher standard for the care of older adults in acute settings.
Equity in Geriatric Emergency Medicine
As we continue to expand the reach and important work of geriatric emergency departments, it is essential to ensure that the distribution of improved care processes is equitable. In many hospitals, geriatric ED care interventions – such as delirium screening or physical therapy consults – are voluntary and often implemented selectively by ED teams. This raises a real concern: healthcare teams may unintentionally direct more intensive, communication-dependent care toward patients who speak the same language as the care team or face fewer social and economic barriers. Moreover, enhanced care processes often require post-discharge instructions, care transitions, follow-up, and support at home, which may be more accessible for certain populations than others.
So how can GEDs address this issue? First, they must discover where their bias lies. GEDs can track the implementation of these care processes across different populations to discover where health equity issues might exist using the electronic medical record (EMR). The patients receiving geriatric ED interventions should reflect the diversity of the ED population. For example, if 30% of the older adults in an ED are Spanish-speaking, 30% of those benefiting from geriatric care processes should also be Spanish-speaking. Emergency departments can also take steps to educate staff on internal bias and health equity issues by participating in workshops, online training, and more.
It is also important that diverse older adults are included in the research that evaluates the impacts of these interventions. Recently a team of researchers led by Dr. Michelle I. Suh focused on strategies for including diverse older adults in emergency medicine research. The team aimed to address the underrepresentation of marginalized groups, in clinical studies. They highlighted several key challenges, including language barriers, socioeconomic disadvantages, and the exclusion of older adults with cognitive impairments. To overcome these issues, they recommended strategies such as using lower age thresholds for inclusion, providing language interpretation services, simplifying consent processes, and adapting research designs to account for diverse abilities. They emphasized the importance of fostering diversity in research teams and ensuring equity in research budgets.
Health Equity in Action: ENA 2024
A prime example of dedicated professionals actively collaborating and planning to enact these principles was seen recently at the 2024 Emergency Nursing Association (ENA) conference. An interprofessional team of nurses and physicians presented an informative and thought-provoking workshop called ‘Are Your Blind Spots Negatively Impacting Older Adult Care?’ to 175 emergency nurses. The workshop explored the principles of diversity, equity, inclusion, and ageism to help reduce the bias experienced by patients and, in turn, influence the best patient care. It’s significant to note that the important topic drew a crowd of front-line ED professionals that exceeded the capacity of the conference room – clearly, these nurses understand the importance of health equity in their practice. And even more significant was the approach of the team of physicians and nurses leading the workshop, who represented multiple professional organizations, over multiple years, tackling the needs of vulnerable older adults in the emergency department.
The ENA Geriatric Committee Chair hosted a team of physicians and nurses from ACEP, SAEM, AGS, GEDC, and GEDA to plan this event, but also how to coordinate efforts moving forward to continue the momentum.