The substantial growth of elderly adults in the United States leads to more emergency room visits and complications from injuries and diseases. To meet this challenge, the Geriatric Emergency Department Guidelines were published in 2014 and later received support from several large medical organizations including Emergency Nurses Association and the American Geriatrics Society.
The guidelines characterize the nuanced needs of older emergency department patients and current best practices to promote more cost-effective and patient-focused care. These recommendations require more staff as well as more resources.
What Researchers Discovered
Unfortunately, researchers at At Schmidt College of Medicine in Florida have found that most emergency departments in the United States do not provide an adequate level of service as suggested by the guidelines. As a result, for many departments, the guidelines are aspirational. The college has even published a recent article in the Journal of Emergency Medicine following a panel discussion about emergency medicine that was held at the 2021 Scientific Assembly held by the American Academy of Emergency Medicine. The authors who wrote the article reviewed three clinical conditions at emergency rooms including falls, delirium, and polypharmacy to emphasize guidelines recommendations as well as challenges and propose realistically achievable expectations.
Cases Involving Delirium
Additionally, the authors clarify that delirium is the most commonly overlooked symptom in elderly adults who visit emergency rooms. The authors also point out that assessment of how to prevent falls is rarely performed and polypharmacy is a widespread problem.
The guidelines make certain recommendations about evaluation protocols, staff education, how emergency departments are structured, how quality improvements should be measured, and how to achieve optimal staffing. The recommendations are substantial and most emergency departments both before guidelines and after had neither the resources nor the staff to offer these additional services.
The authors clarify that approximately 10 percent of elderly adults in emergency departments display delirium, but delirium is only recognized in a third of these cases. The guidelines provide recommendations on how to increase the number of cases where delirium is recognized. Screening now requires dedicated medical professionals to perform assessments.
Common Reasons Why Elderly Adults Visit Nursing Homes
A third of elderly adults endure falls each year. Unintentional injuries are the sixth most common cause of fatalities among elderly adults and falls are the most common cause of fatalities. Following falls, elderly adults in emergency rooms have approximately 30 percent increased risk of a decline in their functions. Elderly adults also face an increased risk of depression at six months following the event. As a result, the guidelines recommend a detailed approach to addressing falls. Even though geriatric guidelines review best practices when falls are involved, these guidelines are often not completed in emergency room visits.
Furthermore, geriatric patients have more illnesses and are prescribed more medications. A third of prescriptions are written for people in this age group.