According to this study, researcher evaluation and their observation on emergency department. When 86-year-old Carol Wittwer took a taxi to the emergency room, she expected to be admitted to the hospital. She didn't anticipate being asked if she cooks for herself. A type of confusion called delirium for the geriatrics-trained nurse who was posing the questions in a special wing of Northwestern Memorial Hospital's emergency department.

Wittwer's care is part of a new approach to older patients as U.S. emergency rooms adapt to serve the complex needs of a graying population. That means asking more questions, asking them earlier and, when possible, avoiding a hospital stay for many older patients. Hospitals can make older patients sicker. More than 30 percent of older adults go home from a hospital stay with a minor or major health problem they picked up at the hospital.

"The doctors are not comfortable sending you home unless you're safe," said Northwestern Medicine's Dwayne Dobschuetz, a nurse practitioner who started making house calls by bicycle a year ago for the health system's geriatrics department. "It's easier to admit older patients than to send them home." "The emergency department is not designed with older adults in mind," said Dr. Scott Dresden, who heads the Geriatric Emergency Department Innovations program at Northwestern.

"You've got really thin stretchers. You've got patients in the hallway. There's mechanical noise all around." Early research at Northwestern and other hospitals shows care from geriatrics-trained nurses in the ER can reduce the chances of a hospital stay after a patient's emergency visit and for a month afterward. About 100 hospitals in the United States have opened geriatric emergency departments or trained ER teams in geriatrics care.

These teams can arrange home services such as light housekeeping or a break for a caregiver. In June, for instance, a man in his 90s arrived at the emergency department at University of California, San Diego's La Jolla medical campus. His left arm and shoulder hurt. He couldn't stand because of weakness and pain in his left foot.

This kind of emergency medicine is only about a decade old. An influential 2007 article described the emergency department of the future, designed to prevent confusion and falls in the elderly and to increase their comfort With Medicare penalizing health care systems for unneeded care, hospitals have financial incentives to change. Older adults in the emergency room use more resources and are admitted to the hospital more frequently than other age groups.

In Northwestern, regularly works beyond the scope of a traditional emergency department. Author concludes that the Northwestern ER patient might have been admitted to the hospital before the GEDI program. Instead, the team set her up with home visits from a nurse and a physical therapist.