A new study published in the Annals of Emergency Medicine has shown that six months after visiting the emergency room (ER), seniors were 14% more likely to have acquired a disability (an inability to independently bathe, dress, climb down a flight of stairs, shop, manage finances or carry a package, for instance) than older adults of the same age, with a similar illness, who did not end up in the ER.
The older adults were not admitted to the hospital from the ER. Illnesses or injuries that lead to ER visits can initiate a fairly vulnerable period of time for older persons. The researchers found sharp declines in older adults' life-space mobility (the extent to which they get up and about and out of the house) after ER visit, which lasted for at least a year without full recovery.
Other research suggests that seniors who are struggling with self-care or with activities such as cooking, cleaning and managing medications are especially vulnerable to the aftereffects of an ER visit. Seniors who fall and injure themselves a leading cause of ER visits may become afraid of falling again and limit their activities, leading to deterioration.
Underlying vulnerabilities that led to an ER visit may go undetected and unaddressed by emergency room staff, leaving older adults susceptible to the ongoing impact of these conditions. In response to concerns about the care older adults are receiving, the field of emergency medicine has endorsed guidelines designed to make ERs more senior-friendly.
The guidelines call for educating medical staff in the principles and practice of geriatric care; assessing seniors to determine their degree of risk; screening older adults deemed at risk for cognitive concerns, falls and functional limitations; performing a comprehensive medication review; making referrals to community resources such as Meals on Wheels; and supplying an easily understood discharge plan.
The American College of Emergency Physicians (ACEP) is launching an accreditation program for emergency rooms, certifying at least a minimal level of geriatric competence — another effort to improve care and outcomes for older adults. Three levels of accreditation — basic, intermediate and advanced — will be offered.
For each of these levels, ERs will be required to provide walkers, canes, food and drink, and reading glasses to older patients. For intermediate and advanced accreditation, physicians will have to oversee improvement initiatives, such as limiting the use of urinary catheters in older patients. Also, changes in the ER environment such as non-slip floors and enhanced lighting will be required, along with amenities such as hearing devices, thicker mattresses and warm blankets.
Dr. Kevin Biese, chair of the board of governors for ACEP's geriatric ER accreditation initiative, offers some recommendations such as escape the crowd, supply a full list of medications, focus on comfort, educate yourself, communicate effectively, follow through, and keep tabs on your loved one. In conclusion, the study researchers have revealed that older persons’ journey to the emergency room (ER) often signals a serious health challenge and should serve as a wake-up call for caregivers and relatives.