Can an Emergency Department Adequately Address an Older Adult who has Complex Needs?

Abstract

Older adults account for a considerable percentage of all emergency departments (ED) patient encounters. Those with very complex needs or multiple co-morbid conditions often have lengthy ED evaluations culminating in admission, many of which are considered potentially avoidable. Provider and process elements can evolve to create efficient and more comprehensive geriatric assessments in ED. This paper describes an older adult with acute on chronic symptoms admitted through the ED to the Acute Care for Elders (ACE) inpatient unit. We illustrate how elements of the ACE model, when applied in the ED, may avoid hospitalization. We review the Domain Management Model as a useful technique for ED-based assessment of older adults with complex medical, functional, and social needs. Finally, we consider geriatric screening tools to promote broad evaluation and safer transitions of care for older adults.