Quality of Emergency Department Care for Elderly

Abstract

With the aging of the population and the demographic shift of elderly in the healthcare system, the emergency departments will be increasingly challenged with complexities of providing care to geriatric patients. Major consumers of emergency health care in the U.S. hospitals are over 65 years old [1]. In 2009, 25% of adults aged 65 years or older had at least one emergency department visit in the past year, and 8% had multiple visits [1]. Rate of emergency room visits by the elderly grew 34 percent during the decade 1993 to 2006, faster than any other group [2]. Projections are that if this trend continues, visits by the elderly could nearly double by 2013 to 11.7 million, up from 6.4 million in 2003 [2]. Another dimension to the emergency department care is the presence of racial differences in usage. Visits for black elderly during the 10-year time period studied increased 93 percent to 77 visits per 100 population whereas the increase was just 26 percent for whites, or 36 visits per 100 population. The rapid increase in emergency department visits by the elderly is fueling fears that demand by the elderly will overwhelm an overcrowded system that is already on the verge of collapse. While reasons for the higher demand are less clear, they may include more elderly surviving with chronic medical issues, as well as problems in accessing primary care doctors. Elderly typically present with complex medical conditions, stay longer for more-extensive diagnostic testing and treatment regimens, and have special needs during their visit. Currently, the physical design and care rendered to the elderly is not aligned with their special needs. Rapid triage and diagnosis may not be feasible in the elderly with multiple comorbidities, polypharmacy, functional and cognitive impairments and presenting with atypical clinical signs and symptoms.