In 2005, when physician Kevin Biese was a medical resident in Boston, a 92-year-old woman with a urinary tract infection arrived by ambulance at a hospital emergency room. Her behavior — confusion and lethargy — suggested she also was suffering from hypoactive delirium, a cognitive disorder.
She was alone, without family or friends. The doctors decided to admit her, but a bed wasn’t yet available. So she had to wait. “She spent 24 hours on a cot in the hallway,” Biese recalls. “She came in during the day on a Thursday and was still there Friday morning. I got mad.”
The emergency care system should “not allow that to happen to those who deserve the most respect in our society,” he says.
Nobody enjoys a trip to the ER. But it can be especially difficult — sometimes even dangerous — for the elderly. Many emergency health-care settings are frenzied and noisy, with glaring lights and slippery floors, often without handrails. Cots and gurneys are hard on fragile bodies. Privacy is scarce.
“The emergency department is not a great place to hang out for anyone, but it can be especially tough if you are older,” says Denise Nassisi, director of the geriatric emergency department at the Mount Sinai Hospital in New York. “Many older patients are frail and have difficulty getting up and down from a gurney, or getting to a restroom. Some have cognitive dysfunction and don’t know their medical history. Some may have impaired vision or hearing. A crowded chaotic environment is not the best for them.”
In recent years, recognition has been growing that older patients need a better ER environment and specialized care than the rest of the population. This has prompted many hospitals to introduce structural changes and new procedures to make their ERs age-friendly. The American College of Emergency Physicians launched an accreditation program last spring for the nation’s emergency departments to encourage them to adopt a more comprehensive and standardized approach for geriatric patients.
The percentage of Americans 65 or older is growing. It was 14 percent in 2012 and is projected to be 20 percent by 2030, according to the Centers for Disease Control and Prevention. About 49.2 million older adults live in the United States today, according to the American Geriatrics Society.