Are geriatric ERs necessary to improve the care of seniors?

January 12th, 2015

As a journalist, I’ve always found it’s good to be cautious of trend pieces. Too often, they’re based on only a couple of data points, or the barest of anecdotal evidence, or the vivid imagination of a writer hard up against a deadline.

So when the New York Times ran a piece the other day about the increasing proliferation of geriatric emergency rooms, I was — and remain — a little skeptical.

Certainly a strong case can be made for treating seniors differently. An NPR article from 2009 cites an excellent point made by Bill Thomas, who helped design the geriatric ER at Holy Cross Hospital in Silver Springs, MD: “[T]raditional emergency rooms were set up to be good at treating trauma and to treat it quickly. But most problems that bring older people to the ER are related to chronic disease and treating those problems takes time.”

Truth be told, traditional EDs may not be doing the best job possible at even identifying the problems of older patients. A recent study in Annals of Emergency Medicine concluded that patients aged 65 or older are “at risk for undertriage,” mainly because of “neglect of high-risk situations and failure to appropriately interpret vital signs.”

Surely some of these problems could be ameliorated by having a separate department staffed with geriatricians and maybe even a geriatric social worker with specific experience in dealing with older patients.

But at what cost?

The final paragraph of the NPR piece noted that Holy Cross’s impressive geriatric ER was made possible by the fact that the hospital had surplus space next to its main emergency department and that the hospital foundation allocated $150,000 for its construction.

Not everybody has the room or the money to follow the lead of a Holy Cross or a Mount Sinai Hospital (the main example in the New York Times article). And it strikes me as a fair criticism that any of the upgrades bestowed on a geriatric ER should accrue to the regular ER as well — a typical example being the use of thicker mattresses to prevent bedsores.

We all know the population is aging. Even now, according to the NYT, 15-20% of emergency room patients are over 65, and those numbers aren’t going down anytime soon. The American College of Emergency Physicians has taken note, setting up a section on geriatric care.

So I don’t actually dispute that there’s a trend here — but does the trend really involve separating seniors out from the general ED population and giving them a room of their own? Given the financial straits most hospitals face these days, I have my doubts.