Elderly Get ER Care Without Chaos

Number of geriatric units may grow as nation ages.

Mary Jo Layton

McClatchy Tribune

April 8, 2010


HACKENSACK, N.J. - St. Joseph's Regional Medical Center in Paterson, N.J., has become one of the first hospitals in the nation to open a geriatric emergency department to treat the growing elderly population.

Doctors and nurses with geriatrics training care for seniors in the specialized 16-bed unit three floors from the tumult of the emergency room.

Besides the more peaceful environment, there are many extras: Mattresses are twice the thickness of regular hospital bedding to prevent pressure injuries. A pharmacist reviews all medications to ensure the multiple medications seniors are often prescribed don't interact. Within 24 hours of discharge, staff contacts seniors to evaluate them. If a return visit is needed, it's scheduled so there's no wait.

"It's a great idea," said Aline M. Holmes, senior vice president of clinical affairs for the New Jersey Hospital Association. "It's a concept that will grow."

More hospitals across the country are expected to offer geriatric emergency departments as the nation's 76 million baby boomers reach their senior years - the oldest turn 65 next year - a demographic surge that will double the number of elderly by 2030.

The first geriatric ER opened last year at Holy Cross Hospital in Silver Spring, Md. Now a chain of seven hospitals in Michigan is considering opening specialized units for the emergency needs of elderly patients. Dr. Mark Rosenberg, chairman of emergency services at St. Joseph's, said he has fielded calls from two dozen hospitals around the country who are interested in creating their own geriatric emergency rooms.

Rosenberg said he saw the need for specialized care for seniors because "there's a tendency to be overwhelmed with the chaos of the emergency department."

In the past two decades, hospitals have established separate areas for treating children to keep them away from the drama of the emergency room. Some, like Hackensack University Medical Center, have separate buildings for their pediatric ER, where children are put at ease in kid-friendly rooms.


Medical experts are now reexamining how seniors fare in a traditional emergency room - and finding how wrong it can be.

"If you're going to design an environment that is the exact opposite of what older people need when they're receiving care, that would be the emergency room of today," said Dr. Bill Thomas, a geriatrician who designed the geriatric ER in Maryland.

Lighting is too glaring, shiny floors can appear as if they're wet and slippery, and walls and trim with little contrast can be disorienting, Thomas said.

Thomas also sees a culture clash in the needs of elderly patients and the rhythm of an emergency room.

"In emergency rooms, it's all about excitement and shock and technology," Thomas said. "Taking care of older people isn't like that. It's about careful deliberation and slower pacing."

In a geriatric ER, what's equally important is what patients can't see: Nurses and physicians trained in geriatrics, who have learned techniques for communicating with patients whose hearing may be impaired or who process information slowly. For every patient on five medications or more, a pharmacist reviews medications to assess drug interactions.

"If you're on five medications, 70 percent of the time you have a drug interaction," Rosenberg said.

The follow-up call is vital.

A "staggering" 40 percent of patients 65 and older have functional decline after an emergency room visit, Rosenberg said.

Patients may have difficulty using crutches. New medications may cause reactions that make them dizzy or nauseous and keep them from eating.

In one instance, an elderly woman treated for dizziness was released after an EKG and other tests revealed no abnormalities. The next day, when a nurse called and went through a detailed questionnaire, the woman said she was still dizzy. She returned to the ER, where a second EKG was different. The patient underwent angioplasty and had a stent inserted to keep her heart artery open.

"That would have been picked up eventually, but how many more visits would it have taken?" Rosenberg said.


In an era when hospitals are suffering from shrinking reimbursements and growing ranks of uninsured patients, the relatively minor cost to create a geriatric unit is appealing. Holy Cross spent about $150,000 to renovate an area for the specialized care. St. Joseph's already had the space and spent just $3,200 for the specialized mattresses, officials said.

The geriatric ER unit frees up beds in the busy regular emergency department. And by getting the right care to geriatric patients, it cuts down on the repeat visits that increase the nation's Medicare costs.

"It benefits the hospital and it benefits the community and probably the entire country," Rosenberg said.