Geriatric Emergency Medicine

The emergency department (ED) is commonly the point of entry to the medical system for older adults, who present with a wide variety of problems. Although the ED is generally thought of as a location for the diagnosis and treatment of acute medical and surgical emergencies, it may also be the access point for older adults with chronic conditions or social and psychiatric problems. For younger adults with single, acute problems, an emergency care model that incorporates history, physical examination, diagnostic testing, diagnosis, treatment, and disposition may be appropriate. However, there may be pitfalls when this approach is applied in the ED to older patients. 1 Older patients may present with vague symptoms or with atypical symptoms of serious disease, which could consequently go undetected. Cognitive impairment, common in older patients, may also go undetected. Comorbidities and polypharmacy are also common and may directly or indirectly affect the older patient’s care. The ED may be a presenting location for an elderly patient with functional decline, or the acute illness or injury that provoked the ED visit may result in a decrease in his or her functional abilities. Additionally, treatment may affect the ability of the older patient to live independently; for example, immobilization of an extremity may impact the patient’s ability to perform basic activities of daily living (ADLs). These factors have led to the development of a geriatric emergency care model that differs from the standard emergency care model. The geriatric model emphasizes the consideration of older ED patients as a special population, analogous to pediatric patients. Emergency physicians should include biologic, psychologic, and social factors in the evaluation of the older ED patient. 2 This chapter reviews the emergency medicine literature to characterize its state of development and to identify important research questions. The goal of research in the emergency care of older patients is to improve patient care through optimum medical management. Other goals include the prevention of disease and injury and the maintenance of physical, social, and emotional functioning. The standard sequence of research leading to these outcomes is descriptive studies, followed by analytic studies and finally by interventional studies. The latter include studies of diagnostic testing, treatments, and outcomes. This scheme is used to classify the stage of existing research in geriatric emergency care and identify areas for future research. This review focuses on ED conditions that practicing physicians and leaders in the field have identified as leading problems.