Emergency departments do not provide the level of care recommended by Geriatric Emergency Department (GED) guidelines, according to a new study published in the Journal of Emergency Medicine.
At the American Academy of Emergency Medicine's Scientific Assembly in 2021, a panel of emergency physicians and geriatricians discussed the GED guidelines and EDs' current ability to provide evidence-based care for patients. The study is a synthesis of the panel's presentation and discussion.
In the analysis, researchers take a closer look at three high-impact GED clinical considerations, including delirium, falls, and polypharmacy.
The authors found that nearly 10% of older adults in the ED experience delirium, but it is only recognized in approximately one-third of cases.
In addition, acute delirium in older adults is associated with increased hospital length of stay; accelerated functional and cognitive decline; and post-discharge depression—even when recognized by emergency physicians. However, when delirium is missed in the ED, six-month mortality rates increase.
The authors report that few EDs seeking American College of Emergency Physicians (ACEP's) geriatric medicine accreditation have developed delirium protocols.
Overall, the group found that implementation of ED-based delirium identification and management strategies is challenging at the levels of the patient, staff, healthcare system, and payer.
About 30% of adults older than 65 who live in the community fall each year, according to the analysis. Nevertheless, fewer than half inform their doctor and less than one-third recall their last fall at their annual wellness visit.
Unintentional injury is ranked as the sixth leading cause of death for older persons, with falls being the No. 1 cause.
In addition, the danger of fall-related death rises with age, with men older than 85 at highest risk.
Older adults who present to an ED after a fall have an almost 30% greater risk of functional decline and depression at six months after the event.
The authors also noted that geriatric patients have more illnesses and, consequently, are prescribed more medications.
While they only represent 13% of the population, 33% of prescriptions are written for this age group.
Polypharmacy (simultaneous use of multiple drugs) is common among older ED patients and has been linked with more adverse drug reactions.
In one recent study, 39% of the geriatric population met the polypharmacy definition, according to the authors.
The most common drugs that cause adverse effects in older patients coming to the ED include, anticoagulants, hypoglycemics, cardiovascular medications or psychoactive medications, and antibiotics.
“The U.S. geriatric population is growing rapidly; this will translate to more ED geriatric patients with their associated higher morbidity and complexity of disease," wrote lead author, Richard D. Shih, MD, with the department of emergency medicine at Florida Atlantic University, and colleagues.
“The 2014 GED Guidelines brought important attention to the specific needs of this ED patient population. These recommendations necessitate increased staff, resources, and education. Unfortunately, the GED Guidelines currently remain aspirational for most U.S. EDs,” the authors wrote.
Read the full study here.