Improving emergency care for older adults

According to the U.S. Department of Health and Human Services, the population of adults 65 and older increased from 38.8 million in 2008 to 52.4 million in 2018 — a 35% increase. The older adult population is projected to reach 94.7 million in 2060.

As this population grows, Sharp Grossmont Hospital has been putting services in place to cater specifically to the needs of older adults. Sharp Grossmont serves a higher-than-average percentage of older adult patients in the ER, many of whom have multiple medical conditions or reduced access to preventive care.

In 2021, the hospital’s emergency department received the Geriatric Emergency Department Accreditation (GEDA) Gold Standard Level 1 accreditation as a “Senior-Friendly Emergency Department” by the American College of Emergency Physicians (ACEP). Sharp Grossmont Hospital is one of a handful of hospitals in the United States to receive Gold Standard Level 1 accreditation.

Julie Dye, a clinical nurse specialist in geriatrics at Sharp Grossmont Hospital, is the GEDA champion coordinator. She explains the significance of the designation and how her department is working to ensure that older adults receive the specialized care they need when using Sharp Grossmont’s emergency services.

How does a “senior-friendly” emergency department provide better care for older adults?
Evidence suggests older adults are at high risk for poor outcomes when hospitalized. The GEDA Gold accreditation seeks to break this cycle by using evidence-based practices and protocols in our emergency department with the goal of keeping older adults as independent as possible.

We have a physician champion, 14 registered nurses with specialty training in geriatrics and staff education on geriatric care. Our team, which includes social work and psychiatry, palliative medicine, pharmacy, physical therapy, and nutrition, responds to the emergency department to support a shorter length of stay. Changes to the care environment, such as warm paint colors and dimmer switches to make the patient rooms more comfortable, have also been implemented to increase comfort for older adults.

What can an older adult expect when arriving at Sharp Grossmont’s ER?
Older adults receive expedited care upon check in to ensure the fastest possible time to see a provider. Every attempt is made to place these patients in our senior specialty unit. Screening for functionality-at-home is performed to look for syndromes that place older adults at risk for losing their independence. These assessments include the ability to provide care for oneself; identify memory issues; mobility struggles; uncontrolled pain; and symptoms of chronic illness, depression, and abuse.

During these assessments, the nurse sits with the patient at the bedside and takes the time to have these important conversations to determine what really matters to the patient and any issues they are facing in their independence. With that information, we can loop in resources to support healthy aging at home. Our nurses are invested in providing the best possible care both during the emergency room visit and after discharge when they call the patient to check on their progress. Our team is known to follow up with the families of patients in crisis as well, providing a holistic approach to healing and quality-of-life issues.

What are some examples of the special way in which older adults are cared for in your ER, and what difference is it making?
We supply comfort items, including amplifiers and magnifiers, to make the visit more manageable and comfortable. Our team has also intervened on several cases of food insecurity, caregiver assistance, depression, and elder abuse. We are committed to helping seniors be successful at home after discharge, and are focused on how we can bring community partners to the patient. Most importantly, our older adult patients report higher satisfaction with their emergency room stay, which motivates us to keep looking for ways to improve.

Why is improving care for older adults important to you?
I have spent a lot of time with older-adult family members accessing medical care in San Diego County. It has given me the opportunity to hear the fears and disappointments from the patient’s perspective.

I’ve felt the discomfort of extended wait times, frustration of misunderstanding the plan of care, and difficulties with accessing follow-up care after discharge. Patients and care providers are trying to navigate outpatient care to ensure the best outcomes and avoid readmission to the emergency department — an issue made exponentially harder during the COVID-19 surge.

Making sure older adults feel safe and cared for during these times ensures their ability to receive the best care. And respecting what matters most to them enables them to live independently, which is our highest aim.

Learn more about Sharp Grossmont Hospital’s emergency department and save a spot in the ER.