The Unique Needs of Elderly Patients in the Emergency Department (Part 1)

VickyRN, MSN, DNP, RN

It is a typical shift in the emergency department (ed). Lydia smith, a 79-year-old woman, has fallen at home, hitting her face on the concrete slab on her front porch. Her medical history includes mild parkinson's disease, congestive heart failure, and osteoarthritis. She arrives via ambulance stretcher, strapped to a spine board, her tiny face dwarfed by the cervical collar and head immobilizer. She presents with an open gash to her right forehead, another laceration between her eyebrows, and a third laceration just over her left eye.

She is sobbing softly, with a frightened look in her eyes. Blood is still seeping from the wounds. The nurse notices multiple bruises, in various hues of red, purple and yellow, on her forearms and lower legs bilaterally.

When asked if she falls a lot, she weakly mouths the word "yes." she appears emaciated, pale, and frail. Her clothing is threadbare and smells of urine and feces. Upon further questioning, the nurse discovers that the elderly woman lives alone, with no family in the area.

Like Lydia, the elderly often present with complex medical and sociological needs and this may pose unique challenges to clinicians in the ed setting. Older adults, those 65 years of age and above, are more likely to suffer from chronic medical issues and impairments in function, be unable to clearly advocate for their needs, take multiple medications with harmful drug interactions, and have inadequate social support systems. The care they need may extend far beyond the ed, requiring careful discharge planning and utilization of community resources.

As a result, the elderly patient typically requires extensive coordination of services for diagnosis, acute intervention, emotional and spiritual support, medication reconciliation, education, follow-up, and possible home or nursing facility care. This can be difficult and time-consuming in the rapid-paced, high-volume ed setting.

The population of older Americans is exploding, increasing more rapidly than any other age group. Accordingly, ed visits by the elderly have increased more than 34 percent during the last decade. People over 65 account for 40 percent of emergency-medical-service responses and 20 percent of emergency room visits, and that number will only grow with the rapidly aging population.

Senior patients are more likely to suffer adverse health outcomes following discharge from the ed. The hospital admission rates for the elderly following a visit to the ed are three times that of the younger population. The elderly are also more likely to have repeat ed visits and to suffer functional decline. Within three months of the ed visit, nearly a third of the seniors have another emergency, are admitted to the hospital, or die.

Clearly, there is an urgent need for nurses with expert knowledge and skill in the care of older adults. To provide safe and effective care for older patients, nurses must have keen geriatric assessment skills, be able to differentiate the normal changes of aging from pathology, have a thorough knowledge of symptom management, be able to manage patients with complex care needs, possess effective communication skills, be able to sensitively address psychological and spiritual concerns, be aware of cultural variations, be able to collaborate with other disciplines to resolve problems and potential complications, be familiar with available community resources to support the elderly individual and caregiver, and be able to use evidence-based clinical research in practice to improve geriatric emergency care.

In part 2 in this two-part article series, we will discuss the 11 principles of geriatric emergency care to facilitate care of patients such as Lydia. Please stay tuned.

References

Geriatric emergency units

The Unique Needs of Elderly Patients in the Emergency Department (Part 1)

About VickyRN, MSN, DNP, RN

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