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It had been a rough few months. Cynthia Tompkins was hospitalized in May for osteomyelitis, a bone infection, then spent six weeks in a rehabilitation facility. \u201cIt was a struggle,\u201d she said. \u201cI didn\u2019t bounce back too well.\u201d<\/p>\n
Ms. Tompkins returned to her home in San Diego, but she was still taking antibiotics, along with a host of other drugs for diabetes, pain and blood clots. The deaths of her husband the previous year and her closest friend more recently had sapped her spirits.<\/p>\n
In early July, a new symptom appeared: violent vomiting three times within about 24 hours. \u201cI was so depleted,\u201d she said. \u201cI got weaker and weaker.\u201d A friend who was visiting her called an ambulance.<\/p>\n
\u201cIt\u2019s the last place you think you want to go, the E.R.,\u201d said Ms. Tompkins, 75, a retired teacher and family program director. She anticipated spending hours on an uncomfortable stretcher in a chilly hallway. Arriving at the emergency department at U.C. San Diego Health in La Jolla early in the morning, \u201cI was in a knot,\u201d she said.<\/p>\n<\/div>\n<\/div>\n
But the place upended Ms. Tompkins\u2019s expectations. Since 2022, this and every other adult E.R. in San Diego has been accredited as a geriatric emergency department, redesigned to address the specific risks and needs of older patients. It\u2019s an approach, recent studies show, that can reduce hospital admissions and deaths<\/a> among older adults and lower costs.<\/p>\n \u201cThey took me right to a room,\u201d Ms. Tompkins said. She was transferred to a gurney with a thicker mattress to prevent bedsores and given blankets. \u201cI got an I.V. right away because I needed fluids,\u201d she said.<\/p>\n She was pleased that the small, curtained room, with sound-absorbing walls to lower the cacophony of emergency care, had a cushioned chair for her friend, who would stay with her, and a window looking out on trees.<\/p>\n The window served a medical purpose, too. Patients \u201ccan see whether it\u2019s day or night,\u201d said Denise Valenzuela, the geriatric emergency nurse assigned to Ms. Tompkins. \u201cIt prevents delirium,\u201d the sudden change in mental status that can arise in hospitalized older patients and increase dementia risk.<\/p>\n Before long, \u201cI just felt a calmness,\u201d Ms. Tompkins said. \u201cI felt, I\u2019m where I need to be right now.\u201d<\/p>\n<\/div>\n<\/div>\n Since 2017, the American College of Emergency Physicians has accredited 624 such geriatric emergency departments across the United States, including 73 in Veterans Affairs medical centers. \u201cA fairly exponential rate of growth,\u201d said Dr. Kevin Biese, the emergency doctor who directs the Geriatric Emergency Department Collaborative.<\/p>\n Few of these units are restricted to older patients. Instead, like the E.R. in La Jolla, they serve all ages but incorporate senior-friendly practices and protocols in an environment aimed at staving off disorientation, falls and other elder hazards. They\u2019re classified from Level 1, for those fulfilling the highest number of criteria, to Level 3.<\/p>\n Adults 75 and older visit the emergency room at a higher rate than any other age group<\/a> except infants: 76 visits per 100 people in 2022. Yet standard emergency care \u201cwasn\u2019t correctly designed for the needs of older adults,\u201d Dr. Biese said.<\/p>\n The mission of a traditional E.R. is to speedily identify the central problem and either fix it or admit the patient to the hospital for ongoing care. \u201cWe ask, \u2018What\u2019s your chief complaint?\u2019\u201d Dr. Biese said. \u201cYou fell down the stairs and broke your leg.\u201d<\/p>\n Older patients rarely arrive with a single ailment, however. Like Ms. Tompkins, most contend with several chronic conditions, take multiple prescriptions and need a variety of tests and assessments. Trained geriatric emergency teams focus not only on the broken leg but on determining what caused the fall, and how to prevent another one.<\/p>\n<\/div>\n<\/div>\n \u201cAn emergency department doesn\u2019t routinely screen for delirium\u201d and cognitive impairment, said Dr. Ula Hwang, an emergency doctor and researcher at N.Y.U. Langone Health. \u201cBut it\u2019s one of the first things geriatric emergency departments will do,\u201d along with a careful review of all the patient\u2019s medications.<\/p>\n Geriatric E.R.\u2019s also try to counter sensory impairment, another contributor to delirium, by distributing reading glasses and sound amplifying devices. They dim glaring lights and offer eye masks and ear plugs to promote sleep. If Ms. Tompkins had forgotten her walker, the unit would have lent her one.<\/p>\n These E.R.\u2019s also aim to address a rising concern in emergency departments: hours or even days spent \u201cboarding,\u201d when admitted patients wait for open beds before they can leave the E.R.<\/p>\n \u201cProlonged boarding has increased among older adults,\u201d said Dr. Cameron Gettel, an emergency doctor and researcher at the Yale School of Medicine, <\/strong>referring to waits that last over three hours. He is a co-author of a study on the topic in Health Affairs Scholar<\/a>.<\/p>\n Spending more time boarding isn\u2019t merely uncomfortable or inconvenient. Researchers studied patients 75 and older in emergency departments across France. They found that those kept there overnight before moving to an inpatient ward had a higher in-hospital mortality rate<\/a> (15.7 percent) than those admitted to a ward before midnight (11.1 percent). Overnight boarding was associated with more falls and infections, too.<\/p>\n<\/div>\n<\/div>\n What geriatric emergency staff prefer, however, is to help patients avoid hospitalization altogether. \u201cAdmission may not be the best thing for an older adult,\u201d Dr. Hwang said. \u201cIt might be the worst.\u201d<\/p>\n Hospital patients, she said, are exposed to infections, staff errors and the rapid deconditioning that accompanies days spent in bed. All pose a greater threat to older patients.<\/p>\n Previous studies have found reduced admissions<\/a> from geriatric emergency departments, but most of those studies involved one or two hospitals. Now, Dr. Hwang and her team have used nationwide data from the federal Health and Retirement Study and Medicare claims for nearly 4,600 adults over age 65, comparing those treated in geriatric emergency departments with a matched group seen in standard E.R.\u2019s.<\/p>\n The differences were stark: Patients in the geriatric units had a 39 percent lower likelihood of hospital admission<\/a> and a 38 percent reduction in mortality over 30 days. The geriatric E.R.\u2019s also saved Medicare<\/a> up to about $3,000 a visit, according to an earlier study Dr. Hwang led.<\/p>\n So having more than 600 accredited<\/a> geriatric emergency departments nationwide represents both great strides and \u2014 in a country with more than 5,000 emergency departments<\/a> \u2014 missed opportunities, Dr. Biese said.<\/p>\n<\/div>\n<\/div>\n \u201cI\u2019d encourage people to ask why their hospitals don\u2019t have an accredited G.E.D.,\u201d he added. \u201cWe should demand that.\u201d<\/p>\n In La Jolla, Ms. Tompkins began feeling stronger. The intravenous fluids supplied anti-nausea medication and corrected the electrolyte abnormalities that her lab work revealed. She was able to sip water and juice and eat a few graham crackers.<\/p>\n A battery of other screens and scans found no serious concerns. After completing a geriatric assessment, Ms. Valenzuela, the nurse, suspected Ms. Tompkins hadn\u2019t been eating well and was taking medications on a mostly empty stomach.<\/p>\n By about 6 p.m., Ms. Tompkins and her doctor agreed she could return home. She left the hospital with numbers to call for further help, and several staff members checked in by phone to see how she was doing.<\/p>\n Better, was her answer. \u201cThey took care of the whole me and put me on the right track,\u201d Ms. Tompkins said. \u201cI\u2019m progressing. It\u2019s slow, but I\u2019m OK.\u201d<\/p>\n The New Old Age is produced through a partnership with <\/em>KFF Health News<\/em><\/a>.<\/em><\/p>\n<\/div>\n<\/div>\n