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Senior Health Issues Get Special ER Attention

The emergency room experience is stressful. You aren’t feeling well, it’s noisy, and you don’t have much privacy during a very vulnerable time. The staff, while well qualified, is usually providing necessary treatment at a fast pace and may not explain everything they are doing to help you and why. Therefore, a patient may leave wondering what exactly happened during their visit and what do to moving forward.

For seniors, the emergency room is especially difficult to navigate. Chronic medical conditions, diminished hearing and neurological limitations common to many seniors make the experience that much more stressful.

A study conducted by George Washington University Medical Center in Washington, D.C., found that visits to emergency rooms by the elderly in the U.S. have increased more than 34% since 2000. This figure and the anticipation of the senior population growing faster now than in any previous time in history has led medical professionals in a handful of hospitals around the country to launch emergency rooms that are designed and operated solely in the interest of seniors.

Holy Cross Hospital in Silver Spring, Maryland was the first hospital to bring the concept to market in 2008. They took a look at their community’s demographics and found that seniors required a more personal approach to the emergency room experience.

Dr. Bill Thomas is a professor at the Erickson School at the University of Maryland, Baltimore County. The Erickson School’s mission is, “To prepare a community of leaders who will use their education to improve society by enhancing the lives of older adults.”

Dr. Thomas was asked by Holy Cross Hospital to be on the team that developed the senior emergency room. He explains that the facility is “adapting high quality emergency room care so that it meets the needs of older people specifically. That is the innovation. That’s what’s new. This new center is the very first example of a health care system recalibrating and redesigning its environment and services to meet the needs of older people specifically.”

This senior-specialized care trend is catching on. Since the Holy Cross Hospital unveiled this model of senior care, the Saint Joseph Mercy Health System in Michigan created eight customized senior emergency rooms with great response.

“This is Michigan’s first implementation of a dedicated program addressing the emergency care needs and physical comforts of adults ages 65 years and up,” said Garry Faja, president and CEO, Saint Joseph Mercy System.

In Houston, the Park Plaza Hospital Senior Emergency Department takes dedicated senior a step further. The department reaches out to local nursing homes and care providers to pinpoint the special needs of each individual patient who is admitted to the unit. Their belief is that by gaining complete knowledge of a patient’s medical history and behavior patterns, the nurses and physicians can provide even better care and create an improved quality of life for the senior.

Medical professionals at these hospitals recognize the importance of senior-focused care and created an environment that provides comfort as well as a comprehensive approach to treatment. Typically, the treatment that a person receives in an ER is acutely directed to relieve their symptoms. Seniors who go to the ER need acute care as well, but they arrive with other considerations – pre-existing medical conditions, medication and nutrition requirements and even tendencies toward depression. Therefore, the scope of treatment that the senior-focused ERs provide is much more inclusive, taking into account the bigger picture of the senior’s health needs to prevent the injury or illness from becoming even more serious.

The senior ER helps to create an environment where a senior feels immediately more comfortable and less anxious with the following physical features:

• Private patient rooms
• Softer lighting
• Warm paint colors on the walls
• Non-skid, non-glare floors
• Strategically placed handrails
• Bedside commodes
• Wheelchairs and walkers readily available
• Pressure-reducing mattresses
• Upright chairs
• Warmed blankets
• Clocks and telephones with larger numbers
• Documents with larger print for easy reading
• Reading glasses
• Hearing assistive devices

These material features help to support a more agreeable experience for the senior, but the specialized care given by the health providers is an even more important asset to the seniors. While it varies from ER to ER, the staff is typically trained to address physical, emotional and spiritual needs and interests of seniors. All physicians and nurses are specially trained on senior-related health problems and on compassionate care. Nurses are certified in Geriatric Emergency Nursing Education (GENE).

On initial contact, nurses are trained to perform a special senior-specific assessment. Once the patient is stabilized, a nurse screens for cognitive and physical function, depression and alcohol and drug use. The nurse looks for signs of falls, neglect and abuse. Then, the patient is referred to the next appropriate level of care.

Other senior ER staff are also close at hand to provide thorough care. A welcome surprise to the immediate care team is the pharmacist. Their role involves reviewing the multiple medications that seniors may already be taking and analyzing how they would mix with new medications to help avoid adverse drug reactions. They also may assist in determining if the medication regime of the senior is related to the cause of their ER visit in the first place.

A geriatric social worker or care manager works closely with patients while they are in the ER. The social worker helps them feel comfortable, acts a problem solver and advocate for the senior and tries to find out if there are underlying causes to the issues that led to the ER visit. Important pieces of senior care that the geriatric social worker provides are outpatient support and continuing care plan determination. This includes a follow-up phone call within a few days to assure that the senior is doing well and to find out if other care or services are needed.

Each of the senior ERs is different, but they offer similar features and a specialized staff to support and operate in a full-service fashion for a senior’s best interest. The Saint Joseph Mercy Oakland Hospital (Pontiac, Michigan) shares, “We strive to provide an experience that is worthy of the dignity and respect seniors deserve.”