History of Geriatric Emergency Medicine
Why Geriatric Emergency Medicine?
The geriatric population is growing dramatically in the United States and is expected to grow to more than 70 million in 2030 due to increased life expectancy and the aging of the "baby boomer" generation. According to the Centers for Disease Control (CDC), older adults comprised 15% of emergency department (ED) visits in 2011 and are projected to increase by 33% by 2030. These patients have longer lengths of stay in the ED, typically require more tests, and have a higher risk of medical complications and functional decline after an ED visit. Among ED admissions, 43% are older adults, and geriatric patients comprise 48% of all intensive care unit (ICU) admissions. Compared to younger adults, older adults:
- Use more medications
- Respond to medications differently due to altered pharmacokinetics
- Are more likely to have nonspecific presentations of disease
- More commonly suffer from some degree of cognitive impairment
- More frequently have adverse outcomes and readmissions after discharge from the ED
In response to this great need, there are national and global collaborations to create ED environments filled with the necessary expertise and resources for this population.
History of Geriatric Emergency Medicine
Geriatric emergency medicine (GEM) is a relatively young subspecialty within emergency medicine (EM). The first two geriatric EDs were established in the U.S. in 2008 after which there was a rise in the number of self-proclaimed geriatric EDs. In 2013, a joint group with representatives from the American College of Emergency Physicians (ACEP), The American Geriatrics Society (AGS), Emergency Nurses Association (ENA), and the Society for Academic Emergency Medicine (SAEM) published a set of guidelines for geriatric EDs with the purpose of consolidating and highlighting the elements necessary for appropriate care of the ill or injured older adult patient. The Geriatric ED Guidelines are now the basis for formal geriatric ED accreditation through ACEP. Geriatric emergency department accreditation (GEDA) aims to verify and oversee EDs that are providing outstanding care in accordance with the Geriatric ED Guidelines. Similar to trauma centers, EDs can receive one of three levels of accreditation based on the number of quality improvement protocols that are followed. Protocols start with pre-hospital care, ED care and equipment, and transition to outpatient care. All levels of accreditation required an MD/DO champion and a nurse champion focused on improving the emergency care of adults. Higher level two and three accreditation requires a greater number of geriatrics care processes, staffing, and equipment and environmental changes. To date, over 100 geriatric EDs have been accredited.
Looking to the Future
GEM has a bright future and is looking for young talent. There is significant need for targeted clinical care quality improvement initiatives, geriatrics-focused research, and improved education initiations. Your medical center may have a GEM specialist to guide you. Consider joining the SAEM Academy of Geriatric Emergency Medicine (AGEM) or review the list of Geriatric EDs.