The Geriatric Emergency Room is designed with the older patient in mind. The space is quieter, and the layout is designed to reduce the risk of confusion, bed sores and over medications.
The senior population is often described as a silver tsunami, and with good reason. The U.S. Census estimates that by 2030 one in five Americans will be 65 or older. This large wave of older people is beginning to impact hospitals. The Center for Disease Control estimates that between 15% to 20% of all emergency room visits are by patients aged 65 and over. As the population matures, more and more seniors will enter hospitals. This predicted influx is causing hospitals to rethink how to better serve older patients. The result is the development of the Geriatric Emergency Department, or Geri-ED.
The traditional emergency room is designed primarily to allow physicians and nurses to make fast diagnoses and treat emergency medical situations. A patient’s comfort is of secondary importance. The wards are usually noisy and crowded. Staff rush by with medical equipment, curtains are pulled back and forth with grating shrieks, and fluorescent lights glare at all hours.
In contrast, the Geri-ED is smaller and quieter than the average emergency department. It is set away from the usual hustle and bustle of the rest of the hospital. The rooms include larger signage that is easy for seniors to read and clocks equipped with larger numerals. Patients can request adaptive equipment such as telephones with large keypads, fluorescent tape on call bells, and hearing devices. Nurses and aides carry extra eyeglasses and magnifying lenses for those who left their eyeglasses at home.
Other features of the Geri-ED include beds that have thicker mattresses that reduce the risk of bedsores; bathrooms equipped with higher toilet seats for easier access; and halls designed with safety handrails and non-slip floors. Even the curtain rings and rods around the beds are designed to reduce the noise of drawing and opening the curtains.
The ward is staffed with teams of physicians, nurses, and social workers who are trained in geriatric care. The team is aware that older people metabolize medications more slowly, are more likely to be treated for chronic conditions and often suffer from polypharmacy — the adverse effects of taking multiple medications.
New York City’s Mount Sinai Hospital is one of the pioneers in geriatric care. It opened New York’s first Geri-ED in 2012. The ward consists of 14 beds and serves between 24-26 patients daily. The medical staff includes discharge planners who evaluate patients’ home needs before they leave and arrange for necessary services such as home care, meals on wheels, and visiting doctors and nurses.
One of the more impressive features of Mount Sinai’s Geri-ED is the artificial skylight in the ceiling. The view shows trees back lit by the sky. The light changes as time passes, simulating evening and nighttime. This design helps to lessen a condition called “sun downing”– agitation and confusion that occurs among some older people at the end of the day.
The growth of the Geri-Ed has a second purpose; to decrease hospital readmission. Medicare estimates the hospital readmission rates cost them $17.4 billion a year. The Geri-ED’s emphasis on at-home after care is beginning to reverse this trend.
As the over 65+ population continues to grow, the medical community is acknowledging that older people have special medical needs, particularly when entering the emergency room. The geriatric emergency department is a major step in creating a resource that will help these people get better care and stay healthier both in and out of the hospital.
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