Geriatrics in ED, challenges and solutions

Emergency departments around the world are experiencing a steady increase in elderly patients, presenting unique challenges to healthcare professionals. Geriatric patients often arrive with complex medical histories, multiple comorbidities, and atypical disease presentations that make diagnosis and treatment intricate. Understanding common geriatric presentations, the inherent challenges, and appropriate solutions is crucial for enhancing patient outcomes.

Common Geriatric Presentations:

1. Polypharmacy and Adverse Drug Reactions: Elderly patients often take multiple medications, which increases the risk of adverse drug reactions and interactions. Polypharmacy can obscure clinical presentations, making it difficult to identify the root cause of symptoms.

2. Delirium and Cognitive Impairment: Delirium is a common but often under-recognised condition in older adults. It can be precipitated by a variety of factors including infections, medications, and dehydration. Cognitive impairment, including dementia, further complicates assessment and treatment.

3. Falls and Trauma: Falls are a leading cause of fatal and non-fatal injuries in the elderly. The presentation can range from minor abrasions to significant head trauma and fractures. Identifying underlying causes, such as balance disorders, medications, or environmental hazards, is crucial for prevention and management.

4. Cardiovascular Events: Elderly individuals may present with atypical symptoms of cardiovascular events like myocardial infarction or heart failure. Symptoms such as fatigue, confusion, or general weakness rather than chest pain are more common, which can delay diagnosis.

5. Infections: Infections in the elderly, including urinary tract infections and pneumonia, often present atypically. Fever may be absent, and symptoms might be non-specific, such as a decline in functional status or altered mental state.

Challenges in Geriatric Emergency Care:

1. Atypical Presentations: The non-specific and varied presentation of diseases in elderly patients can delay diagnosis and treatment, increasing the risk of complications.

2. Communication Barriers: Sensory impairments, cognitive deficits, and speech difficulties can hinder effective communication, complicating history taking and consent processes.

3. Resource Constraints: High patient volumes and limited resources in EDs can strain the care provided to geriatric patients, who often require more time and specialized assessments.

4. Coordination of Care: Elderly patients often need multidisciplinary care involving social services, primary care providers, and specialists, which can be difficult to coordinate in the fast-paced ED environment.

Solutions and Strategies:

1. Comprehensive Geriatric Assessment: Implementing CGA in the ED can help identify medical, psychological, and functional issues. This holistic approach enhances care planning and discharge processes.

2. **Training and Education**: Educating ED staff about the unique needs and presentations of geriatric patients is essential. Simulation training and geriatric-focused modules can improve diagnostic and management skills.

3. Environmental Modifications: Making the ED environment more senior-friendly, with better lighting, signage, and handrails, can help reduce disorientation and falls.

4. Enhanced Communication Techniques: Employing strategies such as speaking clearly, using visual aids, and allowing more time for interactions can improve communication with elderly patients.

5. Multidisciplinary Teams: Forming teams that include geriatricians, nurses, social workers, physiotherapists and pharmacists can ensure comprehensive and coordinated care. Regular MDT meetings can enhance care transitions and follow-up plans.

The rising number of geriatric patients in emergency departments necessitates a tailored approach to ensure that these individuals receive high-quality, efficient care. By recognising the common presentations, navigating the associated challenges, and implementing targeted solutions, healthcare providers can significantly improve outcomes for elderly patients.