Geriatric Emergency Medicine Guidelines for Staffing, Training, Protocols, Infrastructure, and Quality Improvement

Geriatrics and Emergency Medicine: The Demographic Imperative

The geriatric population represented 4.1% of the United States population in 1900, 12.4% in 2000, and will be 20.2% by 2050.¹ Society labeled the surging birth rates in the post-World War II world the "baby boomer era." Population experts advised subsequent generations that as the baby boomers matured into old age, multiple aspects of society would be challenged in unprecedented ways. The young specialty of emergency medicine contemplated these challenges in the 1980s, including the increased demand for pre-hospital services and the need to develop a geriatric emergency medicine curriculum.^2,3 Researchers also began to assess the unique emergency department (ED) epidemiology of the older adult at this time.^4,5

Concurrently, outside of emergency medicine, the American Geriatrics Society (AGS) noted that the number of geriatricians needed to effectively provide health care for aging baby boomers was grossly inadequate.^6,7 Furthermore, the capacity of each specialty to educate medical students and resident trainees about aging principles and geriatrics was half of what was required.⁸ In the early 1990s, the John A. Hartford Foundation addressed this geriatric training and expertise shortfall via the Geriatrics for Specialists Initiative (GSI), which provided the Society for Academic Emergency Medicine (SAEM) with pilot funding to formally assess older adult ED care in 1991. Research supported by these grants and other funding led to several important findings. One GSI-funded study found that geriatric patients perceive the ED as a frightening and confusing place and often depart the ED after prolonged evaluations, dissatisfied with their understanding of the care received.⁹ Older adults had substantially increased risk for functional decline after discharge from the ED compared with younger populations.¹⁰ In addition, older adults were more likely to arrive by ambulance, have laboratory and imaging ordered, and be admitted after longer ED stays than younger populations.^11,12 A geriatric curriculum for emergency medicine residents was proposed.¹³ In response to this rapid expansion of geriatric emergency care knowledge, the John A. Hartford Foundation awarded SAEM a larger grant that facilitated more longitudinal studies. Additionally, the funding led to publication of a comprehensive textbook of geriatric emergency care, Emergency Care of the Elder Person, in 1996.¹⁴ Subsequent studies reported practice guidelines...