New York City’s Mount Sinai Medical Center Emergency Department is one of a growing number of medical centers nationwide that is specializing in geriatric emergency medicine.
What does that mean? In practice, these are emergency rooms with care services designed specifically for older patients, including separate and customized physical spaces, enhanced support staff, and comprehensive diagnosis and treatment plans modified specifically for the elderly.
The goal is to refine treatment to ensure more older patients are able to go home after visiting the ER, instead of beginning a hospital stay.
There’s certainly no shortage of patients: The number of older people visiting ERs rose by more than 27% between 2005 and 2016, according to the Centers for Disease Control and Prevention.
Before it focused on geriatric medicine, 20% of Mount Sinai’s emergency room patients were over the age of 65. And because of the lack of accurate medical history, the staff often played it safe and admitted to the hospital even patients with non-acute issues.
Now there is a specialized collaborative team specifically designed to diagnose and treat people over 65 years old, so patients aren’t admitted for minor flu, for example. Geriatric medicine can prove to be challenging since patients may present unusual symptoms or have a more complicated medical history.
“The elderly often present with atypical symptoms,” Denise Nassisi, M.D., head of Mount Sinai’s Geriatric ED, told AARP. “If they’re having angina, they may not have chest pain. If they have an infection, they may not have a high fever or an elevated white blood cell count. Having this collaborative team support means we can do more for patients in the ED.”
So now geriatric patients are not only getting the care they need but also the support. For example, if a patient comes in alone — which between 30% and 40% of older people do — the team makes sure they have a Visiting Nurse Service appointment set up, medication and instructions on how to use it, and any other follow-ups the patient may need.
And this transitional work seems to be paying off. Hospital admissions for those over 65 years old were reduced by 33%, according to a 2018 study in the Journal of the American Geriatrics Society.
When an older patient is admitted to the hospital, the team is already educated on the nuances of geriatric medicine. When that patient is discharged, they are able to remain healthy at home and avoid a return visit.
“Being multidisciplinary, we have the nursing team assessing for fall risk and proper medication management while social workers check in on social supports. We tailor everything to the specific needs of each patient,” Shari Kaplan, director of the Department of Volunteer Services at Mount Sinai, told AARP.