Answer: A trip to an Emergency Department (ED) can be difficult and stressful at any age. It can be particularly difficult for older adults, who often have a number of health problems and take multiple medications. Because EDs tend to be noisy and hectic, older people can feel overwhelmed. And, if they have to spend a lot of time there, they have a greater chance of developing delirium — serious mental confusion that can sometimes lead to difficulty thinking and remembering.

Fortunately, EDs are becoming more “senior-friendly” as hospitals are making changes so they are safer for older people. Some hospitals are even creating special EDs just for older adults. If you are older, or if you care for an older person, it can be helpful to learn more about the Emergency Department that is closest to where you live as this is where you will likely be taken if you need emergency care. When you visit, ask the staff the five questions below. According to the Health in Aging Foundation, these five questions are important to know and consider:

1. Is there someone on the ED staff with specialized training in the care of older adults? Geriatricians are doctors with advanced training in caring for older people. Nurses, physician assistants, and other members of the health care team may also have advanced training in geriatrics. These professionals are important members of the ED team because older people may respond differently to medications and other treatments than younger people do.

1. Geriatrics health professionals are well aware of these differences.

1. Is there someone at the hospital I can speak with about advanced directives? Advanced directives are legal papers that explain what kind of end-of-life care a person wants, and doesn’t want. For example, in an advanced directive an older person may note that he does not want to be kept alive with a respirator — a device that can breathe for you if you can’t breathe on your own.
2. How do you help make triage less stressful for older people? Triage is a standard system for deciding which patients at an ED get treated first. With triage, patients who need care the most get treated first. Because Emergency Departments are often busy, waits can be long for those who don’t need immediate help. This can be a problem because older adults who have long waits may run an increased risk of developing delirium. Ask the staff if they can move an older person to a quieter, calmer room if they have a long wait. Ask what else they do to make older people’s time in their department less stressful.
3. Does the hospital use medication reconciliation and full pharmacy reviews? These practices lower the chance that an older patient will get incorrect medications or medicines at the wrong doses. Medication errors are the most common medical errors. Many of these errors can be avoided with regular medication reconciliations. These reviews involve making a complete list of a patient’s medications, and then comparing that list with the list of medications in the patient’s record. Pharmacy reviews involve creating a complete and correct list of the current medications a patient should be taking, every time the patient moves from one health care setting to another

1. — such as from the ED to a hospital room to a rehabilitation facility

1. .
2. What do you do to limit the number of “transitions of care” that older adults go through after they reach the ED? Between the time they reach the ED and the time they return to their home, older adults may be moved to new locations several times. For example, they may be transferred to an Intensive Care Unit

1. (ICU)

1. , to a hospital room, to a rehabilitation facility, and back to where they live. With each move

1. (care transition)

1. , patients get care from different health care providers. However, research shows that older people who go through fewer transitions are given fewer inappropriate medications and have better health outcomes.

For more information about this and other topics related to the health of older adults, visit Health in Aging Foundation at www.healthinagingfoundation.org.