Are geriatric EDs the wave of the future?

Eventually, hospitals will develop geriatric EDs, just as many now have pediatric EDs, predicts Lowell Gerson, PhD, professor of epidemiology at Northeastern Ohio University College of Medicine in Rootstown.

"If you look at the parallels — i.e., kids present differently than adults and have tremendous dependency needs — there are a lot of similarities," Gerson says.

Additionally, there will be more geriatric patients in the long-term future than pediatric patients, he adds.

While agreeing with much of what Gerson says, James A. Espinosa, MD, FACEP, FAAFP, chairman and medical director of the emergency department at Overlook Hospital in Summit, NJ, is not convinced his ultimate prediction will come to pass.

"Geriatrics are not just older adults; their physiology is different," he observes. "There are simply not enough geriatricians [as opposed to pediatricians, for example] to run all of those departments. What will happen is that they will teach all of us how to work with geriatrics."

Nonetheless, there are many steps between the current reality and Gerson’s vision, and Espinosa is taking several of them right now. Overlook soon will be moving to a new building, and the ED there will have a geriatric wing.

The new ED will have several beds in an area in which the clocks will have different faces, he explains. Patients will have a two- or three-step stool to help them get onto a bigger bed that’s a little softer than normal, and the décor will have more soothing colors, Espinosa says. The area will have less ambient noise, he explains.

"It’s not a geriatric ED per se, but just as we’ve made a commitment to kids, just the presence of geriatric beds and protocols for things like pneumonia, for example, means we are adjusting to the geriatric population," Espinosa says.

These changes address what Gerson calls the "micro environment" required by geriatric patients. "If you go to a pediatric ED, the decorations are suitable for children," he observes. "What affects older people? One is temperature, two is a lack of anything to orient themselves — i.e., clocks," Gerson says. "They get concerned if they don’t know what’s going on."

Espinosa agrees. "These patients do have special needs," he says. They have special needs for protection, Espinosa says. "Just as there is pediatric abuse, there is elder abuse." However, he adds, it’s also important that the patients’ families be involved in their care. "You need to respect family and caregivers as part of the world of that patient," Espinosa explains.

Despite the many parallels between pediatrics and geriatrics, he asserts that doesn’t mean the future inevitably will lead to specialized EDs for geriatric patients. "In the pediatric world, there were pediatric specialties and subspecialties," Espinosa adds, underscoring why pediatric EDs have been possible — and why geriatric EDs may not be.