It is no secret that the population of the United States is aging. According to the Department of Health and Human Services’ Administration of Aging, the number of persons over 65 in the U.S. will be about 72.1 million in 2030—more than twice their number in 2000. By that point, seniors will make up nearly 20% of the entire American population.
Hospitals have begun to respond to this reality, even in the emergency room. A number of hospital emergency departments have developed special processes or teams for handling seniors, while some have actually opened separate, focused emergency departments that will only take geriatric patients.
The reason for implementing such sweeping reforms is that older patients present unique problems. Seniors are more at risk for adverse effects from medical care. Many find themselves with limited mobility and function after an emergency incident, meaning that return visits to the emergency room are very high for this population. In addition, older patients are more likely to have unusual conditions, suffer from multiple different conditions that can confound diagnosis and treatment, and already take multiple medications that can interact with new prescriptions.
In part, the changes happening in emergency rooms are also the result of perceived problems with previously available care. In 2005, for example, the Society for Academic Emergency Medicine found six areas in which emergency medicine was failing to meet the minimum standard of care for seniors. These included cognitive assessment and pain and medication management, key indicators of return visits.
How does all of this affect emergency medical services, prehospital providers, and dispatch? One recent study identified three areas in which EMS needed more study and improved response.
First, they found that the complex presentations of disease in older patients was confounding diagnosis and treatment in the prehospital setting and that more research is needed to determine the best methods for diagnosis, and the most valuable interventions, for seniors before they arrive at the hospital.
Second, they suggested the importance of alternate care methods for seniors. Because the stress of an ambulance ride, the chaos of the emergency room, and the limited time for treatment all pose risks for older adults, the possibility of instead transporting them to geriatric care centers, treating them at home, or otherwise providing them with alternate care options is particularly important.
Finally, the study argued that EMS could be more effectively involved in screening older patients for conditions that might indicate future problems. Because EMS providers are already interacting with the patient—who may not be receiving regular care—they are in a position to screen the patient for cognitive and physical declines that may pose more serious problems in the future. They could then provide that information to the emergency room staff, the patient’s doctor, or the patient, hopefully leading to better preventive care rather than another trip to the ER for an unidentified, and thus untreated, condition.
Prehospital care providers, both in the dispatch center and on scene, have the potential to substantially improve the quality of care older patients are receiving—and also to reduce the potential harms they may experience from traditional emergency care. As the population ages, EMS will be increasingly involved in such patients’ lives, and we should prepare for this involvement soon—before one in every five of us is over 65.