Nursing issues in care for the elderly in the emergency department: an overview of the literature

https://doi.org/10.1016/S0965-2302(02)00163-7Get rights and content

Abstract

Emergency care is an important link in the chain of care for geriatric patients. Due to the specific physiological, psychological, and social needs of elderly people, the type and quantity of emergency care are different for this group of patients than for other age groups. Consequently, they have a significant impact on the health care system. Doctors and nurses working in an emergency department must be aware of this specific situation and adjust the care that they provide accordingly. Appropriate communication between health care providers and patients, a sound assessment of functional status and cognitive ability, and specific attention to verbal and written discharge guidelines are indispensable.

Introduction

Due to the increasing proportion of elderly people in the population, the number of geriatric patients using emergency care is increasing steadily (Dove & Dave 1986; Eliastam 1989; Lowenstein et al. 1986). Emergency departments are crucial in the provision of emergency care. In the United States, an estimated 15% of patients who present themselves at emergency departments are 65 or older (Strange et al. 1992). This figure is about three percent higher than the ratio of this age group as a proportion of the general population (Lowenstein et al. 1986; Strange et al. 1992).

Emergency care for elderly people is different in terms of both the type and quantity from the care provided to other age groups (Ettinger et al. 1987; Sanders 1992). The specific physiological, psychological, and social needs of geriatric patients require an appropriate approach from health care professionals and an accurate organisation of the care provided to respond to their individual needs. Research is needed to outline how emergency care is used by elderly people and to examine the specific problems for which they require this type of care. The importance will even increase, since predictions of demographic developments indicate that the proportion of elderly people in our society will increase sharply during the next few decades (Clark & Fitzgerald 1999).

After Lowenstein et al. (1986) stated in 1986 that the medical literature did not pay much attention to care for the elderly in emergency departments, the number of medical and nursing publications in this field has increased. Yet, in the mid-1990s a decline was observed in the number of studies in this area. The majority of the available papers have focused on the use of an emergency department, the specific needs of elderly people in an emergency department, and the use of ambulance transport. The need for extensive research has also been perceived by the ‘Society of Academic Emergency Medicine’ (SAEM). This organisation has therefore set up the ‘Geriatric Emergency Medicine Task Force’, which gave a boost in the early 1990s to the organisation of large-scale studies and surveys of the use of emergency care by geriatric patients and the care provided to this patient population in emergency departments (Sanders 1992). Studies of this kind allow to us assess the impact that this patient group will have on emergency care in future. They also contribute to optimise further the emergency care provided to this vulnerable patient group.

It is extremely important for nurses involved in caring for geriatric patients in an emergency department, either in clinical practice or in nursing management roles, to have an insight into the care that is given to this patient group, in terms of both the content of care and financial and organisational consequences. This paper therefore aims to provide an overview of the specific characteristics of elderly people who present at an emergency department, to outline the use of emergency care by elderly people and to discuss a number of important issues that require attention in relation to the care of geriatric patients in an emergency department.

Section snippets

Characteristics of elderly people

Due to normal ageing, a number of physiological processes take place differently in elderly people. This has consequences in terms of diagnostics and the planning of care for geriatric patients. These two factors are vital in delivering adequate emergency care. Eliastam (1989) mentions a number of aspects, which are extremely important in emergency care for elderly people.

  • 1.

    In geriatric patients, far fewer complaints are simply attributable to ageing than was originally assumed. The problem here

Use of emergency care by elderly people

The literature indicates that elderly people use more medical care than other age group categories (Fuchs 1999; Hodgson & Cohen 1999), due to the higher prevalence of chronic conditions. The use of emergency departments, the length of stay in the emergency department, the use of ambulance transport, and hospitalisations from emergency departments have also been investigated.

Specific needs

In addition to the physiological changes associated with ageing, geriatric patients also have specific psychological and social needs. The care provided to elderly people requires specialised knowledge from the doctors and nurses working in an emergency department to meet these needs (Fulmer & Degutis 1992). Furthermore, the architecture and organisation of the emergency department must be appropriate to allow provision of adequate care to geriatric patients. So far, the training of nurses and

Recommendations

This paper indicates that the care provided to geriatric patients in an emergency department is not always optimal. Since the impact of this population group on emergency care is going to increase, more attention needs to be devoted to this area. Eliastam (1989) and Baraff et al. (1992) made a number of important recommendations that may optimise the care and treatment of elderly people in an emergency department and make it more patient-oriented.

  • 1.

    The attitude of nurses and doctors in an

Conclusion

Due to demographic developments, the proportion of elderly people in society is going to increase rapidly. This is having a major impact on emergency care for the population. The specific needs of elderly people, their greater use of health care resources, and the increasing costs associated with this imply that adequate attention must be devoted to emergency treatment for geriatric patients. An accurate assessment of physical, mental, and social functioning, improved communication with

Acknowledgements

A Dutch version of this paper has been published as a chapter in ‘Verpleegkundige zorgaspecten bij ouderen’. Reproduced by kind permission of Elsevier from Moons P, Arnauts H, Delooz H. Verpleegkundige zorg voor ouderen op een spoedgevallenafdeling. In Milisen K, De Maeschalck L, Abraham I. (Eds.) Verpleegkundige zorgaspecten bij ouderen, 2002. Maarssen, Elsevier. ISBN 90 352 2486 8

References (33)

  • G.R Strange et al.

    Use of emergency departments by elderly patients: projections from a multicenter data base

    Annals of Emergency Medicine

    (1992)
  • M.S Weingarten et al.

    Trauma and aging effects on hospital costs and length of stay

    Annals of Emergency Medicine

    (1988)
  • S.A Baum et al.

    Old people in the emergency room: age-related differences in emergency department use and care

    Journal of the American Geriatrics Society

    (1987)
  • F Béland et al.

    Elderly patients’ use of hospital-based emergency services

    Medical Care

    (1991)
  • M.J Clark et al.

    Older people’s use of ambulance services: a population based analysis

    Journal of Accident and Emergency Medicine

    (1999)
  • C.T Currie et al.

    Elderly patients discharged from an accident and emergency department: their dependency and support

    Archives of Emergency Medicine

    (1984)
  • Cited by (30)

    • Unrecognized Incident Delirium in Older Emergency Department Patients

      2019, Journal of Emergency Medicine
      Citation Excerpt :

      Population projections consistently forecast growth in this group of patients aged 65 years and older. It is therefore important that we adapt ED health care services and environment, given older patients’ documented need for more complex care and resources (4,5). Several recommendations and guidelines aiming to improve emergency care for older patients have been published (6,7).

    • Determining emergency physicians' and nurses' views concerning older patients: A mixed-method study

      2015, International Emergency Nursing
      Citation Excerpt :

      In our study, nurses identified the term ‘good nursing care’ using terms involving the manner in which good nursing care should be provided (Table 2). As these patients are more functionally dependent relative to other patient groups, it is necessary for emergency service staff to assess them more accurately during initial presentation and plan patient care more elaborately (Moons et al., 2003). Emergency services provide treatment and care for high-volume patient groups according to their specific characteristics.

    • Older peoples' experience of accessing emergency care

      2010, Australasian Emergency Nursing Journal
      Citation Excerpt :

      ED workload, staffing, overcrowding and access block are key factors in prolonged waiting times and sources of clinical risk for all ED patients.48–50 Waiting times for older people may be prolonged for a number of reasons.2,3,33 First, the complex nature of their presenting problems may result in failure of triage personnel to appreciate that problems such as immobility, falls and confusion are key indicators of acute illness in older people.

    View all citing articles on Scopus
    View full text