Some hospitals open ERs just for graying patients

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The Associated Press
Monday, March 14, 2011; 9:40 PM

WASHINGTON -- Many hospitals run emergency rooms just for children. Now a few are opening ERs specially designed for seniors, without all the confusion and clamor and with a little more comfort.

It's a fledgling trend, but expected to increase as the population rapidly grays. The question is whether they'll truly improve care.

"Older people are not just wrinkly adults. They have totally different needs," says Dr. David John, who chairs the geriatric medicine division of the American College of Emergency Physicians.

Modern ERs are best equipped to handle crises like gunshot wounds or car crashes, not the lengthy detective work it can take to unravel the multiple ailments that older people tend to show up with, John says.

Those older patients may not even have the same symptoms as younger people. They're less likely to report chest pain with a heart attack, for instance, complaining instead of vague symptoms such as dizziness or nausea. Urinary tract infections sometimes cause enough confusion to be mistaken for dementia.

And a study published in January called delirium and dementia an "invisible hazard" for many older patients because ERs don't routinely check for not-too-obvious cognitive problems - yet such patients can't accurately describe their symptoms or understand what they're supposed to do at home.

Seniors already make 17 million ER visits a year, and 1 in 5 Americans will be 65 or older by 2030.

St. Joseph's Regional Medical Center in Paterson, N.J., started a 14-bed Senior Emergency Center two years ago, and plans to open a larger one in the fall, said emergency medicine chairman Dr. Mark Rosenberg.

"It's still hustle and bustle, but it's a couple notches down from the craziness of the main emergency department," he says.

The idea behind senior ERs: Put older patients in an area that's a bit calmer for team-based care to not just treat the problem that brought them to the hospital, but to uncover underlying problems - from depression to dementia to a home full of tripping hazards that might bring them back.

Rosenberg has documented a big drop in the number of seniors who make return visits since his center began day-after-discharge calls to monitor how they're doing.

There's no official count, but at least a dozen self-designated senior ERs have opened around the country since the first in Silver Spring, Md., in 2008. The one in Maryland and eight in Michigan are operated by Catholic health system Trinity Health of Novi, Mich., which plans to open two in Iowa later this year, followed by more in other states.


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