Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine

Do no harm

“…Integration of emergency care into older adults' care networks coupled with well-supported pathways back to community-based care are likely to be key. 7 Further development of gerontological competencies for emergency staff in formal training programmes and at the local level should be supported with access to clinicians with emergency geriatric medical expertise to aid complex, time-bound decision-making around discharge disposition. Finally, the built environment of the ED needs to be urgently reconsidered.…”

“…To do this we know will require adequate staffing of our EDs and adequate capacity in our hospitals and community health services to transitional care when the ED encounter is complete. Integration of emergency care into older adults’ care networks coupled with well-supported pathways back to community-based care are likely to be key 7. Further development of gerontological competencies for emergency staff in formal training programmes and at the local level should be supported with access to clinicians with emergency geriatric medical expertise to aid complex, time-bound decision-making around discharge disposition.…”

Health care for older adults in Europe: how has it evolved and what are the challenges?

“…Over the last few years, many key issues related to health care in older adults have been synthesised on a European level, and new consensus reports help to guide clinical practice. Examples include guidelines for the diagnosis of sarcopenia [ 35 ], guidelines for the provision of care for older adults in emergency departments [ 36 ],or a consensus paper on core principles of geriatric rehabilitation [ 37 ]. Based on a European-wide Delphi consensus process, a screening tool for identifying fall-risk increasing drugs was developed for clinical use [ 38 ].…”

The Geriatric-Focused Emergency Department: Opportunities and Challenges

“…What is needed is more collaboration between hospitals, emergency departments, long-term care settings, and other outpatient providers; increased resources and activity around staff training in geriatric principles; and more research in this understudied and critical area of medical care. Incorporation of elements of geriatric assessment into routine emergency department practice around such issues as frailty assessment, 14e17 and tailoring of service delivery to persons with high frailty scores 18 Prognosis, risk, and functional trajectories of older persons who present for emergency care 19,20 Who, when, and under what circumstances to conduct diagnostic testing 21 Geriatric-specific guidelines for medication use 14 Appropriate use of emergency departments by long-term care facilities, and improved methods of acute care in the facility 13,22e25 Under what circumstances and how best to fold in discussion of and decision making regarding limitation of treatment, advance directives, and palliative care 26e28 Care of persons with Alzheimer's disease and related dementias in emergency department settings 29…”