By Debra Wood, RN, contributor
America continues to age, with 44.7 million people 65 years or older in the United States. By 2033, the U.S. Census Bureau estimates the number of older adults will outnumber people younger than 18 years. All these elders consume more health care.
Vaunette P. Fay, PhD, RNC, said caring for older adults requires an interdisciplinary team educated in geriatric health.
“While older adults currently make up about 15 percent of the population, they currently account for 35 percent of all hospital stays,” reported Vaunette P. Fay, PhD, RNC, a professor at the UTHealth School of Nursing in Houston. “For older adults, those over 65 years of age, and especially adults over 80, there are physiological changes that occur that make it more difficult to fight infection and put them more at risk for injury including falls.”
Some organizations have created Acute Care for Elders (ACE) units, with specially trained interdisciplinary care teams, or geriatric emergency departments to care for older adults.
“There has been some research that has shown the ACE unit interdisciplinary model of care improves outcomes for hospitalized elders while reducing costs for hospitals,” Fay said.
Inpatient geriatric care
On ACE units, the bathrooms and bedrooms have handrails, furniture is designed for easy transfers and a congregate room allows for socialization during meals and activities. Nurses receive training in geriatrics.
“Everything we do is geared to that patient population,” Maureen Pisano, RN, BSN, nurse manager of the 10-bed ACE unit at Jefferson Methodist Hospital in Philadelphia.
Patients are 65 or older, from home and planning to go home, and able to participate in their care. The ACE unit does not accept patients with severe dementia or behavioral issues.
Two geriatric resource nurses staff the unit at all times. They have time to chat with patients and look beyond the physical complaint to learn about the person as a person. They provide holistic care and educate patients and families. Nurse and patient satisfaction remains high.
Richard E. Schultz Jr., BSN, RN, CEN, MICN, said working in a geriatric emergency department requires a different mindset.
“We are about promoting independence,” Pisano said. “It is rewarding to see a patient come in with an illness, and you’re sending them home safer then when they came.”
Emergency care of older adults
St. Joseph’s Regional Medical Center in Paterson, N.J., operates one of the first geriatric emergency departments and has dedicated about one-quarter of its 88 ED beds to caring for older adults.
“The mindset is different,” explained Richard E. Schultz Jr., BSN, RN, CEN, MICN, geriatric nurse navigator in the emergency department at St. Joseph’s. “You have to slow down and not rush these people.”
Many hospitals now operate geriatric emergency departments to care for patients age 65 and older and address their specific needs. Nurses receive geriatric training. Typically, the physical environment differs. Ceiling tiles block noise, railings are everywhere, the floors are nonslip and nonglare, the mattresses are twice as thick, and the electronic medical record system alerts providers if a drug that should not be used in older adults is ordered.
Michelle Moccia, DNP, ANP-BC, CCRN, said that working in a senior ER has made her a better clinician.
“What makes the senior ER different is the senior assessment we do,” said Michelle Moccia, DNP, ANP-BC, CCRN, program director of the senior ER at St. Mary Mercy Livonia Hospital in Michigan.
Nurses assess patients’ risk for readmission or admission to a nursing home, mediations, living conditions, caregiver support, recent falls, weight changes, performance of activities of daily living, and atypical disease presentations. They also screen for cognition impairment or depression.
“We want patients to go home, but we also look at safety factors,” Moccia said. “We are about resilience and keeping that person empowered.”
“You have to worry about co-morbidities and absorption rates for medications,” Schultz said. “Our workups are different, because the body ages.”
Readmission and admission rates fell at St. Joseph’s since opening the geriatric ED. At Trinity, patient and family satisfaction has increased and admissions declined.
“It’s rewarding to take care of patients when they have been looked at as a person,” Schultz said. “Sometimes in the ER, we get fixated on caring for the patient and not the person. That’s where the difference lies.”
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