Gthere elderly people need targeted assistance, which keeps them safe when they go to the emergency room for an emergency. Unfortunately, the opposite happens. The long waits among dozens of people, often suffering from respiratory infections, subject them to a risk of worsening of their pathologies or new infections which then force them to be hospitalized.
This is what the experts recommend Italian Society of Gerontology and Geriatrics (Sigg) on the occasion of the 68th National Congress, in which they highlighted the need for an ‘elderly friendly’ emergency room. The constant and homogeneous presence of the geriatrician starting from the DEA (Emergency, Urgency and Reception Department) would improve the assessment of his clinical needs and could direct him towards the most appropriate care services on a case-by-case basis.
Elderly people, geriatricians are needed in the emergency room to reduce hospitalizations
According to studies by della Italian Society of Gerontology and Geriatrics (Sigg), if there were more geriatricians in the emergency room there would be 20% fewer hospitalizations. This was clearly stated by Professor Andrea Ungar, president of Sigg and professor of geriatrics at the University of Florence: «The presence of the geriatrician in emergency departments is fundamental to reduce unnecessary hospitalizations and ensure correct care of the elderly» .
Elderly people in the emergency room: the numbers
According to the data illustrated during the Florence Congress, visits to the emergency room are the basis of the majority of hospitalizations and are between 230 and 300 per 1000 inhabitants between 40 and 69 years of age. To then surge, exceeding 500 per 1000 inhabitants, after the age of 75.
Although the elderly are the people who most often go to the emergency room, i first responder departments are not prepared to follow them adequately.
This is why it is necessary to guarantee the fastest and most appropriate route with the presence of geriatricians right from the emergency room. This is also demonstrated by the results of the studies published on BMC Geriatrics It is on Journal of the American Geriatrics Society which highlight a 20% reduction in hospital admissions thanks to the inclusion of the geriatrician in the emergency room transition program.
Because emergency rooms are not suitable for the elderly
For the elderly, long waits were described at the Conference as a problem risk factor. Furthermore, inadequate care can contribute to cognitive decline et al worsening of physical conditions. Once you enter the department, one elderly person in three is undermined by it in knowing how to look after himself precisely because of those interventions that should instead be therapeutic.
Prolonged bed rest, multiple drug therapies, change in usual sleep patterns, lack of adequate nutrition and isolation, they increase the incidence of delirium, falls and the spread of infections.
Fewer hospitalizations and more home care
«This phenomenon requires a rethinking of the organization of the evaluation of elderly people who present themselves at the emergency room in such a way as to reduce their stay in environments that could worsenrather than improving their health conditions. It is therefore of primary importance reduce unnecessary hospitalizations and treat the patient as much as possible in a home context. In this context, the geriatrician has a key role in the correct management of the clinical and healthcare needs of the elderly”, states Andrea Ungar.
«The elderly are more complex patients, with many diseases and who take many medications. Often, then, they also present social problems, as well as health ones – adds Antonio Cherubini, IRCCS geriatrics director of Ancona -. They require more diagnostic investigations and therefore require a longer stay in the emergency room. Unfortunately, however, they frequently do not receive an adequate response because the working approach of emergency departments is poorly suited to such complex patients.”
More geriatrics experts in hospitals and emergency rooms
«To solve this problem – adds Enrico Benvenuti, director of geriatrics at the Central Tuscany Health Authority – it is necessary to integrate the professional figures found in the emergency rooms with geriatrics experts. The role of the specialist in this context is that of take care of patients who are already awaiting admission to the DEA through one multidimensional assessment of cognitive functionloss of autonomy, risk of falls and well-being caregiver in order to set up the optimal treatment plan together with the emergency room doctors which favors the best possible treatment path quickly, including the possibility of being followed at home.”
Over 80s followed by a geriatrician are healthier: two studies
There is a Swedish observational study published in BMC Geriatrics which demonstrates the effectiveness of the presence of geriatricians in emergency departments. The researchers have compared the outcomes relating to patients over 80 taken care of by a specialist unit with geriatric experts, and patients in the same age group followed by a standard team, not specialized in the elderly.
From the results it was possible to detect how the elderly followed by the geriatric team had fewer hospitalizations: 31% versus 50% recorded by those who were taken over by the traditional team. An important difference was also noted in the discharge rate which for the elderly followed by the geriatric team was 48.3%i.e. 16% higher than the elderly followed by the traditional team.
The same results were also obtained from an American study published in Journal of the American Geriatrics Society from which a 17% decrease in hospitalizations emerged.
A winning choice, not only for the elderly
«From this it emerges that ‘geriatricising’ the emergency room proved to be a winning choice to ensure better care for the elderly. The geriatric emergency care model includes training of interdisciplinary staff on evidence-based protocols for geriatric syndromes and conditions, coordination of care, and appropriate structural modifications to the physical space, all of which have been shown to successfully improve quality of care and safety of older adults”, underlines Ungar.
The Girot experience: what it is and how it works
A further step forward in the treatment of elderly people who turn to first aid departments is represented by the experience obtained from Girot, rapid intervention group in local hospital, developed in Florence and in use in the city’s emergency departments. «Only last year thanks to Girot was it possible guarantee home hospitalization for 80% of patients who turned to our first aid points and who would otherwise have been sent to the hospital department. This service is mainly aimed at patients in code three, the segment that most clogs up the emergency areas, i.e. patients who present a clinical decompensation and for whom it is difficult to guarantee absorption in the hospital departments”, explains Benvenuti.
The advantages of Girot for the elderly
Furthermore, with this system, the average time taken for each patient was 8-10 days, at the end of which just 7% had to be admitted directly to hospital or to the emergency room and the Mortality was just 5%, a sharp decline compared to the 18-20% national and international average for frail elderly patients admitted to hospital.
«Future developments of the Girot are also being evaluated – continues the expert – which provide for a collaboration with 112, so that operators can access medical records and avoid unnecessary hospitalizations, favoring home stabilization and an alternative to hospitalization.”
Better organization assisted even at home
A strengthening of geriatric care, at the level of departments, emergency rooms and local services is therefore fundamental – concludes Ungar -, especially considering the progressive aging of the population and realizing that this is often not healthy ageing, rather it is accompanied by various concomitant pathologies.
It is therefore necessary equip yourself with multiple synergistic actions: strengthen hospitals to accommodate this vulnerable population segment, increase the number of complex geriatrics operating units. Furthermore, you should increase the offer of geriatric services within hospitals: Orthogeriatrics, Delirium Room, Oncogeriatricsto. Finally, steps should be taken to include the Geriatrician consultant within the EDs, regardless of the possible presence of a complex Geriatrics operational unit in the relevant hospital location”, concludes the expert.
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