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Writer's pictureCindy Davis

Why the Right Emergency Facility Is Crucial for Older Adults


Image with directional sign to the ER

Facing the reality of frequent hospitalizations and emergency room visits as loved one’s age can be a deeply emotional experience, often marked by confusion and a need to make decisions at a rapid pace under tremendous stress. Reflecting on my father’s journey as he approached the end of his life, I recognize now there were numerous signs that his health was declining significantly. Regrettably, the full gravity of his condition and what it meant for our family’s future was never fully communicated by his medical teams. This lack of clear guidance left us navigating a maze of decisions without a map, leading to unnecessary anxiety and a feeling of unpreparedness.

 

This series, “The Crisis”, is born out of the lessons learned during those critical moments and a commitment to share with others to avoid a sense of “if I knew then what I know now, I would have:

 

  • Been more prepared. Understanding the healthcare landscape and what to expect can significantly reduce the shock and stress of sudden hospital visits.

  • Asked better questions about options. Knowing what choices are available, from the type of services to potential treatment settings, can empower decisions that align better with the you and your family’s needs.

  • Requested different resources. Identifying and insisting on the elderly-specific resources could have smoothed the transitions between settings and perhaps improved outcomes.

  • Had difficult discussions. Engaging in honest conversations about the prognosis and the likely trajectory could have helped in managing expectations and making more informed decisions.

  • Made peace with where we were going. Acceptance of the situation, while challenging, is imperative in managing emotional stress and focusing on quality of life in remaining days.”

 

Like giving up driving, frequent hospitalization represents a significant and often irreversible change in an elderly person’s life. It’s confusing, stressful, and laden with emotion. This blog series aims to equip you with the information and insights needed to navigate these tumultuous times with more confidence and clarity.


Why is Hospitalization a Turning Point for Older Adults?

Hospitalization represents a significant turning point for you or your elderly loved one, often heralding a period of substantial lifestyle change. Recent studies have confirmed that older adults, particularly those aged 65 and older, are at a heightened risk of experiencing a decline in their functional abilities after hospital stays for up to one year and continuing for up to three years. The implications of such declines are profound, affecting not only the immediate recovery but also the long-term quality of life.


What are the Key Statistics on Hospitalization Impact for Older Adults?

As you navigate the system for yourself or an aging family member, understanding the statistics can provide a clearer picture of the risks and realities of hospitalization.

 

 

These statistics highlight the critical need for you to understand and prepare for the potential outcomes of hospitalization, as the effects can extend far beyond the initial recovery period, influencing long-term wellbeing, the possibility of institutionalization, and even life expectancy. For a refresher on ADLs and IADLs refer to these posts:

 


What are the Top 10 Reasons and Diagnosis for ER Visits for Those 65+?

When you or a loved one over the age of 65 visits the emergency room, it's critical to understand the common reasons and diagnoses associated with these visits. This knowledge can help you better anticipate and manage potential problems.

 

Top 10 Reasons for ER Visits

According to the Centers for Disease Control (CDC) from 2016-2021 the leading reasons for ER visits for those 65 years of age and older have been:


Pie chart showing to 10 reasons for ER visits

 

  1. Stomach and abdominal pain, cramps, and spasms lead the list, reflecting common digestive system issues among older adults.

  2. Chest pain and related symptoms, not directly referable to any specific body system, often indicate cardiovascular problems.

  3. Shortness of breath, increasingly common, can be associated with a range of respiratory and cardiac conditions.

  4. Cough is a frequent symptom that can signify respiratory infections or chronic conditions like chronic obstructive pulmonary disease (COPD).

  5. Fever, often a sign of infection, can be more severe in older adults due to their typically weaker immune systems.

  6. Headache and pain in the head can range from benign to severe, indicative of conditions like migraines or strokes.

  7. Pain, site not specified, is general pain not linked to any particular part of the body and can be challenging to diagnose and manage.

  8. Back symptoms, including pain and mobility, are often related to degenerative changes in the spine.

  9. Vomiting is usually related to digestive upsets but can also be a side effect of medication or a symptom of a more serious condition.

  10. Other symptoms and problems related to psychological and mental disorders reflect various underlying mental health challenges.

 

These reasons illustrate a range of acute and chronic conditions, highlighting the importance of managing underlying illnesses to prevent emergencies. If you or your loved one are exhibiting any of these symptoms, it is critical to contact your primary care provider (PCP) and/or go directly to the emergency room.

 

Top 10 Diagnoses at Admission

The diagnoses leading to hospital admission for those aged 65 and older according to the CDC often reflect a combination of acute episodes and exacerbations of chronic conditions. Here is a deeper look into these diagnoses:


Pie chart showing to top 10 ER diagonese

  1. Symptoms, signs, and abnormal clinical and laboratory findings often encompass nonspecific symptoms like chest pain, abdominal pain, nausea, diarrhea, vomiting, headache, fever, vertigo, and dyspnea, necessitating thorough investigations to pinpoint the underlying causes.

  2. Common injuries such as broken bones, sprains, and bruises are frequent among older adults, often resulting from falls, with the severity of these injuries often exacerbated by age-related bone density loss and mobility challenges.

  3. Vital and life-threatening circulatory system conditions such as hypertension, heart attacks, heart disease, and cerebrovascular diseases like strokes are common reasons for hospital admissions among the elderly.

  4. Respiratory infections like influenza, pneumonia, sinusitis, and chronic bronchitis are particularly dangerous for the elderly and can rapidly escalate, requiring urgent medical intervention.

  5. Chronic musculoskeletal conditions such as back and joint pain, rheumatoid arthritis, and osteoporosis are prevalent in older adults, significantly affecting mobility and potentially leading to other complications.

  6. Diseases of the broader urinary and genital tract systems, which include kidney failure and infections, urinary tract infections, and other disorders affecting the reproductive system, can lead to severe discomfort and other serious matters.

  7. Disorders of the digestive system including irritable bowel syndrome, constipation, problems with the gallbladder, pancreatitis, diverticulitis, and Crohn’s disease frequently necessitate an emergency room visit due to pain or complications.

  8. Skin conditions such as cellulitis, cutaneous abscesses, and other inflammatory skin conditions are frequent in older adults, often due to compromised skin integrity and other challenges like diabetes.

  9. Dementia, depression, and other mental health issues are significant concerns for older adults, often requiring specialized management of these complex conditions.

  10. Certain infectious and parasitic diseases, including severe infections like sepsis and various viral infections, can be critical and require immediate medical attention.

 

These diagnoses highlight the typical conditions that frequently result in hospital admissions for older adults, emphasizing the complexity involved in managing your quality of life. If you suffer from one or more of these conditions and experience the associated symptoms, the likelihood of needing multiple ER visits increases.

 

Understanding these common medical conditions allows you to better anticipate potential emergencies and how to respond, helping to manage your conditions proactively and reduce the stress of unexpected medical visits.


What is the Average Length of Stay for Those 65+ After an Acute Event?

Although the average length of hospital stays for older adults remains fairly similar across the senior age spectrum, it is important to note that each increment in age tends to see a slight increase in the duration of hospitalization compared to the overall median for all ages, which is around 4.6 days. Here's a breakdown of the average length of stay by specific age groups:

 

  • Ages 65-74: Seniors in this age group have an average hospital stay of approximately 5.3 days, which is 15% longer than the median for all ages.

  • Ages 75-84: This age bracket sees a further increase, with an average stay of 5.6 days or a day longer than the average.

  • Ages 85 and older: Consistently, this group also records an average of 5.6 days in the hospital.

 

These figures underscore that while the duration of hospital stays is relatively consistent among those aged 65 and older, it is generally higher than the median stay observed across all age groups. The incremental increase in hospital stay duration as seniors age reflects the growing complexity and severity of illnesses faced by this demographic, necessitating longer recovery times and more intensive interventions during hospitalization.


Where are Older Adults Going After Hospital Stay?

The transition from hospital to home or another institutional setting is a critical phase for older adults, often complicated by the medical complexities and functional disabilities they face. Understanding the trends in discharge locations and the need for post-acute aid is fundamental for planning and support.

 

Older adults, particularly those aged 65 years and older, frequently require continued support following a hospital discharge. Nearly 70% of seniors require some form of post-acute care, such as home health or skilled nursing facility (SNF) services. This is in stark contrast to middle-aged adults (ages 45 to 64), who require post-acute attention at a much lower rate of only 23%.

 

More than half of patients discharged from the hospital receive support from home health agencies (23%) or are admitted to skilled nursing (20%), inpatient rehabilitation (4%), and long-term care (LTC) hospitals (1%) or choose hospice (4%).


Bar chart showing trends in hospital discharges by location

 

This high demand for post-acute services among seniors underscores the significant challenges they face in preserving their functionality and independence after being admitted to the hospital following a trip to the emergency room.


Impact of Hospitalization on Functional Ability

The effect of hospital stays on seniors are profound, especially in terms of their functional abilities. Research indicates that about one-third of patients over 70 years old and more than half of those over 85 leave the hospital with more disabilities than when they were admitted.

 

This increased disability often includes diminished capacity to perform necessary daily activities such as bathing, dressing, and walking. The loss of functional abilities is a critical concern, as it directly impacts seniors' independence after discharge. Consequently, many require substantial assistance at home or need to transition to facilities equipped to provide nursing aid.

 

Caregivers need to be prepared for the increased responsibilities that often accompany the discharge of an older adult. This might involve arranging for home health agency, physical therapy, or even considering placement in a skilled nursing facility if the level of attention needed is beyond what can be provided at home.


Where Should You Go for Emergency Care?

When facing an emergency, knowing where to go in advance is crucial, especially for older adults who have specific needs. Researching and selecting the right emergency room options can significantly impact outcomes for the elderly. Here's how to effectively evaluate hospital options and understand the benefits of specialized units like Acute Care for Elders (ACE) wards.


How Do You Research Hospital Options for the Elderly?

Experts recommend researching nearby emergency departments to understand which ones offer the best services for specific emergencies, such as stroke response or trauma care. Some facilities have earned certification as geriatric emergency departments from the American College of Emergency Physicians, indicating they offer specialized support for older adults. Even if a hospital hasn't obtained this certification, it may still provide age-friendly features like having geriatric social workers and nurse practitioners on duty, making them an excellent choice.

 

Discussing with your PCP about where to go for specific types of emergencies can provide valuable guidance. For less urgent concerns, consider whether your primary doctor can accommodate same-day visits or if an urgent care center might offer quicker service and lower co-payments than an emergency room.  It's also advisable to check if the hospital accepts Medicare to avoid unnecessary costs.


Consider an Acute Care for Elders (ACE) Wards

ACE wards represent a significant hospital advancement tailored specifically for elderly patients. These units utilize an interprofessional, team-based approach to provide elder-friendly emergency and acute services. This model integrates seamlessly with ambulatory, home, community-based, and transitional programs, targeting high-need older adults. They focus on reducing the risk of functional and cognitive decline, as well as the need for future hospitalization.

 

The ACE program is designed to support frail older adults with an acute illness that required hospitalization by identifying potential candidate through electronic protocols, concentrating particularly on those with:

 

  1. Recent functional decline

  2. Changes in cognition or behavior

  3. Common issues like falls or polypharmacy

 

In ACE wards, you'll find features specifically designed to benefit you or your elderly loved one, distinguishing these settings from more traditional hospital environments:

 

  • Early and Direct Attention. From the moment you arrive, social workers and therapists provide a comprehensive evaluation, significantly reducing your risk of hospital-associated disabilities such as falls, delirium, and pressure ulcers. These are especially harmful to older patients, and early intervention can greatly improve your outcomes.


  • Enhanced Geriatric Care. The treatment you receive is highly protocolized and delivered by a medical team with specialized skills in supporting frail and elderly patients. For example, all treatments and interventions are precisely tailored to meet the unique needs of older adults suffering from multiple chronic conditions—arthritis and diabetes—that may impact how you respond.


  • Comprehensive Discharge Planning. Right from your admission, discharge planning is initiated to evaluate your living environment and support systems to ensure a smooth transition when you leave the hospital. This meticulous planning aims to prevent readmissions and includes arranging for appropriate ongoing primary and specialist appointments, as well as home- and community-based supports that cater to your specific needs.


  • Prevention of Functional Decline. The physical environment is thoughtfully designed to prevent the typical decline associated with traditional hospital stays. This proactive approach focuses on enhancing your safety and functional independence. As you age, you may experience a natural loss of muscle mass, strength, and aerobic capacity. These can be further compromised by the deconditioning effects of immobility, such as 1) postural instability, which makes it hard for you to maintain balance and 2) impaired baroreceptor reflexes, which can lead to sudden drops in blood pressure when you stand up causing dizziness, unsteadiness, or even falls. Additionally, these physical impairments might impact your cognition, potentially leading to delirium, anxiety, or depressive symptoms. The ACE ward environment helps mitigate these risks, supporting a healthier and more stable recovery for you.


  • Cultural Change in Hospital Experience. ACE wards foster a significant shift in hospital culture, emphasizing a holistic approach rather than merely treating specific diseases. The culture incorporates all aspects of your physical, emotional, and environmental wellbeing. Additionally, ACE wards move away from the traditional silo-based approach, which often isolates various aspects of treatment and excludes you or your family caregivers from actively participating in the recovery process. This integrated approach not only enhances your overall experience but also supports your functional status and independence, making it easier for you to recover and regain as much independence as possible.

 

ACE ward characteristics are crafted to guaranty that your hospital stay is not only safer and more comfortable but also more attuned to the specific needs that come with aging, ultimately aiding you and your loved ones in coping more effectively during and after your hospital stay.

 

As we conclude this first installment of "The Crisis" series, we've explored why choosing the right emergency facility is critical for older adults. Managing chronic conditions and serious illness as you age involves significant complexities and selecting the appropriate setting for emergency treatment and hospitalization can greatly influence the outcomes of such visits. This post aims to educate you and your loved ones on the top 10 reasons and diagnoses for an emergency department visit by highlighting the importance of understanding and anticipating the needs that come with aging.

 

Looking ahead, our next post titled "What Experienced Seniors Bring for ER Trips and Hospital Stays" will build on this foundation. You will discover the essential items and strategies that experienced seniors and their caregivers use to make sure each visit to the ER or hospital as smooth and effective as possible. You'll receive practical advice on what to pack, what to leave at home, and how to set up a contingency plan to manage duties during hospital stays. Stay tuned to further equip yourself with knowledge and tools that enhance your preparedness for potential challenges, ensuring each encounter is as efficient, effective, and manageable as possible.


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