Frail seniors' needs in ER missed

Emergency departments often miss meeting the needs of frail seniors, says a Canadian geriatrics researcher who led a new international study that offers suggestions on improving care.

The study published recently in the Annals of Emergency Medicine looked at nearly 2,300 patients with an average age of 82 in seven countries, including 532 in Canada.

Prof. John Hirdes of the University of Waterloo's School of Public Health and Health Systems and his co-authors found:

• 78 per cent depended on others for personal activites of daily living such as bathing or dressing, had a cognitive problem or had fallen in the past 90 days
• 49 per cent could not walk without supervision.
• 26 per cent showed cognitive impairment.

"They may not come to the emerg because they're about to die, but they may come because they've got chronic disabilities, a high level of fraility and their caregivers aren't coping and they're coming there as a first point of contact for help," Hirdes said today. "Those folks are the ones that's its critical to connect properly with the home-care system and to reconnect with primary care."

When a frail person comes to the chaotic and noisy environment of an emergency department, the risk for misdiagnosis, for example delirium as dementia, is high, he said.

The researchers suggested managing seniors in emergency rooms differently, such as:

• Expand geriatric nurses who receive specialized training in meeting the needs of older adults.
• Consider seeing frail seniors in a separate, quieter and accessible area.
• Use the short screening tool tested in the study to assess seniors' disability and need for referral.

The screening tool is already used to assess patients for home-care in most provinces, Hirdes said.

Dr. George Heckman is a geriatrician in Kitchener-Waterloo who works with Hirdes but wasn't involved in this study. Heckman said he gets a sense the findings are true in his practice.

• Ageism in health care needs to end, doctor says

Heckman teaches family health teams about dementia and heart failure that seniors face.

"These are all really good, hard-working professionals but they've been trained in a system that doesn't allow them to recognize this," Heckman said, noting both doctors and nurses receive few lessons in geriatric care in their training.

"We really have to go upstream," to family medicine, Heckman suggested. "Start intervening there first because it's always less expensive to do it before the wheels fall off."

The researchers called the study the most extensive international study of the characteristics and outcomes of older emergency department patients that they're aware of.

The study was funded by the Canadian Institutes of Health Research, Princess Alexandra Hospital Research Foundation in Australia and Bavarian Ministry of Environment and Health in Germany.