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Introduction

As life expectancy rises, the number of emergency department visits for adults aged 65 years and greater will continue to increase. The need to define and provide high-quality geriatric-specific emergency care has given rise to the new subspecialty of Geriatric Emergency Medicine (GEM). The combination of chronic medical conditions and reduced physiologic reserve complicates the clinical presentation of older adults, making diagnosis and treatment of even common diseases difficult. Leaders in the field have written that, “Vulnerable older patients often arrive to the emergency department with multiple comorbidities and vague chief complaints that require more complex decision making and prolonged evaluation times and increase the likelihood of admissions. ED providers are concurrently pressured to increase throughput and discharge many of these patients." The care of older adults necessitates in-depth investigation of complex social influences, including baseline independence and functioning, medication adherence and polypharmacy considerations. For acute presentations of illness, the ED visit often necessitates unplanned goals of care discussions. These tasks necessitate a robust interdisciplinary approach to each geriatric ED patient and highly impact admission and readmission rates. As a result, Geriatric Emergency Medicine has emerged as a subspecialty of emergency medicine that is geared toward understanding how best to care for elderly in the acute care setting.

United States: The population of adults in the United States over age 65 is projected to increase from 40 million in 2010 to 70 million in 2030, notably due to aging baby boomer generation. Older adults patients will constitute a quarter of all emergency department (ED) visits, up from 15% in 2010. Wilber S, Gerson L, Terrell K, et al. Geriatric emergency medicine and the 2006 Institute of Medicine reports from the Committee on the Future of Emergency Care in the U.S. health system. Acad Emerg Med. 2006;13(12):1345-1351. A proposal for GED accreditation was accepted in January 2017 and will be awarded to hospitals on a three-tier platform as determined by each hospital’s level of implementation of GED guidelines.

Research: Researchers in Geriatric Emergency Medicine recognize the critical need for randomized, controlled trials for older adult care, as much EM research historically has excluded older adults from study populations. There is also robust interest in shared decision making as the management of older adults in the ED is often a difficult puzzle to solve, complicated by limitations in communication, contradicting treatment plans, and the frequent misalignment of patients’ priorities with those of their caregivers.

Organizations: Several organizations within Emergency Medicine societies have been established to improve the care of Geriatric Emergency Medicine patients, disseminate GEM guidelines, and assist in the establishment of GEDs. These include the Academy for Geriatric Emergency Medicine (AGEM) within the Society for Academic Emergency Medicine as well as Geriatric Emergency Medicine Section (GEMS) within ACEP. For more information, the website Geriatric ED as well as podcast GEMCAST serve as resource-packed hubs for updates and collaboration within the GEM movement. GEM has also been featured in Academic Life in Emergency Medicine.

Training: The recent development of Geriatric Emergency Medicine Fellowship following traditional EM training will increase the availability of this knowledge and training to EM residency-trained physicians with expanded opportunities to work in Geriatric Emergency Departments.