Care of the Geriatric Patient

Older adults (65 and older) are the fastest growing segment of the population and represent an increasing proportion of emergency department visits. Older adults have unique issues that affect their emergency department care and disposition. Ideally a holistic approach is needed for frail older patients. Evaluation and management are more complex and often more time-consuming. Presentations can be nonspecific and chief complaints may be vague. Diseases can have atypical signs and symptoms. Acute coronary syndrome, acute intra-abdominal diseases, and infections may present atypically in older adults. Syncope may be underrecognized and is more likely to be of cardiac etiology, compared to younger patients. The patient’s cognitive status, both delirium and dementia, should be recognized. Functional status, falls, psychosocial issues, multiple comorbidities, and polypharmacy complicate assessment, care, and disposition. Emergency departments can utilize components of a Comprehensive Geriatric Assessment (CGA) which is a coordinated multidisciplinary diagnostic and intervention process that identifies and addresses geriatric syndromes, which are issues that plague older adults. Care of older adults is ideally patient-centered, and goals of care should be considered to improve the quality of life for aging patients.