Seniors in the ER, The Care that Costs

by Dr. Macie Smith, CEO, Diversified Training Consultants Group, Columbia, SC 

One trip to the emergency room (ER) lands someone’s 86 year-old mother in the hospital with limited memory, limited inhibition, verbal and physical aggression, and hallucinations. Now what could possibly have caused this? There are many reasons seniors experience “hospital induced delirium”. Delirium is a sudden state of confusion caused by various stimuli. When entering the halls of the emergency room/department there are many unwanted stimuli, such as the lighting; the noise; the people; and the procedures (prodding and poking with or without permission). And in many cases, seniors may receive anti-psychotic or anti-anxiety medications to treat behaviors of aggression. Certain medications, such as anti-psychotic, anti-anxiety, pain medications, and muscle relaxants (to name a few) can have adverse affects on seniors. In fact, The American Geriatrics Society warns of many different medications that the geriatric population should avoid or use with caution. The Beers Criteria provides a comprehensive look at medications that could potentially cause harm to seniors and should be discussed with one’s physician

  1. When accessing the emergency room/department for an acute condition, there must be some awareness that the hospital staff is not familiar with the patient that is coming for an emergent condition. Because of this ambiguity, the senior may not receive a proper treatment plan. In most cases this is the first and only time the hospitalist will lay eyes on this patient; therefore, the treatment provided is based on presenting symptoms, not necessarily the patient’s history; the physician only knows what he/she is told and witnesses.
  2. Studies support that at least 92% of American’s baby boomers have at least 1 chronic illness and at least 77% have at least 2 chronic illnesses. To date, chronic illnesses account for 75% of our healthcare spending, but only 1% of healthcare dollars are spent on public efforts to improve overall health

So, what does this mean? As a collective unit (i.e. families, faith-based organizations, medical, social, and governmental agencies etc.), we must invest in geriatric care education on all levels. I recommend accessing the Beers Criteria,, as the first course of action to gain a better understanding of the medications that are not recommended for seniors. You will also want to reduce the number of times emergency rooms/ departments are utilized for conditions that can be treated by a primary care physician or in a less stimulating environment. Additionally, ask questions about the benefits and risks of all medications prescribed. The best deterrent to adverse events is asking the right questions. By doing so, you can reduce cost and improve one’s quality of living.

  1. Sources: 
  2. Agency for Healthcare Research and Quality. (2015). American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults.

Center for Disease Control and Prevention. (2015). Death and mortality.