The number of geriatric visits to United States emergency departments continues to rise. This article reviews demographics, statistics, and future projections in geriatric emergency medicine. Included are discussions of US health care spending, geriatric emergency departments, prehospital care, frailty of geriatric patients, delirium, geriatric trauma, geriatric screening and prediction tools, medication safety, long-term care, and palliative care.
Key points
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As the number (and percentage) of Americans 65 years and older continues to grow, the number (and percentage) of geriatric emergency department (ED) visits will continue to rise significantly.
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The aging of the United States population is a force that is driving up the cost of health care.
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There is a growing movement in the United States to incorporate features into EDs to make them friendlier for elderly patients.
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Geriatric patients are often sicker than their younger counterparts and may be lacking many classic features of disease states.
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Recognizing delirium in the elderly ED patient is an essential component of geriatric emergency medicine.
Background
According to the Administration on Aging (AoA), US Department of Health and Human Services, 14.1% of the population in the United States, totaling 44.7 million Americans, was 65 years of age or older in 2013. AoA projects that older Americans will make up 21.7% of the population by 2040 and that there will be 98 million older persons living in America by 2060 ( Fig. 1 ).
The National Center for Health Statistics of the Centers for Disease Control reports 136.3 million emergency department (ED) visits in 2011, of which 20.4 million (15%) were senior citizens (age ≥65 years) ( Table 1 ). More recent statistics estimate the current percentage of ED visits of patients older than 65 years at 18% , with patients 75 and older having the highest visit rate compared with all other demographics. Senior citizens presenting to the ED are more likely to be triaged to higher levels of urgency (levels 1, 2, and 3) ( Table 2 ), spend more time in the ED for diagnostic testing, and use more resources compared with their younger counterparts.
| Selected Patient Characteristics | Number of Visits in Thousands (Standard Error in Thousands) | Percent Distribution (Standard Error of Percent) | Number of Visits per 100 Persons per Year a (Standard Error of Rate) | |||
|---|---|---|---|---|---|---|
| All visits | 136,296 | (6413) | 100.0 | — | 44.5 | (2.1) |
| Age a | ||||||
| Younger than 15 y | 24,823 | (1724) | 18.2 | (0.9) | 40.6 | (2.8) |
| Younger than 1 y | 3485 | (303) | 2.6 | (0.2) | 87.3 | (7.6) |
| 1–4 y | 9773 | (737) | 7.2 | (0.4) | 60.5 | (4.6) |
| 5–14 y | 11,565 | (823) | 8.5 | (0.4) | 28.2 | (2.0) |
| 15–24 y | 22,150 | (1140) | 16.3 | (0.3) | 51.7 | (2.7) |
| 25–44 y | 39,124 | (1997) | 28.7 | (0.6) | 48.7 | (2.5) |
| 45–64 y | 29,828 | (1537) | 21.9 | (0.5) | 36.4 | (1.9) |
| 65 y and older | 20,372 | (1172) | 14.9 | (0.5) | 50.8 | (2.9) |
| 65–74 y | 8208 | (518) | 6.0 | (0.2) | 36.9 | (2.3) |
| 75 y and older | 12,163 | (729) | 8.9 | (0.3) | 68.2 | (4.1) |
| Sex and age a | ||||||
| Female | 74,621 | (3622) | 54.7 | (0.4) | 47.6 | (2.3) |
| Younger than 15 y | 11,385 | (820) | 8.4 | (0.5) | 38.1 | (2.7) |
| 15–24 y | 13,289 | (746) | 9.8 | (0.2) | 62.6 | (3.5) |
| 25–44 y | 22,534 | (1192) | 16.5 | (0.4) | 55.1 | (2.9) |
| 45–64 y | 15,381 | (862) | 11.3 | (0.3) | 36.4 | (2.0) |
| 65–74 y | 4353 | (296) | 3.2 | (0.2) | 36.6 | (2.5) |
| 75 y and over | 7678 | (498) | 5.6 | (0.2) | 72.1 | (4.7) |
| Male | 61,676 | (2890) | 45.3 | (0.4) | 41.2 | (1.9) |
| Younger than 15 y | 13,439 | (945) | 9.9 | (0.5) | 43.0 | (3.0) |
| 15–24 y | 8861 | (463) | 6.5 | (0.2) | 41.0 | (2.1) |
| 25–44 y | 16,590 | (906) | 12.2 | (0.3) | 42.1 | (2.3) |
| 45–64 y | 14,446 | (768) | 10.6 | (0.3) | 36.4 | (1.9) |
| 65–74 y | 3855 | (283) | 2.8 | (0.1) | 37.2 | (2.7) |
| 75 y and older | 4485 | (293) | 3.3 | (0.2) | 62.4 | (4.1) |
| Patient residence | ||||||
| Private residence a | 126,297 | (5984) | 92.7 | (0.4) | 41.2 | (2.0) |
| Nursing home b | 2557 | (184) | 1.9 | (0.1) | 74.2 | (5.3) |
| Homeless c | 1092 | (160) | 0.8 | (0.1) | 171.7 | (25.1) |
| Other | 1401 | (135) | 1.0 | (0.1) | 0.5 | (0.0) |
| Unknown or blank | 4949 | (475) | 3.6 | (0.3) | 1.6 | (0.2) |
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