The number of older people in emergency rooms is expected to increase significantly over the next 30 years, doubling in the case of those older than 65 and potentially tripling among those over 85.
Our healthcare system is in critically short supply of primary care physicians and geriatric specialists to treat seniors. As a result, many seniors end up in emergency rooms rather than being treated in the community.
The emergency room can be an overwhelming place for seniors, as they must enter an unfamiliar environment, field rapid-fire questions, then experience fear and anxiety about the diagnosis that awaits.
Are our emergency rooms prepared for this significant growth in senior patients? The answer might be no, unless we heed a call to arms in the following critical areas.
Nationwide, more than half of the people with mental illness go untreated, according to Mental Health America. Many seniors with mental illness don’t realize they have it because they are dealing with multiple medical issues.
Their challenges are rarely purely psychiatric, and consequently, it’s hard in the ER to receive prompt comprehensive care for their mental illness.
Two hospital studies conducted from 2007 to 2010 found that the number of patients age 65 and older coming to the ER with mental health issues such as dementia, Alzheimer’s and depression increased nearly 21 percent. A lack of awareness among the general population about the mental illnesses facing seniors leads to older patients often ending up in the ER when a crisis occurs.
Drug side effects
An increasing number of older people are arriving at the ER as a result of side effects or adverse reactions to the prescription drugs they are taking.
According to Centers for Disease Control and Prevention, 35 percent of ER visits due to adverse events from prescription medications in 2013-14 were by adults age 65 years and older, compared with 26 percent in 2005-06. Among that group, seniors made up 44 percent of those who required hospitalization as a result of the drug’s adverse effects.
Blood thinners, antibiotics and diabetes agents were involved in almost half of the prescription-drug-related visits.
In our fragmented healthcare system, patients are often seen by multiple physicians, each having an incomplete view of the patient’s drug use. Clinicians often hesitate to discontinue medications because of lack of familiarity with the medication or patient.
Just last week the California Health Report published an article stating that the rate of patients over 65 seeking care at hospital ERs for opioid-related issues in California was second only to Arizona among the 50 states.
Often, older Americans who struggle with opioid addiction have been prescribed the medication to deal with managing pain upon being discharged from the hospital following surgery.
According to the Journal of the American Medical Association, of those who received an opioid prescription, more than 42 percent still had the prescription in place 90 days after they left the hospital.
ER visits often focus on the physical injuries (pain and broken bones from a fall that really was due to the loss of fine motor skills—a result of long-term opioid use) and push the root cause into the background. Because of the stigma, seniors also struggle with admitting drug dependency.
Identifying the caregiver
Almost half of all seniors over the age of 70 live alone today. Who advocates for them and how are these advocates identified in the emergency room?
Seniors enter the ER either from home, an assisted-living facility or, in some cases, from the streets. Frequently they do not have a family caregiver or an individual who is operating as their designated healthcare proxy with them.
The ER can be an overwhelming place, and a second set of ears, eyes and voice can lead to a better set of outcomes. Family caregivers also play critical roles in transitions from hospital to home or other post-acute settings.
As a community, we have an opportunity to work together to educate seniors and caregivers on what to expect when they enter the hospital and to inform hospital staff about the many challenges today’s seniors face.
Consider joining Senior Concerns as it hosts a seminar titled “Things You Should Know Before Your Next Hospital Stay” from 5:30 to 7 p.m. Tues., Sept. 19 at 401 Hodencamp Road, Thousand Oaks. Call (805) 497- 0189 to reserve your seat.