When older adults visit a hospital emergency department, the experience can be overwhelming and the consequences serious. A wrong decision about whether to admit them to the hospital can lead to infections, falls, or worse.
Over the past decade, a growing number of hospitals have created specially designed "Geriatric Emergency Departments" (GEDs) staffed by teams trained in the unique needs of older patients, with quieter environments, better fall prevention, medication review, and careful planning for what happens after the visit.
Yet, until now, data on whether GEDs are actually improving quality of care and saving lives on a national scale has been limited.
In a new study published in the Journal of the American Geriatrics Society, researchers from the Yale School of Public Health (YSPH) and NYU Langone Health found that GEDs are a promising and potentially life-saving model of care. But as their use expands across the country, policymakers must tackle deeper inequities that are preventing all older adults from benefiting equally from the targeted care.
“We are very excited about these findings — it is the first national study showing that GEDs make a difference in patient outcomes,” said Dr. Xi Chen, PhD, associate professor of health policy and management at YSPH and one of the study’s corresponding authors.
“Our findings suggest that geriatric-focused emergency care can improve outcomes by better aligning treatment with older patients’ needs.” Dr. Chen continued. “Low patient volumes in geriatric Eds — despite documented clinical benefits — underscore a critical need for broader implementation.”
The study examined data from a large nationally representative survey of Americans aged 65 and older using deidentified Medicare records. The researchers found that older adults treated at a GED were substantially less likely to be hospitalized or die within 30 days compared to those treated at a regular emergency department. The benefits were mainly seen among white patients and patients younger than 80 years old. Black and Hispanic older adults did not show the same improvements, the researchers noted, likely because they face additional barriers outside hospital emergency departments, such as limited access to follow-up care and social support, that the ED alone cannot fix.
“We see the upsides of GED care are not reaching all populations equally, with non-Hispanic white patients benefiting most,” said Dr. Ula Hwang, MD, MPH, a former Yale professor and authority on geriatric emergency medicine, who is also a corresponding author of the present study. “Addressing these barriers and biases will be critical for equitable care.” At NYU Langone, Dr. Hwang has built the Geriatric Emergency care Applied Research Network (GEAR) that aims to establish infrastructure to support collaborative, interdisciplinary research to improve care for older adults.
The study accounted for a wide range of factors that could influence outcomes, including patients’ age, health status, socioeconomic background, and the severity of their condition at the time of the emergency visit. Researchers also tested their findings across different subgroups, such as older versus younger seniors and across racial and ethnic groups, to ensure the results were consistent.
Hospital admissions are a key measure because they can expose older adults to additional risks, including infections, confusion, and longer recovery times. By reducing unnecessary admissions, GEDs may help patients recover more safely at home while easing pressure on hospitals.
The study did note several limitations. Because the study relied on observational data rather than a randomized trial, it cannot prove cause and effect in terms of the impact GED care had on patients. In addition, hospitals that adopt GED practices may differ in other ways that could influence patient outcomes.
This study was funded by the National Institutes of Health and the John A. Hartford Foundation.