Life In The Slower Lane

In recent years, the care of older individuals in emergency departments (ED) across Australia and New Zealand has received considerable scrutiny and improvement, primarily due to the increasing complexity of their health needs. One key area of focus is the incorporation of frailty assessments into emergency care protocols. Findings suggest a significant prevalence of multidimensional frailty among elderly patients who present to the ED, indicating that social frailty, along with physical and psychological frailty, substantially affects these patients’ health outcomes (Atkinson & Lang, 2024; Tsai et al., 2024). These insights prompt a paradigm shift in emergency care practices, advocating for protocols that specifically address the unique vulnerabilities of older patients.

Moreover, systematic reviews and studies have emphasized the integration of early warning systems (EWS) in the ED to enhance the ability to predict clinical deterioration among older adults. The utilization of EWS scores has demonstrated effectiveness in monitoring vital signs and initiating necessary interventions before critical deterioration occurs, thereby improving patient safety and potentially reducing mortality rates within this demographic (Guan et al., 2022). This approach aligns with recommendations from the Australian and New Zealand Society for Geriatric Medicine, which suggest that geriatricians should play a significant role in ED processes to ensure that the specific needs of older people are prioritized during critical episodes (Ischia et al., 2021).

Telehealth has also become increasingly prominent as a means to support older individuals post-ED visits, particularly during the COVID-19 pandemic. Innovative initiatives, such as the SCOUTS program, have been piloted to facilitate the transition of care for older adults utilizing telehealth. This program has shown improved access to necessary follow-up care while addressing barriers such as the digital divide that older adults often confront (McQuown et al., 2022). This modern approach aims to optimize health resources, efficiently connect patients with outpatient services, and ultimately prevent unnecessary ED revisits.

Finally, integrated community-based models of care such as Te Whiringa Ora in New Zealand and the Hospital Admission Risk Program in Australia represent transformative strategies that enhance health and social care for older populations. These models have demonstrated reductions in emergency presentations and lengths of hospital stays, underscoring their effectiveness in managing chronic conditions through improved access to primary care and community resources (Mann et al., 2021). Such comprehensive strategies are crucial in minimizing the risk of hospital visits for frail older individuals and ensuring that their care is managed in a more holistic and continuous manner.

In conclusion, the past few years have seen significant advancements in the care of older adults in emergency departments within Australia and New Zealand. Focused efforts on frailty assessment, the implementation of early warning systems, the adoption of telehealth for continuity of care, and community-based integrated care models mark a collective move toward age-friendly health systems in these regions. These initiatives not only enhance the quality of care for elderly populations but also demonstrate a responsiveness to their complex health challenges.

References: Atkinson, P. and Lang, E. (2024). Ensuring comprehensive access to care for frail and complex patients, but not just through the ed. Canadian Journal of Emergency Medicine, 26(8), 509-510. https://doi.org/10.1007/s43678-024-00743-y Guan, G., Lee, C., Begg, S., Crombie, A., & Mnatzaganian, G. (2022). The use of early warning system scores in prehospital and emergency department settings to predict clinical deterioration: a systematic review and meta-analysis. Plos One, 17(3), e0265559. https://doi.org/10.1371/journal.pone.0265559 Ischia, L., Naganathan, V., Waite, L., Couteur, D., & Thillainadesan, J. (2021). Covid‐19 and geriatric medicine in australia and new zealand. Australasian Journal on Ageing, 41(2), 301-308. https://doi.org/10.1111/ajag.13027 Mann, J., Thompson, F., McDermott, R., Esterman, A., & Strivens, E. (2021). Impact of an integrated community-based model of care for older people with complex conditions on hospital emergency presentations and admissions: a step-wedged cluster randomized trial. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-06668-x McQuown, C., Snell, K., Abbate, L., Jetter, E., Blatnik, J., & Ragsdale, L. (2022). Telehealth for geriatric post‐emergency department visits to promote age‐friendly care. Health Services Research, 58(S1), 16-25. https://doi.org/10.1111/1475-6773.14058 Tsai, Y., Huang, E., Huang, C., & Chen, Y. (2024). Multidimensional frailty in elderly emergency department patients: unveiling the prevalence and significance of social frailty. Canadian Journal of Emergency Medicine, 26(8), 549-553. https://doi.org/10.1007/s43678-024-00717-0