Improving Emergency Care for Older Adults in Australia and New Zealand (2021–2025)

Introduction

Australia and New Zealand are experiencing rapid population ageing, leading to a higher proportion of older patients in emergency departments (EDs). In Australia, people aged 65+ comprise about 16% of the population but account for 21% of ED presentations; moreover, over half of these older ED patients end up admitted to hospital (52% vs 28% for all ages)(1). Older adults often present with complex, multifactorial health issues (frailty, multiple comorbidities, social care needs) that challenge traditional, fast-paced ED care models. This research search (2021–2025) has focused on innovative clinical care models and interventions to improve outcomes for older ED patients. Key themes include the development of geriatric-focused ED care models, frailty screening and comprehensive assessment, multidisciplinary team approaches, staff education in geriatric care, and interventions to improve discharge planning, reduce avoidable admissions, and enhance patient safety and experience. This report summarises these findings and their implications for emergency practice.

Geriatric ED Models and Multidisciplinary Care

One major strategy has been implementing geriatric-focused ED models of care, often with dedicated teams or pathways for older patients. These models typically embed geriatric expertise into the ED workflow to provide early comprehensive assessment, coordination, and tailored care for older adults:

• Geriatric Emergency Department Intervention (GEDI): Originally developed in Queensland, GEDI is a nurse-led, physician-championed model deploying experienced geriatric nurses in the ED. A 2022 evaluation showed that when GEDI was translated to two large EDs, it improved key outcomes for patients ≥70. The GEDI model significantly increased the likelihood of discharge home, decreased ED length of stay (LOS), and reduced in-hospital costs, with a trend toward lower short-term mortality risk ⁽²⁾. Although benefits were somewhat less pronounced than in the original trial site, the study confirmed that GEDI can be successfully adapted to new ED settings with positive results. Another study focusing on nursing home residents (aged care facility patients) presenting to a regional ED found GEDI led to a 15% higher hazard of ED discharge and markedly shorter ED stays for this frail subgroup without increasing 28-day revisit or mortality rates ⁽³⁾. This indicates that a geriatric ED team can safely avoid hospital admissions for many nursing home residents while expediting their care. Together, these findings establish nurse-led geriatric ED teams as effective in optimising disposition and flow for older patients, especially the frail or institutionalised.
• Multidisciplinary Allied Health Integration: Beyond nursing and medical staff, allied health professionals (such as physiotherapists, occupational therapists, social workers) are being integrated earlier in the ED care of older adults. A 2025 mixed-methods study mapped older patients’ journeys in a Perth ED and found major delays in allied health assessment, occurring on average 6 hours after presentation ⁽⁴⁾. By that time, many older patients had spent 11+ hours in ED. The study co-designed an Early Allied Health “Frailty Service” at triage to address this. Focus groups with ED clinicians perceived that an early allied health intervention could shorten overall ED LOS, expedite disposition planning, increase staff confidence in managing older patients, and streamline decision-making. Key barriers noted were limited space in ED, overlap with doctors’ assessments, and tests not being done yet, but proposed solutions included refining referral criteria and staff education. The study concluded that current allied health involvement often misses the ideal window (far exceeding national time targets), and there is clear opportunity to implement allied health–led frailty teams much earlier in the ED process. This aligns with the GEDI experience that having dedicated gerontology-skilled personnel in ED (nurses or allied health) leads to more timely comprehensive care. Some hospitals have also experimented with “geriatric ED” zones or pathways, creating physical or process separation for older patients. While formal evaluations in Australasia are limited, patient feedback (discussed later) suggests older people appreciate having tailored ED services, and staff reports indicate that a geriatric-friendly area (e.g. quieter space with appropriate equipment) could improve safety and comfort ⁽⁵⁾.

Outcomes: Geriatric ED models in Australia show tangible improvements in patient outcomes and system metrics. With GEDI, studies report increased safe discharges home, shorter ED stays, and no adverse effect on readmissions or mortality ^(2,3,6). Early multidisciplinary involvement (nurses plus allied health) is expected to prevent prolonged waits and address geriatric issues (mobility, functional needs, home support) earlier in the visit ⁽⁴⁾. Overall, these models shift the ED approach from reactive care to a more proactive, team-based management of older adults, tackling problems (falls risk, delirium, social needs) before they lead to ED complications or admissions. The research underlines that success requires dedicated staffing (geriatric-trained nurses/allied health), administrative support (space and processes for the team), and physician champions to integrate these services into ED workflows.

Frailty Screening and Comprehensive Assessment

Because chronological age alone is an imperfect predictor of risk, many ED initiatives have turned to frailty screening and Comprehensive Geriatric Assessment (CGA) to identify vulnerable older adults and tailor care accordingly. Frailty – a syndrome of reduced reserve and increased vulnerability – is highly prevalent among ED seniors and correlates with adverse outcomes (long LOS, admission, mortality). However, frailty screening in ED is not yet routine practice in Australia/NZ EDs. A recent qualitative study of emergency physicians in Adelaide found that ED doctors generally do not prioritise formal frailty assessment, given their focus on acute issues and time pressures (7). Physicians reported limited knowledge of frailty tools and concern about adding to their workload. Interestingly, they tend to gauge frailty informally (clinical gestalt) rather than via standardised instruments. Despite this, the same study noted ED doctors recognise the potential value of identifying frailty – many felt that better frailty recognition could improve care planning for high-risk elders, if adequate resources and workflows were in place. There was strong support for more geriatric training and evidence to convince clinicians of the benefits of frailty screening and leadership to implement frailty-focused practices in ED (7). In short, the ED staff mindset is beginning to shift: frailty is acknowledged as important, but integration into practice will require education, efficient tools, and management buy-in.

Research is helping define how frailty screening can be implemented effectively. An international Delphi consensus study (with Australian input) in Age and Ageing (2023) established key requirements for ED frailty screening instruments ⁽⁸⁾. Experts agreed an ideal ED frailty screen should be brief (<5 minutes), multidimensional (covering multiple domains of health) and performed early – within the first 4 hours and at first contact (e.g. at triage or initial nursing assessment). Notably, the screen should capture the patient’s baseline functional status in the weeks before the acute illness, rather than just current vital signs, to truly reflect frailty. The consensus identified functional ability, mobility, cognition, medication use, and social support as the most critical variables to include. This means an ED frailty assessment goes beyond typical triage questions, touching on whether the patient can walk, their memory or delirium risk, what medications they take (polypharmacy), and if they have help at home. There was also consensus that from a practical standpoint, feasibility and cost-effectiveness trump perfection: the tool must fit into ED flow without causing delay. Participants highlighted ongoing uncertainty about the impact of screening – a barrier to widespread uptake – and urged further research to demonstrate that frailty screening leads to improved outcomes (justifying the effort) (8). In summary, current best practice advice is to use a quick frailty screening tool early in the ED stay to flag high-risk older people and then ideally follow positive screens with a more detailed geriatric assessment or targeted interventions.

Evidence suggests that formal geriatric assessment in the ED setting can improve outcomes. Several comprehensive geriatric assessment (CGA) programs have been trialled in EDs, often led by geriatricians or advanced practice nurses, to evaluate older patients’ medical, functional, and psychosocial issues. Results have been mixed: some studies show reduced functional decline and better long-term outcomes, while others show no change in readmissions or even slight increases in initial resource use. For example, a systematic review in 2024 identified that a nurse-led CGA model in ED significantly reduced ED length of stay for older patients (median ~12.7h vs 19.1h) in one trial. Still, a similar intervention in a different hospital unexpectedly lengthened ED stay slightly in another study ⁽¹⁾. In terms of downstream impact, those interventions had complex effects: one reported a small increase in hospital admissions among the assessed group (perhaps because comprehensive assessment uncovered issues needing admission), and another noted higher 28-day ED return and 1-year admission rates in the group that received allied health care coordination before discharge. However, in both cases, the “control” group was comprised of lower-risk patients, making comparisons difficult. On a positive note, interventions that specifically targeted preserving function and independence show promise. In one trial, an ED screening and nurse assessment program for seniors at risk of functional decline cut the odds of deterioration in activities of daily living by half at 30 days. Another multi-component program in Asia-Pacific that combined ED CGA, frailty-focused education, and a structured discharge care plan found that participants were significantly more likely to maintain or improve their ability to perform daily activities over 12 months. They had a much lower ED revisit rate at 6 months (rate ratio 0.35, i.e. 65% lower) than usual care. These gains in functional outcomes without excess returns suggest that thorough geriatric evaluation and planning in the ED can set patients up for more stable recovery at home. On the other hand, some studies noted that even when ED teams made referrals (for example, advising follow-up with the patient’s GP or geriatrician), many patients did not act on those referrals after discharge ⁽¹⁾. This highlights a gap in transitional care: identifying frailty or needs in ED is only half the battle – ensuring that post-ED care plans are implemented is equally crucial.

Outcomes: Overall, research supports early recognition of frailty in the ED as a means to triage patients to appropriate care pathways. Frailty screening tools (like the interRAI ED screener used in GEDI or the ISAR tool) can predict which patients are at risk of adverse outcomes, enabling targeted interventions (e.g. activating a geriatric nurse consult or fast-tracking to a short-stay geriatric unit). When comprehensive geriatric assessment is applied, it can improve functional outcomes and may reduce repeat ED visits, though effects on admissions and mortality vary. Importantly, these interventions don’t seem to harm and can uncover unmet needs (like undiagnosed conditions or unsafe home situations). The implication is that EDs should incorporate frailty identification as part of routine triage for older patients and have protocols (geriatric team consults, referral to geriatric services) ready for those flagged as frail. Building an evidence base to show improved patient-centred outcomes (better function, fewer falls or delirium episodes, etc.) will further convince ED clinicians to embrace frailty assessments.

Staff Education and Geriatric Training Initiatives

Improving care for older ED patients also involves educating ED staff – nurses, doctors, allied health – about geriatric principles, common syndromes, and best practices. Several educational interventions in recent years demonstrate that targeted training can change processes and outcomes in the ED:

• Pain Management: Older patients often have undertreated pain (due to communication barriers or fears of analgesic side effects). An Australian study reported that an educational and audit-feedback program for ED staff significantly improved pain management for older adults. In particular, there was more frequent use of regional nerve blocks for hip fractures post-education ⁽¹⁾. These nerve blocks are an evidence-based analgesic technique in frail patients to control pain while minimising systemic opioids. After training, clinicians were more likely to perform femoral nerve blocks in neck-of-femur fracture patients, resulting in better pain relief scores. This suggests that even without adding new staff, upskilling existing ED teams in geriatric-specific protocols (like early nerve blocks for fractures or delirium prevention strategies) can close care gaps.
• Medication Safety: Older adults are especially vulnerable to medication-related adverse events in ED (polypharmacy, drug interactions, confusion with medications). A notable program called EQUiPPED(Enhancing Quality of Prescribing Practices for Older Adults in the ED) was implemented in some hospitals (initially in the US, with principles applicable to Aus/NZ). EQUiPPED combines provider education on geriatric pharmacotherapy, electronic decision support (alerts for high-risk meds), and audit and feedback to ED prescribers. When rolled out to multiple sites, EQUiPPED led to a significant reduction in potentially inappropriate medications (PIMs) prescribed to older ED patients ⁽¹⁾. For example, ED doctors were less likely to prescribe medications like benzodiazepines, sedating antihistamines, or anticholinergics that are on the Beers Criteria list of drugs risky for seniors. Another study found that after a simple educational intervention, junior doctors were markedly less likely to prescribe a potentially inappropriate medication to older patients ⁽¹⁾. Moreover, leveraging technology or specialist input can help – one project showed that involving a telehealth geriatrician to assist with medication review in real-time also cut down PIM use in the ED ⁽¹⁾. Collectively, these outcomes underscore that training ED clinicians in geriatric pharmacology and providing them with tools/guidelines leads to safer prescribing, reducing risks like delirium or falls caused by ED medications.
• Screening and Referral: Education can also increase the detection of geriatric issues. The 2024 systematic review noted an intervention where educating nursing staff in comprehensive geriatric care improved their screening rates for issues like delirium, falls risk, and functional decline (though details were not provided in the excerpt) ⁽¹⁾. Another study in the review mentioned that training and protocols for junior doctors improved the frequency of appropriate referrals (e.g., ensuring high-risk seniors got follow-up appointments or community services referrals) ⁽¹⁾.
• ACEM Geriatric Emergency Medicine Network (GEMN): At a systems level, the Australasian College for Emergency Medicine has recognised the need for geriatric training. In 2021, ACEM established the GEMN to coordinate education and practice improvements for older patient care ⁽⁹⁾. The GEM Network has delivered workshops, webinars, and curriculum enhancements focused on the unique needs of older people in EDs. A 2024 editorial, “Emergency medicine and population ageing: A call to action,” emphasised that formal geriatric education must be embedded into emergency medicine training to equip clinicians with skills in areas like cognitive assessment, communication with families, end-of-life care, and system navigation for older patients ⁽¹⁰⁾. The GEMN also promotes multi-centre research and sharing of best practices across Australia and New Zealand.

Outcomes: Even though education is harder to tie to patient outcomes than a new service, the evidence shows targeted training can yield measurable improvements. After geriatric-focused education, ED teams improved on process measures (more appropriate analgesia, fewer dangerous meds) that directly impact patient comfort and safety ⁽¹⁾. These process improvements likely translate to better outcomes: for instance, better pain control can reduce delirium risk and improve early mobility, and avoiding inappropriate medications prevents iatrogenic complications. Staff also report increased confidence and knowledge in managing complex older patients ⁽⁷⁾. The implication is that hospitals should invest in ongoing geriatric emergency medicine education – from simulation training on delirium management to short courses on geriatric trauma care to decision-support tools – as part of quality improvement. Such initiatives build a more geriatric-aware ED culture and complement the structural models of care described earlier.

Discharge Planning and Hospital Admission Avoidance

Older adults often experience fragmented care during transitions, so improving how EDs plan discharges and coordinate follow-up is critical. Several interventions in Australasia have aimed to ensure that when an older person is discharged from ED, it is done safely with proper arrangements, thereby avoiding unnecessary admissions and preventing repeat crises:

• Care Coordination and Transitional Packages: One strategy is to deploy specialised coordinators or packages that bridge the ED-to-home transition. For example, in the aforementioned comprehensive frailty intervention ⁽¹⁾, a key component was a discharge transition package. This typically includes arranging follow-up appointments, educating the patient/caregiver on warning signs and medication changes, and liaising with primary care or community services (such as home care and falls clinics). The positive results – higher ADL independence and fewer ED returns – illustrate that meticulous transitional care planning can keep older patients stable at home after an ED visit. Another study in the review found that patients who did not receive an advanced practice nurse follow-up and multidisciplinary geriatric review after ED discharge had higher rates of worsening frailty over 1–6 months ⁽¹⁾. This suggests that a geriatric specialist nurse’s post-ED follow-up (even a phone call or home visit) can make a difference in patient trajectory. However, simply making referrals in ED (e.g. instructing the patient to see their GP in a week) may not be enough – as noted, many patients did not act on ED advice to follow up, indicating that EDs might need to take a more active role (such as booking the GP appointment for the patient or involving care managers).
• ED-Based Care Coordination Teams: Some Australian EDs have Care Coordination Teams (CCT)or similar, which include nurses or social workers dedicated to arranging safe discharges for the elderly. These teams perform tasks like functional assessments, checking home supports, arranging interim services (e.g. equipment, in-home nursing), and communicating with family or general practitioners. Early research (pre-2021) showed that such teams can facilitate discharge for patients who might otherwise be admitted. However, one study noted those patients had higher 1-year admission rates (likely reflecting their underlying risk) ⁽¹¹⁾. The recent practice continues to support that coordinated discharge planning is “relatively safe” in the short term for selected older adults ⁽¹⁾, meaning EDs can discharge frail patients with appropriate support without a spike in immediate poor outcomes. The focus now is on refining these models to reduce longer-term hospitalisations through better community management.
• Hospital Admission Avoidance Services: Sometimes, the best discharge plan is to avoid ED altogether. Australia and New Zealand have been experimenting with “ED avoidance” or hospital avoidance programs for older people. One South Australian service (Care Awaiting Primary Care or CARE) provides rapid geriatric assessment and short-term community care for certain patients who would otherwise go to the ED. A 2023 study in the Emergency Medicine Journal reported that such services can alleviate ED demand and improve patient experience ⁽¹²⁾. Patients and families appreciated being treated at home or in a more home-like urgent care setting, avoiding the stress of an ED visit. While this occurs outside the ED proper, it’s an important part of the system-wide approach to reducing avoidable ED presentations and admissions among the elderly. For ED clinicians, being aware of and collaborating with these programs (e.g. referring an eligible patient to a “hospital in the home” service instead of admitting) is a key practice change.
• Advance Care Planning and End-of-Life Coordination: Another aspect of discharge/transition planning is recognising when hospital-level care is not in the patient’s best interest. With many older adults attending ED near the end of life, ED staff are increasingly involved in end-of-life discussions and decisions (13). A large 2018 binational cohort study (published in 2024) found that among older patients who died within 48 hours of ED presentation, over a quarter died in the ED itself, and a similar fraction had been triaged initially as non-urgent. This indicates that some patients nearing end-of-life may present with seemingly mild issues that rapidly deteriorate. Implication for practice: ED teams should quickly identify patients who may be in their final days and coordinate with palliative care or families for appropriate plans (possibly avoiding futile ICU admissions and instead arranging hospice or comfort care). While not always framed as “discharge planning”, ensuring a patient’s goals of care are met is an important outcome. Fast-tracking advanced care directives and engaging geriatricians or palliative specialists can improve the quality of these patients’ experience and avoid unwanted hospitalisations ⁽¹³⁾.

Outcomes: Effective discharge planning interventions generally aim to reduce unplanned returns and hospital admissions while maintaining patient safety. The evidence suggests that when older patients are sent home from ED with robust support plans, they do not have higher short-term mortality or adverse events than those admitted – and in fact can do better in terms of functional recovery. Key outcomes achieved in studies include lower ED revisit rates at 1–6 months, maintenance of independence, and high discharge rates of nursing home residents without increased readmission. Challenges remain in ensuring longer-term linkage to primary care and community services, but innovative solutions (ED care coordinators, direct booking of follow-ups, outreach services) are being tested. For ED practice, this means integrating a “disposition planning” mindset from the start of an older person’s ED visit – involving allied health or care coordinators early and considering alternatives to admission. By doing so, EDs can both avoid hospitalizing seniors unnecessarily and prevent the common cycle of repeat ED presentations.

Patient Safety and Experience Enhancements

Research in the past four years also highlights the importance of creating a safer and more senior-friendly ED environment and improving the patient experience for older adults. Older patients have unique safety risks in ED – they are susceptible to falls, delirium (acute confusion), and hospital-acquired infections and can easily become disoriented or distressed in a chaotic emergency setting. They also often value communication and comfort measures that younger patients might not vocalise. Key findings and interventions related to safety and experience include:

• Environment and Equipment: Qualitative studies indicate that the standard ED environment is not ideally suited to frail older people. Issues include loud noise, stretcher trolleys not conducive to frail bodies, lack of mobility aids, poor signage, and inadequate lighting for those with visual impairment. Health professionals in one Australian study observed that the physical environment and equipment were often “unsuitable” for older patients, contributing to a “poor fit” between EDs and older peoples’ needs ⁽⁵⁾. As a result, there have been calls to create elder-friendly zones or modifications: for instance, some EDs have introduced quieter waiting areas for older patients, non-slip flooring and lighting to prevent falls, hearing amplification devices, large-face clocks and whiteboards for orientation, and reclining chairs or beds that are more comfortable for long stays. While rigorous outcome data on these changes are sparse, the consensus is that such modifications promote safety, independence and dignity ⁽⁵⁾. Even the simple presence of a volunteer or “patient sitter” to provide toileting assistance or calm a confused elder can prevent adverse events like falls.
• Frailty/Delirium Safety Protocols: Many EDs are implementing protocols to screen for delirium and cognitive impairment on arrival, given that delirium is common and often missed. Identifying a patient with dementia or delirium allows staff to adjust care (e.g., ensure they have their glasses/hearing aids, avoid certain meds, and keep family informed). Although specific Australasian studies on delirium protocols in ED were not highlighted in 2021–2025 publications, there is a growing focus on patient safety. Similarly, screening for falls risk in ED and intervening (bed alarms, assistance when walking) can directly reduce ED falls. These safety processes often stem from hospital quality improvement rather than published research, but they align with the broader theme of comprehensive risk assessment for seniors in ED.
• Patient Experience and Satisfaction: How older patients experience emergency care is a critical outcome in itself. A 2021 Irish mixed-methods study (while not Australia/NZ, it offers relevant insights) analysed thousands of older patients’ reports on their ED experience (14). It found that the chief complaints among older people were the long wait times and uncomfortable conditions (lack of communication, privacy, and basic personal care). Notably, patients aged 85 and over, despite being frailer, were paradoxically more likely to report positive ED experiences than those 65–74. This might reflect different expectations or gratitude for care among the oldest-old. Nonetheless, the clear message was that prolonged waiting in ED hallways without updates or adequate comfort harms older patients’ overall hospital satisfaction ⁽¹⁴⁾. Some older respondents even preferred dedicated geriatric ED services, feeling they would be better cared for in a separate stream. This feedback reinforces initiatives like GEDI and frailty units as clinically beneficial and perceived by patients as a way to improve their experience. The study also showed a strong link between the ED experience and the person’s impression of their entire hospital stay – those who had a poor ED experience were over twice as likely to rate their overall care negatively. Thus, improving front-end experience (timeliness, communication, comfort) could elevate outcomes like patient-reported satisfaction and confidence in the health system.
• Staffing Levels and Time: ED crowding is a less direct but vital factor in safety and experience. Overcrowding has been associated with higher error rates and worse outcomes for all patients (1), and older patients are particularly vulnerable. Australian data have shown a decline in the proportion of ED visits completed within recommended timeframes over recent years, meaning patients spend longer in ED. For older individuals, every extra hour in the ED can increase the risk of delirium, pressure injuries, or just exhaustion. Therefore, policies aimed at reducing access block and ED length of stay (such as the NZ target of 95% of patients seen within 6 hours and similar Australian KPIs) are implicitly patient-safety measures for the elderly. The research on GEDI and allied health interventions supports this: by getting older patients out of ED faster, either discharged or admitted to the right ward, we reduce exposure to the busy ED environment and its risks ⁽¹⁾.

Outcomes: Efforts to improve safety and experience yield outcomes like fewer adverse events (falls, medication errors) and higher patient satisfaction scores. While exact metrics from 2021–2025 studies are not always reported, we can infer impact. For example, reducing inappropriate medications in ED (mentioned earlier) is a direct safety win with likely fewer side effects. Shorter ED stays for frail patients mean less time in a high-stimulus environment, likely lowering delirium incidence (though not explicitly measured in the GEDI study, it’s a reasonable extrapolation). Patient-centric improvements – better communication about wait times, involving families in decision-making, providing food/drink when appropriate, etc. – lead to improved patient experience, which is increasingly recognised as a key quality domain. The implication for practice is that EDs should treat patient experience as an important outcome for older adults alongside traditional clinical outcomes. Simple interventions like more frequent updates, a comfortable reclining chair instead of a hard trolley when feasible or having a dementia-trained nurse on shift can greatly enhance an older person’s journey through ED.  Listening to older patients’ feedback (through surveys or consumer representatives) can also identify problem areas and drive quality improvements.

Implications for Practice

The research from 2021–2025 provides a clear roadmap for enhancing emergency care of older adults in Australia and New Zealand. Implementing dedicated geriatric care models in EDs has proven benefits – hospitals should consider establishing teams like GEDI or an equivalent multidisciplinary geriatric ED service. These teams facilitate early identification of high-risk patients (using frailty screening) and prompt interventions (e.g. comprehensive assessments, allied health referrals, activating community services) that improve patient flow and outcomes ⁽¹⁵⁾.

Routine frailty screening and geriatric assessment should be integrated into ED protocols. This means adopting a validated frailty tool at triage or soon after (as per consensus guidelines) and ensuring a pathway for positive screens (such as an automatic consult to a geriatric nurse or rapid geriatrician involvement) ⁽⁸⁾. By doing so, EDs can triage not just by acuity but by vulnerability, allocating resources to those who will benefit from extra support. Hospitals might also develop “fast-track” paths for frail older patients to be admitted directly under geriatric units or short-stay geriatric observation units, bypassing the general ED milieu.

Strengthening multidisciplinary collaboration is essential. The studies repeatedly show that older patients have better plans and outcomes when emergency physicians, nurses, allied health, geriatricians, and primary care providers work together. ED managers should ensure allied health professionals (physio, OT, social work) are available in the ED, at least during peak hours for older presentations, and involved sooner rather than later ⁽¹⁵⁾. Similarly, formal links between ED and geriatric medicine can be established – for instance, a geriatrician “hotline” for ED docs to call for advice or geriatricians doing ED rounds twice daily to review older patients’ care plans.

Education and training emerge as low-hanging fruits – investing in geriatric training for ED staff has demonstrated improvements in care processes (pain control, medication use) ⁽¹⁾. Emergency departments should incorporate regular geriatric-focused training sessions. Topics could include: delirium recognition and management, communicating with patients with cognitive impairment, polypharmacy and deprescribing in the ED, safe mobilization and falls prevention, and end-of-life conversations. The ACEM GEM Network can be a resource for curriculum and materials. Hospitals might also designate a geriatric emergency care champion to lead these educational initiatives and keep geriatric care on the ED’s quality agenda.

From a policy perspective, hospital administrators and health services should recognise that improving ED care for older adults can reduce downstream costs (by preventing admissions and rapid returns) ⁽²⁾. Support in terms of funding positions for geriatric ED nurses or therapists and revising performance metrics to value comprehensive care (not just rapid turnover) will be important. The misalignment noted between current ED performance measures (focus on speed) and the needs of complex older patients should be addressed ⁽¹⁾. For example, success could also be measured by outcomes like 7-day revisit rates, functional status post-discharge, or patient satisfaction among older cohorts – not solely the 4-hour length-of-stay target.

Finally, patient-centred improvements – making EDs more age-friendly – should be part of ED design and operations. Implementing age-friendly ED principles (the “4Ms”: what Matters, Medication, Mentation, Mobility) might serve as a framework. This would mean always eliciting the patient’s goals and preferences (what Matters), reviewing Medications for safety, assessing Mentation (delirium, dementia) and ensuring Mobility (walking ability, fall risk) is attended to. The studies reviewed reinforce that doing these things leads to better experiences and likely better outcomes for older adults ^(1,14). In practice, an ED could create a checklist or order set for patients over a certain age that covers these domains.

In conclusion, the period 2021–2025 has seen substantial progress in tailoring emergency care to the older population in Australia and New Zealand. Geriatric ED models, frailty screening, multidisciplinary care, staff education, and improved discharge planning all contribute to safer, more effective care. EDs that have adopted these innovations report shorter stays, more discharges home, improved functional outcomes, and high patient and staff satisfaction. As the demand from older patients continues to rise, the implication is clear: integrating geriatric principles into emergency medicine is not just beneficial but necessary. By prioritizing the needs of older adults – through specialized teams, training, and patient-centred processes – EDs in Australasia can markedly improve clinical outcomes and the healthcare experience for this growing segment of patients.

References

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