Safety Net for Seniors

Luis Diaz, 73, came to the emergency room complaining of chest pain. Before a doctor examined him, a nurse at Mid-State Medical Center asked him some routine questions and learned he was having trouble doing chores at home.

"He said he was trying to clean his house the other day and barely had the strength to hold the mop," said nurse manager Camila Rubino, who translated Diaz's answers from Spanish. "He said he had a stroke in the past, which caused some physical limitations on his left side." She set up a consultation with a social worker to see if there were any services that could help.

In a traditional ER, Diaz's difficulty getting along at home might have been missed. But Diaz had come to one of a small but growing number of senior-friendly emergency departments in the country where staff is specially trained to deal with the unique needs of older adults.

The goal is to not only treat the medical problem that brought the patient to the ER, but also to address the psychological and social issues that can coincide with aging and make the patient more likely to return, said Dana Garvey '03, a registered nurse who led the multidisciplinary committee that brought the changes to Mid-State.

Since the program launched in May, nurses at the Meriden, Conn., hospital conduct a six-question screening on every patient 65 or older who visits the ER. This includes questions about the patient's living arrangements, their medications and whether they are there because of a fall.

As more baby boomers turn 65 and more seek care in the ER, it makes sense for hospitals to address their unique needs, said Lynne Hodgson, professor of sociology and director of the gerontology program.

Hodgson said a trip to the emergency room can be especially frightening and disorienting for seniors, who may have deficits in vision, hearing and mobility. At MidState, the hospital has tried to make the ER calmer and more comfortable with thicker mattresses and heated blankets, softer lighting and extra safety features.

Jean Lange, dean of the School of Nursing and an expert in geriatric nursing, said it is crucial to assess how an older patient is faring "physically, mentally and spiritually" when they come to the ER. But she said many practicing nurses were never taught how because the research is so new.

"People just coming out of nursing school in that last five years have received that training, but many of the people in practice have not," she said.

Garvey said often, older people see multiple doctors and use more than one pharmacy, so coordination of care is difficult. Because the ER has social workers, physical and occupational therapists, pharmacists and doctors on site, it is easier to "see the big picture," she said.

"And sometimes we're that safety net because we're the only place that patient is ever going to go (for care)," Garvey said. "If we were to drop the ball, there would really be nobody else."

October 2013
 

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