Background: The aging population in our health service was projected to increase by 47% from 2017 to 2027. In early 2019, it was estimated that older adults comprised of 13% of the catchment population and nearly 1 in 4 emergency department (ED) presentations, which resulted in half of inpatient bed days. The complexity of these patients is increasing due to their advancing age, frailty, and comorbidities. This among other factors, contributed to a longer average length of stay by >2 days compared to the younger patient cohort. Traditionally, older patients were referred by the Emergency Physicians to the general medical teams, before being reviewed by a Geriatrician in the inpatient wards.
Change: The Geriatric Assessment Team (GAT) was established in September 2021. This Geriatrician-led team aimed to provide Comprehensive Geriatric Assessments and multidisciplinary care for older adults in ED including critical care areas, assessment pods, ramp, and ambulance bay. All patients age ≥ 65 or ≥ 55 for Indigenous population, were considered. This model of care focuses heavily on a dedicated Geriatrician in ED, proactively facilitating comprehensive assessments of older adults and arrange direct admissions to appropriate inpatient wards or rehabilitation units. Admission avoidance strategies include urgent care clinics and multidisciplinary home support programs. The number of older adults’ re-admissions was found to be reduced by almost 5% for a comparative patient group over a 9-month period.
Learning: Although this model has been well received and continues to be refined, it was met with a few challenges, mainly due to limitations of workforce availability. This model provided a platform for collaboration with other staff in the hospital and adaptations were made along the way to incorporate a Frailty pathway in ED. The model of care and data obtained can serve as resources for acute training in Geriatric Medicine, while advocating for the need for Geriatricians to provide timely, comprehensive care in managing older adults with medico-social complexities in the acute setting. This service continues to grow and innovate by strengthening pathways and relationships with primary health care providers and community supports, with a clear focus to deliver safe quality care for all older adults.