Wilson et al.1 discuss older patients experiencing cognitive decline after hospitalization and suggest that older patients might benefit from care in emergency departments with discharge to their home vs hospitalization.
After care in emergency rooms, however, older patients also have functional decline and are at greater risk of medical complications.2 Care in most emergency departments is not well suited to care of the elderly. Rapid triage is not appropriate for older patients who have complex problems. Rapid diagnosis and treatment may be inadequate as well since the acute problem may be subtle and not discoverable under the time pressure of most busy emergency rooms.2
Recent publications have outlined ways to improve quality of care for seniors in emergency departments and reduce hospitalization rates.2,3 Implementation of geriatric emergency departments with assessment by an interdisciplinary team of geriatrician, social worker, and nurse discharge coordinator with plans for rapid follow-up by the primary care physician might decrease return rates and need for hospitalization.2 In addition, emergency department geriatric observation units that would allow for longer periods for assessment and management of older patients prior to discharge may decrease admissions to the hospital.3
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