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Assessing geriatric vulnerability for post emergency department adverse outcomes: challenges abound while progress is slow
  1. Ula Hwang1,2,
  2. Christopher Carpenter3
  1. 1Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  2. 2Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  3. 3Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
  1. Correspondence to Dr Ula Hwang, Department of Emergency Medicine, Box 1062, One Gustave L. Levy Place, New York, NY 10029, USA; ula.hwang{at}mountsinai.org

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An ageing population is straining reliable and timely access to emergency department (ED) care for all patients worldwide.1–6 Compared with younger populations, older adults have lengthier ED evaluations are more frequently admitted, and if discharged, return to the ED more often but still leave the ED dissatisfied with the care delivered.7–9 In response to an ageing demographic, Emergency Medicine and Geriatric organisations in the UK and USA released evidence-based and consensus-based guidelines to optimise the care and outcomes for this population.10 ,11 Over the past decade, professional organisations,10 ,12 residency educators13 and quality improvement experts have advocated that geriatric risk stratification instruments be widely employed in adult EDs worldwide, while researchers simultaneously supported development of more accurate instruments.14 One immediately palpable challenge for clinicians (physicians, mid-level providers, nurses) and policy-makers is to identify accurately the most vulnerable older adults, real time in the busy ED and have them receive more intensive, geriatric-focused ED care.15 ,16

One recommendation from the US guidelines highlighted the need for risk-stratification of older adults using instruments like the Identification of Seniors at Risk (ISAR) tool.12 ,17 In the ED environment, an ideal geriatric ‘vulnerability’ screening instrument would be precise and reliable for a broad spectrum of presenting illnesses and injuries, including illnesses and injuries of variable severity managed across heterogeneous healthcare settings, and for patients with differing levels of socioeconomic and health literacy states.18 The original ISAR was developed …

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