Examining the geriatric-friendliness of emergency departments in the Canadian province with the oldest population.

Abstract

Objectives: The number of older adults presenting to emergency departments (EDs) is rising. The care of older adults in the ED is challenged by atypical disease presentations and multimorbidity, among other factors. The geriatric ED guidelines-first developed in the United States in 2014-were developed to help EDs improve the care of older adults. However, little is known about Canadian EDs adherence to or implementation of these guidelines and geriatric-friendly ED principles. Our study aimed to describe the geriatric-friendliness of EDs and identify barriers to implementation in Newfoundland and Labrador, the Canadian province with the oldest population.

Methods: A cross-sectional study was performed at EDs across Newfoundland and Labrador. We recruited ED site representatives through social media, email listservs, and word of mouth. ED site representatives were healthcare professionals familiar with the care of older adults in the ED. A 28-item questionnaire and a semi-structured interview via telephone were conducted. Proportions and percentages are reported for categorical data. Interview data were grouped into themes based on common patterns in participant responses.

Results: Twenty-three EDs participated in the study. ED site representatives were physicians (n = 13), nurses (n = 5), and advanced care paramedics (n = 2). One site identified a physician with a focused education in geriatric emergency medicine. No sites had a nurse with a focused education in geriatric emergency medicine. Only one site tracked process and outcome measures. Most sites had wheelchair-accessible toilets and food and drink available. Barriers to making EDs more geriatric-friendly were identified and included challenges related to resources, infrastructure, education and training, the provision of adequate care, awareness of geriatric-friendly ED principles, and ability to implement change.

Conclusion: This study demonstrates a lack of geriatric-friendly EDs in Newfoundland and Labrador. Barriers to implementation were widespread and similar between participating ED sites.