The Journey Of Geriatric Emergency Medicine: Acceleration, Diffusion, And Collaboration As Keys To Continued Growth
As more and more of us live longer and healthier lives, we are becoming part of one of the largest demographic shifts in US history, as some 10,000 Americans now turn 65 every day. Innovations in health and care have helped make that increased longevity possible, and now a new wave of innovations to our health care system and community-based services must emerge to reflect our country’s changing demographic. One of these innovations is already occurring within emergency departments (EDs), which are increasingly becoming our nation’s “front porch” of health care for older adults. One out of every two older adults makes an ED visit annually, a large proportion of which result in hospital admission. As more Americans approach that “front porch,” the opportunity to ensure that EDs are delivering care tailored to the needs of older adults has never been greater.
In response, EDs need access to the wealth of research and innovation on senior-appropriate acute care, and with more than 5,000 EDs operating across the United States that is no small feat. The diffusion of innovations theory, which has a long history in the social sciences, helps explain how, why, and at what rate new ideas and technology can spread. While not without its critics, the theory remains widely recognized and has been applied to a variety of real-world challenges, including health care. At its core, the theory relies on three basic principles central to successful adoption of innovations: First is the perception of the innovation, notably the perceived benefit of change. Second are the characteristics driving those who adopt innovation (or fail to do so). And third, contextual factors such as communication, incentives, and leadership also encourage or potentially discourage how innovations get disseminated.
A new collaborative announced today known as the Geriatric Emergency Department Collaborative (GEDC) is demonstrating promising progress across all three of these principles. Supported by the John A. Hartford Foundation and the Gary and Mary West Health Institute and managed by the American Geriatrics Society (AGS), the GEDC is bringing together professional societies with a vested interest in older adult care—the American College of Emergency Physicians (ACEP), the AGS, the Emergency Nurses Association, and the Society for Academic Emergency Medicine—as well as hospitals and health systems across the United States. Early GEDC member sites—Aurora Health Care System (Wisconsin), Emory University/Grady Memorial Hospital (Georgia), Magee Women’s Hospital (Pennsylvania), Mount Sinai School of Medicine (New York), Northwestern University (Illinois), St. Joseph’s Regional Medical Center New Jersey), University of California, San Diego Health, the University of Chicago (Illinois), and the University of North Carolina—all represent early adopters within geriatric emergency medicine.
Perception: Why Innovation Of Geriatrics And EDs?
To understand how change happens, we first need to appreciate why it is necessary. With so many more Americans than ever before looking forward to the potential for longer active lives, the opportunities for health care professionals who can make that possible has never been greater. Today, for example, we need about 20,000 geriatricians—to care for our senior population, yet there were fewer than 7,300 certified geriatricians practicing nationwide as of 2016.
Additionally, EDs are also a critical medical and social safety net for many of our nation’s seniors. They manage care transitions to help us avoid hospital admissions when appropriate, and they connect us to ambulatory care options within the community, when available. Taken together, this growing reality has given rise to the field of geriatric emergency medicine, which focuses on providing senior-appropriate care in the ED to address both the acute and social services needs of everyone as they age.
In fact, between 2007 and 2017, estimates indicate that the number of geriatric emergency departments (GEDs) in the United States went from zero to more than 100, a trend that illustrates the perceived benefit of senior-appropriate care in the ED. Unfortunately, the evidence base for GEDs has not kept pace with their rapid growth—we still know too little about how and why GEDs provide better care and outcomes for seniors, which is why understanding the characteristics of early GED adopters has become so critical.
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