Feb. 12, 2025
Leaders in Mayo Clinic trauma and emergency care have determined that while the medical center offers compassionate care for older adults, a different care model for this population is needed. The volume of patients seen in this population has grown over the past 10 years, reflecting a general change in the U.S. population landscape, says Jessica A. Stanich, M.D., an emergency medicine specialist at Mayo Clinic in Rochester, Minnesota.
According to the American College of Surgeons (ACS), older adults compose 16% of the U.S. population, and this group is projected to increase to 20% by 2040. Older adults bring with them into the emergency and trauma care environments a collection of comorbid diseases that uniquely affect them and require care tailored to their specific needs. Frailty, common with this population, affects all aspects of older adults' medical needs and subsequent care.
Dr. Stanich and Susan M. Bower, M.S.N., R.N., are leading an effort to implement the most recent ACS geriatric guidelines and prepare Mayo Clinic's emergency department to become accredited as a Level 1 geriatric emergency department through the American College of Emergency Physicians (ACEP). They hope this accreditation will occur in early 2025. The accrediting body ensures that a variety of best practices are embraced in the Mayo Clinic emergency department, including geriatric education, interdisciplinary staffing and optimal transitions of care.
How the environment of emergency and trauma care may conflict with the needs of older adult patients
These are some of the unique characteristics of emergency and trauma care for older adults:
- All parties need to move more slowly during the assessment.
- The mechanism of injury and the resulting injuries do not always correlate.
- Vital signs and the mechanism of injury do not always correspond with patient presentation.
At the same time, any trauma bay environment does not reflect these needs: It tends to be noisy and fast paced, and it goes against all recommended practices to care for the needs of older adults.
Meeting the span of older adult needs in emergency and trauma care
ACS geriatric trauma management guidelines aim to reduce future risk through fall prevention and suggest careful, tailored care for older adults, says Dr. Stanich.
"With older adults, we may find significant injuries that can lead to marked debility due to the patients' underlying frailty," she says.
Bower and Dr. Stanich say the guidelines emphasize gentle care for this population, an approach that Mayo Clinic in Rochester's emergency department takes with older adults. Dr. Stanich indicates that gentle care includes talking slowly, assisting with vision needs, minimizing noise and using hearing amplifiers, along with reviewing medications and arranging follow-up for these patients. Bower and Dr. Stanich also indicate that feeding older adults is important for emergency and trauma care to implement.
"An older adult could be at emergency medicine or the trauma bay for even longer than patients from other populations, and the patient could have missed a few meals," says Dr. Stanich. "Evidence shows that not feeding these patients can lead to bad outcomes."
Dr. Stanich notes that she and Bower are facilitating quality improvement projects to enhance care for older adults, including fall prevention, transitions of care, and provision of senior-friendly foods, including foods that are softer and easier to eat than those that might be given to other patient populations.
Bower indicates that an interdisciplinary, collaborative approach is important for emergency and trauma care for older adults, noting that personnel in Mayo Clinic emergency services work closely with specialists in Community Internal Medicine, Geriatrics and Palliative Care.
For more information
American College of Surgeons. Best Practices: Geriatric Trauma Management.