Cynthia Tompkins, 75, faced a challenging recovery following hospitalization for osteomyelitis and a subsequent six-week rehabilitation stay earlier this year. Returning home in San Diego while managing ongoing antibiotic treatment and multiple medications for chronic conditions, she experienced sudden, severe vomiting in early July. When a friend called an ambulance, Tompkins anticipated a long, uncomfortable wait in a standard emergency room setting.

Instead, she was treated at the emergency department of U.C. San Diego Health in La Jolla, which is accredited as a geriatric emergency department (GED). Since 2022, all adult E.R.s in San Diego have adopted this model, designed to accommodate the unique health needs and risks facing older adults. The approach aims to reduce hospital admissions, lower mortality, and improve patient outcomes while also controlling healthcare costs.

Upon arrival, Tompkins was promptly admitted to a private, quiet room equipped with features to prevent discomfort and confusion common among elderly patients, such as thicker mattresses to reduce bedsores and windows offering natural light to help maintain circadian rhythms and minimize delirium risk. Denise Valenzuela, a geriatric emergency nurse assigned to Tompkins, emphasized the importance of such features in reducing mental disorientation, a frequent hazard for hospitalized seniors.

The American College of Emergency Physicians has accredited 624 GEDs nationwide, including 73 within Veterans Affairs medical centers. These units serve patients of all ages but incorporate specialized protocols to address complex issues prevalent among older adults, such as multiple chronic conditions, medication management, and fall prevention. Accreditation levels range from Level 1, meeting the most comprehensive standards, to Level 3.

Older adults, particularly those over 75, visit emergency departments at high rates—approximately 76 visits per 100 individuals in 2022—yet conventional E.R.s often focus on treating isolated complaints without fully accounting for the multifaceted health challenges that older patients face. “Older patients rarely arrive with a single ailment,” said Dr. Kevin Biese, who directs the Geriatric Emergency Department Collaborative. GEDs emphasize comprehensive assessments to identify underlying causes of acute problems and mitigate future risks.

This includes routine screening for delirium and cognitive impairment, thorough medication reviews, and accommodations to address sensory impairments such as providing reading glasses or hearing amplifiers. Efforts are also made to facilitate rest by adjusting lighting and offering sleep aids. Importantly, GEDs aim to minimize prolonged stays in the emergency department—a problem linked with increased mortality, falls, and infections among admitted older patients, especially when boarding times extend overnight.

Research comparing outcomes of older adults treated in GEDs versus standard emergency departments has shown significant improvements. A study analyzing Medicare data for nearly 4,600 patients over 65 found a 39 percent reduction in hospital admissions and a 38 percent decrease in 30-day mortality among those seen in GEDs. Additionally, these specialized units have demonstrated potential cost savings of up to $3,000 per visit for Medicare.

Despite the expansion of GEDs, many emergency departments nationwide have yet to adopt these standards. Advocates like Dr. Biese encourage patients and families to inquire about the availability of accredited geriatric emergency care, underscoring its benefits for older adults.

Following her treatment in the La Jolla unit, Tompkins received intravenous fluids and anti-nausea medication, along with a comprehensive geriatric assessment that identified nutritional issues contributing to her symptoms. She was discharged the same day with ongoing support and follow-up care, expressing relief that her complex needs had been addressed holistically. “They took care of the whole me and put me on the right track,” she said, noting steady, if gradual, progress in her recovery.