Sixty-five. The quintessential age for retirement. The age to qualify for full Medicare benefits. The age the oldest of the baby boomers started turning in 2011. Its also the target age for some specialty senior EDs that are opening in anticipation of the complete graying of the generations members. Many boomers are going to rail against being referred to as senior, elderly or in need of geriatric services. Some boomers may never think of themselves as old. They bike, ski and play tennis in their 50s and early 60s, and many would rather start new careers than retire and focus on their hobbies like their parents did a generation ago.
It was a mindset that Holy Cross Hospital in Silver Spring, Md., carefully considered when making 65 the eligibility age for its senior ED, the first in the country when it opened in 2008. We deliberated over this long and hard, said Judith Rogers, RN, PhD, president of the hospital. We were sensitive to how people would feel about being called senior.
But the clientele seems to appreciate the EDs ambiance despite its for seniors label. We found that no matter how healthy and active our patients are in this age group they appreciate the more tranquil, quieter experience of the senior ED, she said.
In addition to specialized lighting, less noise, nonskid floors, thicker mattresses and larger numbers and letters on phones and calendars, these specialized EDs offer expertise in the assessment, treatment and care of older adults. Rogers compares the senior ED to other perks of being of a certain age, such as early bird specials and senior discounts. You may not need them, but they are there for you if you want them, she said.
JoAnn Lazarus, RN, MSN, CEN, 2013 president of the Emergency Nurses Association, defines geriatric more as a physiological condition than a chronological state. You can have someone who is 65 and may be considered geriatric because they have multiple health conditions and needs, she said. And
you can have someone 75 who is in good health and lives an active, more youthful lifestyle.
Boomers who go to St. Mary Mercy Livonia (Mich.) Hospital present in the ED with many of the same issues as their parents and members of younger generations, said Michelle Moccia, RN, MSN, ANP-BC, CCRN, program director of the hospitals senior ED. They include heart disease, high blood pressure, substance abuse of prescription medications, mental health conditions and injuries and trauma. Outside of the typical diagnoses, health experts can identify unique characteristics of the approximately 78 million baby boomers that will affect their use of healthcare services. These experts predict that, as they continue to age, boomers sheer numbers and unique health requirements will hit healthcare like a tsunami.
This wave of aging baby boomers will reshape the healthcare system forever, according to the American Hospital Associations May 2007 report When Im 64: How Boomers Will Change Health Care.
According to the report, four factors drive the boomer impact on U.S. healthcare:
There are significantly more of them and, as they age, they will require more healthcare services than any other generation of Americans.
The prevalence of chronic diseases is increasing among boomers
They have different needs and expectations than past generations.
More medical services and technologies are available to them
than ever before.
By 2030, boomers will account for more than twice as many hospital admissions as they do today, the report states. While length of stay may continue to decrease, the intensity of the care provided for each patient day will likely increase as the proportion of inpatient admissions over 65 rises. Services elsewhere in the hospital will increase including 4 million more ED visits than occur today.
Boomers versus the greatest generation
In general, boomers between the ages of 54 and 59 report having more chronic health conditions, pain, problems with alcohol and psychiatric problems than their parents reported having when they were the same age, the AHA report states.
Falls, states the report, are the most common cause of injury to older adults. Increasing incidence of falls means more ED visits and hospitalizations, the report adds. Boomers also are more active than previous generations, according to the AHA report. Healthcare innovations from joint replacements to new pain medications have helped them live more active lives than their parents did at the same age. These innovations have translated into a decreasing percentage of Americans who are considered chronically disabled.
Nicholas A. DiNubile, MD, a well-known orthopedic surgeon who coined the term boomeritis to describe the musculoskeletal problems he observed in fellow boomers, said a sharp rise in injuries seen in this group in the ED just hints at the rate of orthopedic injuries. Most boomers who injure joints, tendons, muscles and bones first self-treat or go to the family physician or chiropractor, he said. They
go to the ED for more traumatic injuries such as fractures, ruptures and tears.
Boomers, according to the AHA report, exercise more than their parents did, and this has led to a 33% increase in sports injuries. As a result, boomers will need more orthopedic treatments and they will want to quickly return to their active lifestyle.
According to DiNubile, Weve doubled our life expectancy in a short period of time; now were seeing our frames fail. Weve achieved longevity, now we need durability. The baby boomer generation will be interesting to watch when we really start getting into trouble. We will want things fixed, we will want multiple opinions and our expectations are much higher about what medicine can do.
Baby boomers heed many of the public health warnings that their parents did not have and are benefiting from smoking and drinking less and exercising more, said David John, MD, FACEP, a spokesman for the American College of Emergency Physicians and chair of emergency medicine at Johnson Memorial Medical Center in Stafford Springs, Conn. Combined with advances in technology, pharmacology and treatment protocols, boomers who do go the ED complaining of chest pain or signs of a stroke are discharged with less disability.
Its rare that someone comes to the ED with a heart attack and ends up having heart damage. Rapid assessment and treatment with cardiac catheterization and stents and bypasses have resulted in a generation with fewer cardiac cripples, he said.
Back to the senior ED
Although many 65-year-olds may not need the services of a senior ED, the earlier the intervention, the better, Moccia said. Boomers who come to Moccias senior ED are screened for cognitive changes, depression and neurological impairments. Staff assess patients nutrition, whether they have lost weight or have difficulty chewing or swallowing. All of this is done to earlier detect and treat progressive illnesses such as dementia, cancer and mental health problems that can eventually hinder independent living.
Rogers said Holy Cross has devoted money, labor, resources and training to ensure its senior ED offers substantive care and not just ambiance to patients. The ED staff includes a geriatric nurse practitioner and geriatric social worker along with pharmacists skilled in polypharmacy review to address the slew of medications prescribed to many older patients. The nursing staff also receives training in older adults special health needs.
Holy Cross does not yet have hard data to show that the senior ED leads to better patient clinical outcomes. We cannot tell you that the senior ED has singularly caused a reduction in readmissions because we have so many strategies trying to do that, Rogers said. And even collectively, reducing readmissions requires more than a single intervention.
We can, however, tell you that our patients report a superior, improved ED experience. We closely monitor patients satisfaction. In general they are overwhelmingly satisfied with the senior ED, she said.