Older adults are more likely to be misdiagnosed than other adults. Multiple conditions and medications can make it tricky. Geriatric ERs are an answer to this problem and they are catching on.
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It can be hard for doctors to accurately diagnose older adults. They may have multiple conditions or take multiple medications. Ashley Milne-Tyte reports on a new effort to address this problem – geriatric ERs.
ASHLEY MILNE-TYTE, BYLINE: At this community hospital in Glen Cove, N.Y., a third of the people who arrive in the ER are over the age of 65. Dr. Maria Carney is chief of geriatrics and palliative medicine for Northwell Health. She says an older person coming in may be weak or confused, and it could be their first time here.
MARIA CARNEY: If you don’t know that person’s baseline, if you don’t know that there was a new medication started, if you don’t know that they had a fall a week ago, and you can’t get that information because they’re not able to communicate, it’s very hard to diagnose accurately.
MILNE-TYTE: But this emergency department is specially designed to accommodate older adults, with subtle enhancements for safety and comfort.
CARNEY: Nonskid floors – if you see, textured. Ambient lighting.
MILNE-TYTE: Instead of those harsh fluorescents. And there are tools to help with communication. Carney says when older patients arrive, they may not have their eyeglasses or hearing aids with them – if they use them.
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CARNEY: So it’s a microphone with earphone attached.
MILNE-TYTE: The patient puts the earphones in, and the device acts as a makeshift hearing aid. Carney says all this turns the emergency department into an easier place for older patients to be. With less stress and better communication, an accurate diagnosis is more likely. Dr. Patrick Coll is medical director for senior health at UConn Health in Connecticut. He says there would be fewer diagnostic errors if more young doctors became geriatricians, like him and Carney. He says this year…
PATRICK COLL: There were just over 170 geriatric fellows placed in geriatric fellowship programs across the United States, and there were more than 1,000 cardiology fellowship positions filled.
MILNE-TYTE: He’s not saying cardiology isn’t vital, but he says with the population of older people growing fast – especially those over 85 – the U.S. needs more expertise in older bodies and minds.
COLL: If we were training providers right across the board to better care for older adults, then I think we would get better care for older adults, and I believe that the appropriate diagnosis would be a part of that spectrum of better care.
MILNE-TYTE: Nurses spend more time with older patients than anyone else, says Allie Tran, a former nurse herself. She’s now a researcher at Medstar Health Research Institute, and she’s working on a project to involve nurses in improving diagnosis.
ALLIE TRAN: Because what we’ve found when we’ve talked to nurses is many nurses don’t consider expressing a diagnosis as part of their scope or role. You know, they say that’s kind of the physician’s job.
MILNE-TYTE: She says ideally, nurse, physician, patient and family members could work together on figuring out what’s wrong. As it is now, patients like Karla Stromberger, who’s 80, say they have to be their own advocates at the doctor’s when a diagnosis feels off.
KARLA STROMBERGER: To try and convince that person that something else is going on, and please listen, is just exhausting.
MILNE-TYTE: Stromberger, a retired physical therapist, had polio in the 1950s. As she’s aged, she’s had a lot of health problems related to that, but she says medical staff often see her age before her symptoms.
STROMBERGER: And they kind of go, well, OK, that’s an elderly patient. And we are elderly, but some of us are competent enough still to be able to help them figure out what’s going on.
MILNE-TYTE: When that happens, she considers it a victory.
For NPR News, I’m Ashley Milne-Tyte.
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