Geriatric emergency departments (GEDs) are transforming care for older adults by addressing their unique medical and social needs, reducing risks like delirium and falls, and improving outcomes through specialized protocols. Since the first GED opened in 2008, over 500 U.S. hospitals now offer age-friendly care, though disparities in benefits persist.
Geriatric emergency departments (GEDs) are redefining how hospitals care for older adults, addressing the unique challenges of aging patients through tailored protocols, quieter environments, and specialized staff training. These units, which emerged as a response to the growing elderly population, aim to reduce complications like delirium, falls, and hospital readmissions by focusing on the distinct needs of patients over 65.
The Rise of Geriatric Emergency Departments
The first geriatric emergency department opened in 2008 at a New Jersey hospital, marking the start of a national movement to address the limitations of traditional ERs for older patients. By 2024, over 500 U.S. hospitals had earned accreditation for age-friendly care, with initiatives like the American College of Emergency Physicians’ Geriatric Emergency Department Accreditation program driving adoption. In the past, we've always treated everybody in the ED the same, regardless of age,
said Dr. Liz Goldberg, an associate professor of emergency medicine and geriatrics at the University of Colorado School of Medicine in Aurora. Now, there's more focus on doing things differently for older adults because they have different needs and different diagnoses.
Studies show GEDs reduce hospitalizations and mortality for elderly patients. A 2024 national study led by Dr. Xi Chen at Yale found that older adults treated in GEDs were significantly less likely to be hospitalized or die within 30 days compared to those in traditional ERs. However, benefits were most pronounced among white patients and those under 80, highlighting disparities in access to care. The upsides of GED care are not reaching all populations equally,
Chen noted, citing barriers like limited follow-up care for Black and Hispanic patients.
Key Practices in Geriatric ERs
GEDs employ a range of strategies to improve care, from physical design changes to specialized assessments. Quiet, well-lit spaces with non-slip floors and ample handrails reduce fall risks, while staff receive training in geriatric-specific issues like dementia screening and medication review. The emergency department is a very fast-paced, loud environment,
said Dr. Ula Hwang, medical director of geriatric emergency medicine at NYU Langone Health in New York City. You really don't want an 85-year-old or older patient lingering and sort of stranded in the emergency department for hours and days on end.
It’s been shown that if you’re an older adult and you board in the emergency department overnight, you are at greater risk for developing delirium,
Hwang explained. An age-friendly emergency department helps prevent such problems through protocols and environmental changes.
Impact on Patient Outcomes
Research underscores the effectiveness of GEDs in improving outcomes. We were able to identify functional impairment and lower extremity strength issues,
said Dr. Liz Goldberg, who led a trial at the University of Colorado.
Despite these gains, challenges remain. Many GEDs struggle with low patient volumes, limiting their ability to scale. Low patient volumes in geriatric Eds—despite documented clinical benefits—underscore a critical need for broader implementation,
the Yale study noted. Additionally, patients with dementia often go undiagnosed in traditional ERs, leading to missed opportunities for prevention.
What Comes Next for Geriatric Care
As the U.S. population ages, the demand for GEDs is expected to grow. The American College of Emergency Physicians reported in 2024 that the number of accredited GEDs has expanded rapidly, with over 500 hospitals now certified. However, disparities in access and outcomes persist, prompting calls for policy changes to address systemic barriers. Addressing these barriers and biases will be critical for equitable care,
said Dr. Ula Hwang, who co-authored the Yale study.
Future efforts will likely focus on standardizing care across regions and improving follow-up support for vulnerable patients. At the VA Washington DC Health Care system, for example, GEDs are integrating care transitions to ensure patients receive ongoing support at home. Every Veteran’s needs are different and may change as they age,
said Dr. Kevin Jeng, an emergency medicine leader at the VA. Pursuing accreditation as a Geriatric Emergency Department is another step in our ongoing commitment to excellence in geriatric care.
