Every day, hospitals across America witness an unfortunate scene – older adults lying on gurneys in emergency room (ER) hallways experiencing excruciating pain while harried medical staff deal with pressing situations nearby. Even when physicians determine that these patients require hospitalization, they often have to wait for hours or even more than a day in the ER without receiving adequate food, water, movement, bathroom assistance, and necessary care as per doctors’ recommendations. This issue known as ‘ER boarding’, is worsening despite being equally problematic during the initial years of the COVID-19 pandemic when hospitals were filled with critically ill patients.
According to estimates from 2019 (before the onset of the pandemic), around 30% to 50% of ER boarding patients were senior citizens above age sixty five, and almost a tenth of all patients admitted through ERs suffered ‘boarding’, even prior to the ongoing health crisis. Physicians who staff emergency rooms have stated that this issue is as severe now as it was earlier; maybe even more complicated since administrative committees designate increasingly lesser hospital beds in favor of lucrative surgeries and procedures, leading to bottlenecks within ERs while leaving patients stranded for longer periods.
The impact on senior citizens who are frail with multiple medical issues is particularly severe as they remain confined to stretchers or hard chairs without reliable nursing assistance, thereby risking losing strength, missing essential medications, and encountering complications such as delirium (confusion) during their prolonged waits. When these patients finally secure a hospital bed after spending an entire day in the ER’s hallways filled with alarms blaring repeatedly around them, they are likely to stay longer than usual, face higher risks of medical complications and death.
New research reveals that older adults who remain boarded overnight within an ER setting confront greater possibilities of perilous circumstances including delirium and prolonged hospital stays coupled with adverse events such as falls, infections, bleeding, heart attacks, strokes, bedsores (pressure ulcers), etc. These senior citizens might experience more profound distress after undergoing extensive physical activities compared to others due to their age-related conditions.
Several weeks ago, Saket Saxena who directs Geriatric Emergency Medicine Department at Cleveland Clinic helped attend to an eighty-year old lady from a basketball match, sustaining severe hip injuries. She remained stranded in the ER for approximately sixteen hours while experiencing intense pain that was challenging to alleviate adequately due to the nature of emergency rooms designed primarily to manage crises and stabilize patients rather than catering to those already determined by physicians as hospital candidates.
Doctors from different parts of America, including Hashem Zikry (UCLA Health), Jesse Pines (US Acute Care Solutions), Michael Malone (Advocate Aurora Health) among others have expressed their concerns about this issue and suggested some measures that older adults could adopt to mitigate the situation. They recommend bringing another person along for advocacy, speaking up if they feel worse or when staffers miss problems, carrying hearing aids, eyeglasses, medication lists, medications (if possible), books, magazines, music etc., as these can help them cope better with ER waits and reduce delirium risks.
ER doctors have emphasized that boarding is primarily an issue for health systems to address through policy changes rather than individual actions by older adults or their caregivers; however, they suggest being prepared to face long waiting periods in emergency rooms while bringing essential items such as earplugs and eye masks to help them rest amidst the non-stopping stimulation. Friends or family members accompanying these elderly people can ask for permission from healthcare personnel so that someone could stay by their bedside whenever possible, ensuring they eat, drink water regularly, use bathrooms frequently, take routine medications etc., as per doctors’ recommendations.
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