Phillip Magidson, assistant professor in the Department of Emergency Medicine and the Division of Geriatric Medicine and Gerontology, wants to change the way older adults are assessed and treated in emergency departments (EDs). New best practices, he says, could improve patients’ ED stays and health outcomes after they leave. He has forged a collaboration between emergency medicine and geriatrics that’s proving a powerful tool for improving the care of older adults.

The ED is a challenging setting for clinicians, who must make quick decisions, often without knowing a patient’s full medical history. This setting is also hard on patients, especially those with visual, hearing or cognitive impairments. Yet despite the increasing number of geriatric ED patients, many doctors don’t receive much, if any, training specific to the geriatric population, says Magidson.

Older adults are not exact biological, physiological or psychosocial copies of their younger selves. Their lab values, vital signs and presentation of symptoms may be different than those of younger adults, and they may have different treatment goals.

“Often in medicine, we’re focused on making a rapid diagnosis and providing a clear treatment plan,” Magidson says. “Sometimes that diagnosis and treatment aren’t consistent with what’s important to the patient. Often, less is more in older adult patients: fewer interventions, less testing. Sometimes doing more doesn’t add a lot of value and is associated with serious risks.”

“ EDs can do more to support care partners, who are “really a large part of gathering information and formulating a treatment plan for older adults.” — Phillip Magidson

As current ED best practices aren’t always most effective for older adults, Magidson has collaborated with researchers on better ways to identify and manage cognitive impairment in the ED. Doing formal screenings for cognitive issues is difficult in this fast-paced setting because they typically involve lengthy questionnaires and assessments. But other approaches may work.

“There’s some thinking that prior to a formal diagnosis of dementia, you sometimes see an uptick in ED visits: more falls, a couple more traffic accidents, a medication misadventure. And in isolation, OK, but if this patient’s been here for two traffic accidents and one medication issue and in the preceding 30 years they’ve never been in the ED, why now? If there’s some cognitive impairment, can we identify that? It could be an issue that’s settled with a referral to a memory clinic or a person’s primary care physician.”

Magidson’s work also focuses on improving ED care of patients with known cognitive impairments, so they don’t stay as long or develop as many complications. This research includes looking at health systems with the resources to help older adult patients recover better and leave the ED sooner.


Additionally, EDs can do more to support care partners, who are “really a large part of gathering information and formulating a treatment plan for older adults.” This can be as simple as having chairs present so people can sit and specifically inviting them into the conversation from the beginning.

This collaboration between geriatrics and emergency medicine has been key to Magidson’s research. “With that understanding that these patients are unique, these two departments are really thinking about care processes and research projects, and looking at these patients in the ED space,” he says. “We’ve had support recognizing that it’s an important patient population. This has been a good laboratory to do that thinking and that work.”