Written by Tanner Meyer, Masters Research Fellow in Aging, Class of ‘21, Friedman Center for Aging
Recap: At the start of our conversation with Barnes-Jewish Emergency Department Physician, Dr. Chris Carpenter, we asked how emergency departments are working to modify their methods of care to treat older adults. Dr. Carpenter, alongside other geriatricians in the U.S. and Canada, created The Geriatric Emergency Department Collaborative (GEDC). Barnes-Jewish Hospital has adopted the GED Guidelines specified by the GEDC with the top four priorities including: functional assessments, cognitive assessments, medication assessments, and transitions of care.
We asked Dr. Carpenter how the GED care model has been impacted by COVID-19. According to him, the GED Guidelines have not been updated since its 2014 publication. He explained, “creating them was a two and a half-year project and updating them will also be a multi-year endeavor.”
In a quick effort to optimize emergency care for vulnerable populations, especially older adults, during the coronavirus pandemic, EM-Critical Care physician and GED collaborator, Chris Palmer launched a telehealth program in St. Louis. Though in its infancy, telehealth seemed a viable alternative to going to the emergency department (ED), where risk for contracting the novel coronavirus was higher. WashU had established a free triage system for patients to speak with a physician by video and decide whether telehealth was appropriate or whether they needed to come to the ED. Unfortunately, the free triage system was shut down “due to university legal concerns about patient privacy rights” said Dr. Carpenter.
At the time we spoke with Dr. Carpenter, nationwide emergency department volumes had dropped significantly, as treatment for non-emergent medical and surgical conditions were postponed. Some cities, like New York and Detroit, had seen an influx in COVID-19 patients, but St. Louis did not. Alarmingly, ED’s across the board saw a drop in the number of patients with strokes, heart attacks, trauma and other infections. Presumably, people with these health concerns were told to shelter in place, or, they were too afraid of going to the hospital and contracting the virus. Today, if there is not a telehealth option for older adults with chronic conditions, their options are to either seek treatment and risk infection, or stay at home and risk worsening symptoms. The options appear bleak.
Given this “catch 22”, I wanted to ask Dr. Carpenter his advice. He recommended that “older adults and their families seek emergency care in hospitals that have focused efforts to render the best geriatric outcomes.” As a resource, he mentioned HealthinAging.org, a site with a comprehensive list of questions that older patients and their families can ask in order to determine if their local ED complies with the GED Guidelines. Read the characteristics of a geriatric-friendly ED. Dr. Carpenter cautioned us: with geriatricians in short supply across the United States, other critical care departments have yet to compile their own set of geriatric guidelines.
Where does that leave older adults sheltering in place? Dr. Carpenter said it best, “Physical distancing should not mean social distancing; look out for one another by checking in frequently. Anxiety and depression are very real during this pandemic, but need not be so common with smart phone and computer teleconferencing.”
“Most importantly,” he adds, “When injured or ill, do not be afraid to seek emergency care as you normally would, because hospitals have worked hard to isolate potential COVID patients from others.”