America is aging at an unprecedented rate, and as the economy worsens and health care costs rise, hospital emergency departments are often challenged by the complexities of providing care to older adults.

The special needs of seniors may not align with how emergency departments are physically designed, and how care is provided. I was an emergency department nurse for several years, and I know first hand how the fast pace of the center isn’t always designed for seniors.

Older patients may have multiple and complex pre-existing diagnoses, thus making rapid triage and diagnosis (a primary emergency department goal) difficult. They may also be more likely to have some sort of cognitive impairment that makes getting an accurate health history difficult.

In my experience, many older people would simply reply, “Oh, my doctor knows all that,” when they were asked about their health history. That lack of knowledge sometimes delayed care while the doctor had to obtain all aspects of their medical background. These patients are also more likely to be taking multiple prescription drugs that make diagnosis even more difficult due to cognitive and physical side effects.

What’s more is the fact that seniors may have atypical symptoms of an acute illness. In other words, symptoms may be overlooked as “just aging,” and by the time the diagnosis is more obvious, they may be seriously ill.

The physical set up of many emergency departments is not always suited for caring for an older person. There are often long waits in the emergency department for various reasons, and the only place to lie down is a gurney, which is very uncomfortable when used for long periods of time, and can be physically exhausting. Crowded emergency departments are also loud and can be stressful to older patients.

Seniors may also have an increased risk of falling when in the emergency room. For example, stretchers have hard to manage side rails and the bathrooms are often some distance from the treatment room. Since it’s hard to provide one-on-one care in the emergency department, an elderly person may try to get up and go to the bathroom alone by climbing over the guard rails. The typical slippery hard tile floors also make the risk of injury from a fall worse.

So what’s the good news?

An increasing number of hospitals are recognizing the special needs of geriatric patients in the emergency department and they are doing something about it. For example, Holy Cross Hospital in Maryland has designed emergency service with the needs of senior patients in mind:

While patients in the main ER typically share a room crowded with monitors and equipment, separated from one another only by a flimsy curtain, each patient in the new center has an uncluttered cubicle, with a comfortable chair for a family member or visitor. Rayner said she appreciated the extra privacy. She also was grateful for the mattress — twice as thick as other ER beds and specially designed to prevent skin breakdown that leads to bedsores, which can develop rapidly in elderly patients. There are plenty of blankets — kept toasty in a blanket warmer — and pillows.

Holy Cross consulted with the Erickson School on all aspects of the center and drew on experts in lighting and audiology to make the experience as soothing as possible on aging eyes and ears.

Walls are painted a warm gold, with wooden handrails for safe walking. Rather than slick linoleum, the floor is made of faux wood. Each patient has a television with headset, a large-face clock and overhead lighting controlled by a dimmer switch.

When my mother was ill, we spent a great deal of time in the emergency room, and many of these things would have made such a difference. The goal of addressing the special needs of seniors in the emergency department is to make care less fragmented, increase satisfaction and comfort, reduce future hospital stays and to keep them warm. Because even when you work there, the emergency room can be a cold place.