Recent Advances in Geriatric Emergency Medicine

Dear Colleagues,

Geriatric emergency medicine (GEM) is expanding due to the aging of the general population in all countries of the world, particularly in the West.

Emergency Medicine is implemented as a primary specialty in many countries in Europe and all over the world. 

The International Federation for Emergency Medicine defines EM as follows: “Emergency medicine is a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of episodic undifferentiated physical and behavioural disorders; it further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development.”

The European Society for Emergency Medicine adds some specific elements: “Emergency Medicine is a specialty based on the knowledge and skills required for the prevention, diagnosis and management of urgent and emergency aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders. It is a specialty in which time is critical. The practice of Emergency Medicine encompasses the pre-hospital and in-hospital triage, resuscitation, initial assessment, and management of undifferentiated urgent and emergency cases until discharge or transfer to the care of another physician or health care professional. It also includes involvement in the development of pre-hospital and in-hospital emergency medical systems.” GEM is considered a subspecialty in the USA. The American College of Emergency Physicians proposed guidelines for EM in 2013 . In Europe, GEM is integrated to the EM specialty. The European Society for Emergency Medicine developed a European GEM curriculum, and ACEP developed one in the USA.

Efforts have been focused on setting the design and organization of pre-hospital systems and emergency departments (ED) as well as on improving outcomes of life-threatening conditions such as myocardial infarction or trauma. Despite all the international multicentric studies including all ages of patients, attention towards older patients still remains low despite this elderly representing one of the most important groups because of the changing population demographics.

The WHO’s definition of elderly starts from 60 years old, but problems are critical for older patients over 75 years of age who experience loss of autonomy, difficulties of staying at home, and cognitive deficiencies (e.g., dementia). The emergency care of older people will increase exponentially because the number of old people will increase for the next 50 years. This evolution will generate an increase in health demand in emergency medicine settings and significant increases in health costs at the national and global levels. In 2050, the number of people over the age of 85 will outnumber those under 16. Europe has 23 of the world’s 25 “oldest” countries. The number of older patients visiting the ED is increasing continuously, and new models of care processes are proposed in some countries to improve the quality of care.

In addition to specific studies conducted by geriatricians, little is known on GEM. Relevant data and registries are in development in the context of pre-hospital and ED care management. GEM is a specific area which is of interest for emergency physicians and geriatricians.

ED visits by older patients are always a crisis for them because three dimensions are involved; social, somatic, and psychological. The clinical manifestation of disease is often atypical, and a diagnosis could be difficult to make. The complexity of elderly care needs a careful evaluation from the triage to the diagnostic and treatment area.

This Special Issue of the Journal of Clinical Medicine has the goals to propose the most updated knowledge in GEM from both basic and clinical research. Accepted publications will focus on specific areas of care management in the ED from the pre-hospital setting to the ED. Studies on the design and organization of specific ED tracks for older patients will also be proposed for publication.

Prof. Dr. Abdelouahab Bellou
Prof. Dr. Giovanni Ricevuti
Prof. Dr. Xin Li
Guest Editors

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