Older adults treated in emergency departments specifically designed for them had a 39 percent lower likelihood of hospital admission and a 38 percent lower 30-day mortality rate compared with similar patients seen in standard emergency rooms, according to a national analysis of Medicare-linked data.
That finding matters because for an older adult, avoiding admission is often the better clinical outcome rather than a cost-saving compromise. Hospitalized patients face exposure to infections, medication errors, and the rapid physical deconditioning that comes with days spent in bed, and each of those risks falls harder on someone who is 80 than someone who is 40.
There are now 624 accredited geriatric emergency departments in the United States, including 73 in Department of Veterans Affairs medical centers. Most are not separate wards. They serve all ages while running senior-specific protocols, and they are classified from Level 1, for sites meeting the highest number of criteria, to Level 3.
The First Question Is No Longer the Chief Complaint
A conventional emergency department is designed to quickly identify a single problem and either fix it or admit the patient. That design works well for a broken leg. It works poorly for a patient who fell because of a blood pressure medication interacting with dehydration and an undiagnosed urinary tract infection.
The clinical model differs in specific, checkable ways. Trained geriatric emergency teams screen for delirium and cognitive impairment, which standard emergency departments do not routinely do. They conduct a careful review of all the patient's medications. They assess mobility and function rather than only the presenting injury. And they build a discharge plan that includes follow-up contacts rather than handing over paperwork.
Ula Hwang, an emergency physician and researcher at NYU Langone Health who led the new analysis, told KFF Health News that for this population, "admission may not be the best thing for an older adult." The environmental changes follow the same logic. Rooms have windows so patients can distinguish day from night, which reduces the risk of delirium. Sound-absorbing walls lower ambient noise. Units distribute reading glasses and sound-amplifying devices to counter the sensory impairment that contributes to disorientation, dim glaring lights, and keep walkers on hand.
The evidence base has strengthened recently. Earlier studies showing reduced admissions generally involved one or two hospitals. The new work, published in a geriatrics journal, used Health and Retirement Study data linked to Medicare claims for 4,570 adults aged 65 and older, comparing those treated at accredited sites with a matched group seen elsewhere.
Boarding Turns a Waiting Room into a Clinical Risk
These departments also target a problem that has grown worse across emergency medicine: boarding, the hours or days admitted patients spend waiting in the emergency department for an inpatient bed.
Cameron Gettel, an emergency physician and researcher at Yale School of Medicine and a co-author of research on boarding published in Health Affairs Scholar, has reported that prolonged boarding, meaning waits over three hours, has increased among older adults. The consequences are measurable rather than merely uncomfortable. A study of patients 75 and older across French emergency departments found that those held overnight before transfer to an inpatient ward had a 15.7 percent in-hospital mortality rate compared with 11.1 percent for those admitted to a ward before midnight. Overnight boarding was also associated with an increased number of falls and infections.
Adults aged 75 and older visit emergency departments at a higher rate than any other age group, except infants, at 76 visits per 100 people in 2022, according to federal ambulatory care survey data. That volume is why the design question is not marginal.
The evidence has real limits worth stating plainly. The national analysis is observational, not a randomized trial, so it establishes association rather than proof that the model itself caused the difference. The associations with admission and mortality were observed among non-Hispanic White patients, and the admission association was observed among adults aged 65 to 80, meaning the benefit has not been demonstrated evenly across all groups. Researchers noted that Black and Hispanic older adults may face barriers outside the emergency department, such as limited access to follow-up care, that an emergency visit alone cannot fix. Only 270 of the older adults in the study, about 6 percent, received care at an accredited site. Current medical guidance has not changed as a result of this work.
Six Hundred Accredited Sites Against Five Thousand Emergency Rooms
The access gap is the practical story for most families. The country has more than 5,000 emergency departments. Roughly 600 carry the accreditation. Kevin Biese, the emergency physician who directs the Geriatric Emergency Department Collaborative, has argued that patients should press hospitals on this question, asking why their local hospital lacks an accredited program.
Households can check accreditation status through the American College of Emergency Physicians accreditation program, which maintains the list of recognized sites and their levels. Whether that changes where an ambulance takes someone is a separate matter, and in a genuine emergency, it should not. Chest pain, stroke symptoms, difficulty breathing and serious injury go to the nearest capable facility. The accreditation question is useful for planning non-emergency visits and for knowing what to ask when a hospital admission is being discussed.
There are things families can do regardless of which department they end up in. Bring a current, complete medication list, including supplements, because the medication review is one of the highest-value steps, and it depends on accurate information. Bring hearing aids and glasses. Stay with the patient if possible, as a familiar person can reduce disorientation. Ask directly whether delirium screening was done and whether admission is necessary or whether outpatient follow-up would work. Ask what the discharge plan includes and who will call.
Cost is not the barrier here, as it is elsewhere. Accreditation does not add a fee to the visit. The financial argument runs the other way for health systems, and an earlier analysis led by Hwang found the model saved Medicare up to roughly $3,000 per visit.
The accreditation program continues to expand, and additional analyses from the same research group are expected. MedicalDaily will report new outcome data and any changes to accreditation standards.
Key Questions Answered
What is a geriatric emergency department? An emergency department accredited for meeting standards in staffing, care processes, physical environment and equipment tailored to older adults. Most serve all ages rather than operating as separate units.
What do these departments actually do differently? They screen for delirium and cognitive impairment, review all medications, assess mobility and function, provide reading glasses and hearing aids, use rooms with windows and reduced noise, and build discharge plans with follow-up contact.
Does the research show that the model leads to better outcomes? No. The national analysis is observational and shows association. It found 39 percent lower odds of admission and 38 percent lower 30-day mortality, but it cannot rule out that patient or hospital differences explain part of the gap.
Is avoiding hospital admission actually better? For many older adults, yes. Hospitalization carries risks of infection, medication error, and deconditioning that fall harder on older patients. The goal is to match the setting to the need, not to avoid admission when it is warranted.
How do I find out if a hospital near me is accredited? The American College of Emergency Physicians maintains the list of accredited sites and their levels on its accreditation program page.
Should this change where we go in an emergency? No. For chest pain, stroke symptoms, breathing difficulty, or serious injury, go to the nearest capable facility or call 911. Accreditation is useful for planning and for asking better questions once care begins.
What should families bring to the emergency department? A complete current medication list including supplements, hearing aids, glasses, and if possible a person who can stay with the patient and answer questions about baseline function.
