Unheard Voices in the Emergency Room

Not too long ago I had the unique experience of needing the services of the emergency room of a major teaching hospital in New York City.  (Don’t worry, I’m fine now.)  During my thirty-four hours in the ER, I had the opportunity to observe the other patients crowded around on gurneys, in wheelchairs, or in chairs with canes and walkers resting nearby.  The ER was overflowing (I was told later that their capacity is 35 and there were about 100 people waiting), and most of the people were older than 60.  The doctors and nurses were incredibly busy and were doing their best to provide attention and comfort to everyone.  Yet medical care wasn’t all some patients needed.  The older people waiting alone needed an advocate.  They needed someone to help them understand what the nurses and doctors were telling them and doing to them, someone to reassure them during the long wait to be seen by a doctor and/or to be admitted onto a hospital floor.  More than several people were obviously very confused and agitated.  They, like me, were waiting for hours, even days until they received care or were admitted to a room.  But unlike me, they did not have family there to support them (my fiancé was with me), and they were not able to, or at least did not, verbalize their discomfort and need for food, water, or the bathroom.

After two nights, I was finally admitted to a cardiac surgery floor.  I didn’t need cardiac surgery; it was just the only bed available.  Every person who entered my room, from aides to meal servers, physical therapists, nurses, and doctors, was surprised to see someone under 60 on their floor.  Each of them asked me, “What are you doing here?” I realized that they are so used to working with older people that someone obviously younger than 60 seemed out of place.

This whole episode got me thinking about the training hospital personnel receive in geriatrics.  If everyone on the cardiac care unit expected to see a patient older than 60, and if most people in the ER were over 60, then shouldn’t all personnel receive training in geriatrics and care of the elderly?  Yes, but this isn’t likely. Most medical schools do not have a geriatric curriculum or rotation, which is why the John A. Hartford Foundation provides grants to schools of medicine, nursing, and social work to help in developing more leaders and curriculum in geriatric education.


The ER is not the only place in the hospital that older patients need an advocate. They need one once they are admitted, too. Take the case of my hospital roommate.  She was a woman over 60, who had previously had a lung transplant and was now in the hospital post cardiac surgery. She was quite sick and spent most of her time sleeping. However, she was very much alert and oriented when awake.  When her sisters came to visit, they inquired about her care.  A nurse told them that the physical therapist and the doctor had been in to discuss her condition with their sister but that they were unable to do so because she was sleeping.  This was not true; I had not seen anyone come into the room and told the sisters so.

The hospital also left food for my roommate while she was sleeping. When she awoke, not only was the food cold, but she couldn’t reach it. When the aide came to remove the tray, he asked her if she wanted it but didn’t offer to help her eat or to get her a fresh meal.  I had to speak up and request a hot meal for my roommate, who was too timid to ask.  For the two days I shared the room with her, my roommate relied on me or her sisters to advocate on her behalf. She was too weak and/or timid to do so for herself.  If the hospital personnel had been better trained in caring for older patients they would have had, hopefully, more sensitivity to someone so frail.

My time in the ER and the cardiac care unit confirmed what I already knew from the data (See this article as well as CDC statistics on emergency care, p. 6): more than half of patients in hospitals are over 60. Yet it was obvious that the patients and their families were overwhelmed and uninformed about the care and the process of receiving care.  Would it really be that expensive or difficult for hospitals to hire social workers or specially trained nurses to serve as patient advocates? Or, better yet, to improve training for all personnel so all of them, from the aides to the nurses to the surgeons, see themselves as an advocate for every patient? I don’t think so. Stay tuned; in a few weeks I’ll share the good news about some emergency rooms that are doing just that for their older patients.

Nora O’Brien-Suric is senior program officer with The John A. Hartford Foundation.

This post originally appeared at healthAGEnda, the blog of The John A. Hartford Foundation.

6 replies »

  1. EMRs were pushed on us by a corrupt Clinton administration. They were not and are not ready for prime time. We doctors wouldn’t buy the things because they did not add much value, but took substantial time away from patient care. So, rather than improve their products like good little capitalists, they did an end run around us, got a government hand-out in the form of mandated purchase/use and voila, our current mess that is EMRs. Pardon the run-on.

  2. One’s first visit to an ER can be a real eye-opener. Sit in the waiting room every night for a month and you will see the same things with a different reaction. Work in it for 29 years (as of tomorrow) and you get like me.

  3. @PCP – not true. Most docs at larger institutions (esp. tertiary care centers) appreciate that a lot of medical information is always at hand with the EHR. (I am not saying that it’s aways rosy and I am not always sure whether it’s worth the huge effort/cost, and also, a lot of template garbage is collecting in many EHRs.)

    The OP is a little strange. She goes to the ER and notes terrible overflow, then notes that her roommate wasn’t receiving optimal care (maybe they were undersatffed too?) and the writer’s main lesson learned is that the staff should have more training in geriatrics? And there is never anyone under 60 in cardiac surgery in that “major teaching hospital”? Weird.

  4. Doctors have, at best, mixed feelings about EMRs. I’ve never heard a single floor or ER nurse say that the EMR allowed them to provide better patient care. In fact, just the opposite.

    Get used to it, folks.

  5. You can bet each patient had a computer record carefully chronicalling the care of each patient. Full of errors and untruths, these records will live much longer than the patient and will have had the most attention from teh nurses. It takes more time to document care than to provide care.