Older adults currently represent 15% of annual US ED visits, as much as 60% in areas in Florida, Arizona, and parts of the Northeast. Due to the growth of the older adult population as the "baby boomer" generation ages and to trends in ED usage, geriatric patients are projected to represent as much as 33% of total ED visits by 2030. These patients are often more challenging to treat in the ED than younger patients, as their care requires more time and resources, they are more likely to be admitted and more likely to require intensive care, and they have a higher rate of adverse outcomes after discharge.
New York Presbyterian Emergency Medicine is a national leader in Geriatric Emergency Medicine, with a unique fellowship program, significant active research, and an innovative, comprehensive curriculum for residents.
Dr. Neal Flomenbaum, co-director of the Geriatric Emergency Medicine Fellowship, created the fellowship in 2004. The fellowship is the first of its kind in the US. Four fellowship graduates continue as Cornell attendings, including Dr. Michael Stern, who now serves as Fellowship Co-Director, and Dr. Alexis Halpern, now Assistant Director.
Our geriatric EM team is actively engaged in research in a broad spectrum of topics:
- ED assessment and management of agitated delirium
- indwelling urinary catheter placement in the ED
- transitions of care between nursing homes and the ED
- elder abuse assessment in the ED
- geriatric burn injuries presenting to the ED
- suicide assessment for older adults in the ED
- providing palliative care in the ED
We have developed and successfully launched comprehensive, evidence-based protocols for ED assessment and management of agitated delirium and for indwelling urinary catheter placement in the ED. Our Geriatric EM faculty researchers collaborate closely with other divisions at New York Presbyterian, including Geriatrics, Toxicology, Palliative Care, and Burn. The work of this group was recently featured in the Weill Cornell Medicine magazine.
Residents actively contribute to our research, with several choosing geriatric topics for their scholarly projects, publishing manuscripts, and presenting their work at national conferences both in Emergency Medicine and Geriatrics.
Medical students in the MSTAR (Medical Student Training in Aging Research) summer program sponsored by the American Federation of Aging Research have been active participants in our research. These students, with mentorship from faculty and residents in the Emergency Medicine and Geriatrics Divisions, have led research projects in delirium assessment and management, alcohol withdrawal in older adults, and indwelling urinary catheter placement and have presented their work at the annual American Geriatrics Society conference.
New York Presbyterian EM residents are exposed to a comprehensive, unique geriatric EM curriculum, which anticipates that geriatric patients will likely represent a large component of the practice of emergency physicians training today. This curriculum, which includes nationally recognized Grand Rounds speakers, interactve case presentations, simulations, and lectures is constantly updated based on the recent literature and on resident feedback. The Geriatric EM faculty has collaborated closely with the Toxicology division to develop an innovative curriculum for polyparmacy, a particularly challenging issue to assess for and treat in the ED.