John Bosco Kamugisha, Uganda

Background

In Uganda, geriatric emergency care is a specialty that hasn’t been fully developed, and older patients are always seen with other patients at emergency units. Older people continue to crowd emergency units, which poses challenges as we try to identify true emergency patients needing immediate attention.

This also increases waiting times and drains the few available emergency care providers and resources, leading to inadequate patient outcomes. The management of older trauma victims within Emergency units is challenging as it is hard for most of these patients to support themselves, including talking to explain what has happened. For those brought in after any kind of accident, the assessment becomes hard because of other ailments they usually have. This is often complicated by a deficit of knowledge, skills, and expertise in the management of older patients in the units. Uganda has not developed protocols for managing geriatric patients but is developing protocols for managing general emergency patients encompassing all ages. This means that Uganda’s readiness to deliver geriatric care is not ready to take off, as seen in one of the studies by Ssesamba (Sseesamba et al., 2019)

Many older patients present with ill health syndrome or nonconforming complaints that don’t fall under the available protocols, and this makes it hard to distinguish between who has an emergency syndrome and the chronic non-emergency syndromes. 

Common Syndromes

Though potential for trauma is present everywhere for geriatric patients, common mechanisms of injury are: Falls from standing height or less, such as from a wheelchair, bed or commode. Motor vehicle crashes. Other issues related to the physical environment of older patients inside or outside the home. The other syndromes presenting to Emergency units include cognitive impairment, stroke, delirium, hypertension, Prostatic cancer, cancer of the GIT, musculoskeletal, trauma, unintended drug poisoning, and other related elderly symptoms. 

What’s being done

Different hospitals are coming up with guidelines and protocols to manage different patients, especially triage protocols and treatment protocols, and they are training most of the health workers in the management of different patients. Geriatric emergency medicine is being incorporated fully in these systems thus neglecting it.

Most emergency departments are managed by nurses with some kind of training in general emergency care that doesn’t give geriatric emergency care a priority. Nurses offer some kind of care to older patients and are the frontline health workers available in most units. With this opportunity nurses are able to critically bring ideas in the management of older patients and help to understand the nursing management, have always emphasized the need for specialized care for every patient and should be listened to and engaged in the management of all patients since they play a pivotal role geriatric emergency care.

Conclusion

Geriatric Emergency Medicine is a specialty that hasn’t been thought about and needs parallel approaches to increase care for the older people at EDs. Developing organized protocols and guidelines for managing older patients will increase the impact on their clinical care. Training of emergency care professionals will improve patient outcomes for those with acute illnesses at the emergency units, thus bridging the gaps in management of different syndromes. Training institutions need to implement geriatric emergency care courses or include it in the medical curricular to cater for their needs and ensure that geriatric care and its principles can be taught to the medical students. More research regarding older persons care needs to be done in different hospital to evaluate different options for helping older victims of trauma at emergency units and devise means for improving it. Laurent, (2020) 

KAMUGISHA JOHN BOSCO (Emergency Care Practitioner, Global Health Specialist)

Program Coordinator

Global Emergency Care

Representative for Geriatric (SIG) IFEM

Reference

Ssensamba, J.T., Mukuru, M., Nakafeero, M. et al. Health systems readiness to provide geriatric friendly care services in Uganda: a cross-sectional study. BMC Geriatr 19, 256 (2019). https://doi.org/10.1186/s12877-019-1272-2

Lauren J. Hunt. Improving care for older adults in the Emergency Department warrants greater investment in geriatric nursing- Geriatric Nursing, Volume 41, Issue 3,2020,