Nemat Alsaba, Australia

Rosa McNamara, Ireland

End-of-life (EoL) care in the Emergency Department (ED) is gaining significant attention as the population ages. Recent research by our Geriatric Emergency Medicine (GEM) group highlights the complexities and urgent needs associated with providing EoL care for older adults in the ED setting. The study funded by the Emergency Medicine Foundation (EMF) underscores the critical importance of understanding the unique requirements of this vulnerable group.

The ED traditionally provides care and rapid curative-focused interventions for patients with acute injury or illness. EDs are also used by older people living with chronic life-limiting illnesses, nearing EoL. Understanding older people’s current and future ED service use, especially as they near EoL, is essential for any ED service planning and development.

Huang et al. (2019) explores the landscape of EoL care in the ED through a scoping review. This analysis identifies the challenges and gaps in current practices, emphasizing the necessity for tailored interventions that align with the goals and preferences of older persons.

A subsequent study by Sweeny et al. (2024) examines the epidemiology of dying within 48 hours of ED presentation. This retrospective cohort study across Australia and New Zealand reveals crucial insights into the trajectories and outcomes of older adults nearing the end of life. Box 1 summarises the factors associated with dying in the ED.

The authors recommend that health care architecture within the ED and the community needs to evolve to meet patients’ needs and support the establishment of national advanced care planning registers to expedite appropriate care and facilitate admission processes. They also note that the triage system did not always prioritise those who were dying, with some who died within 48 hours being assigned lower triage categories (4 and 5), perhaps reflecting the challenges in recognizing death and dying in this vulnerable cohort.

Another study by Sweeny et al. (2024) delves deeper into exploring the characteristics and outcomes of older individuals who died within 48 hours of ED presentation in two Australian EDs. This retrospective cohort study published in Emergency Medicine Australasia (EMA) examines the clinical and demographic factors influencing these outcomes. The research advocates for a systematic approach to EoL care, including planning around unscheduled care by triggering specific responses for those nearing the end of the life – a ‘code comfort.’

Collectively, these studies underscore the urgent need for enhanced EoL care practices in the ED. The collaboration between GEM and EM groups on this topic offers a promising avenue for improving patient outcomes and ensuring that the ED environment can provide dignified and compassionate care at the end of life.

Alsaba N, Crilly J, Lukin W, May K, Grealish L, Broadbent A, Ranse K, Ranse J, Denny K “Understanding end-of-life care for older people presenting to the ED” Emergency Medicine Foundation (EMF) grant, 2019. $88,357

Huang, Y., Alsaba, N., Brookes, G., & Crilly, J. (2019). Review article: End‐of‐life care for older people in the emergency department: A scoping review. Emergency Medicine Australasia. doi:10.1111/1742-6723.13414 https://onlinelibrary.wiley.com/doi/full/10.1111/1742-6723.13414

Sweeny, A. L., Alsaba, N., Grealish, L., Denny, K., Lukin, B., Broadbent, A., Huang, Y.-L., Ranse, J., Ranse, K., May, K., & Crilly, J. (2024). The epidemiology of dying within 48 hours of presentation to emergency departments: a retrospective cohort study of older people across Australia and New Zealand. Age and Ageing, 53(4). https://doi.org/10.1093/ageing/afae067,  https://academic.oup.com/ageing/article/53/4/afae067/7642670?searchresult=1

Sweeny, A. L., Alsaba, N., Grealish, L., May, K., Huang, Y., Ranse, J., Denny, K. J., Lukin, B., Broadbent, A., Burrows, E., Ranse, K., Sunny, L., Khatri, M., & Crilly, J. (2024). End‐of‐life care: A retrospective cohort study of older people who died within 48 hours of presentation to the emergency department. Emergency Medicine Australasia, 36(1), 13–23. https://doi.org/10.1111/1742-6723.14331  https://research.bond.edu.au/en/publications/end-of-life-care-a-retrospective-cohort-study-of-older-people-who