Emergency Department (ED) visits can be disruptive and take a damaging toll on older adults, especially those with Alzheimer’s disease and related dementias (ADRD). The unfamiliar environment and personnel, the sensory overload of lights, or strange sounds and activity can trigger negative patient behavior. Research shows these ED patients may be vulnerable to delirium and falls, and an ED stay can not only be terrifying and overwhelming, but accelerate cognitive decline.
Meanwhile, ED staff has limited time and training to address the unique needs of frail older adults during an acute event.
With the help of a Washington Square Health Foundation grant, CJE SeniorLife is undertaking a groundbreaking 18-month pilot, the Emergency Department Elder-care Navigator (EDEN) program. EDEN seeks to improve patient-centered care in the ED for older adults.
The project trains community members to be EDEN volunteers who accompany CJE clients to the ED and provide patient, family and ED staff support. EDEN, which launched September 1, 2017, is being piloted at CJE’s Weinberg Community for Senior Living. The campus includes CJE’s Friend Center for Memory Care, Adult Day Services and Gidwitz Place for Assisted Living.
Should a resident or ADS client go to the ED, each has an individualized EDEN pack for the ED visit filled with information including legal medical directives, prescribed medications, the best way for ED staff to communicate with the client and other pertinent information. It also includes things such as notebooks, headphones and activity books to ease patient waiting time.
“EDEN was conceptualized because of negative outcomes experienced by Friend Center residents with ADRD when they visited the ED,” said Amy Eisenstein, director of Research and Quality Improvement at CJE.
CJE is partnering on the project with NorthShore University HealthSystem’s Glenbrook Hospital and is training ED staff on drug-free approaches to working with older adults with ADRD. Glenbrook’s ED serves a primarily geriatric population including a large proportion of patients with ADRD.
“ED staff is thrilled because it will be very helpful,” said Dr. Jeffrey Graff, former head of Glenbrook Hospital ED and currently clinical professor at the Pritzker School of Medicine at the University of Chicago. Dr. Graff, a CJE board member, is liaison between CJE and Glenbrook Hospital and helps in the design and facilitation of EDEN training sessions.
The information in the packs will help improve care as will volunteer assistance in keeping patients calm and cooperative so the need for physical restraints and sedation can be avoided, he said.
“Having the EDEN volunteer along with the information that often can guide acute treatment is a game changer,” Dr. Morris Kharasch, head of the Division of Emergency Medicine at NorthShore University HealthSystem, said in endorsing the project. “EDEN should be a template for the home or other care centers. This project can have national impact on how we treat the elderly population in the acute environment.”
