Takeaway
When caring for older adults, limit tests and interventions where possible, spot cognitive red flags, and create clear and pragmatic care plans. Small steps like these can improve health outcomes, experiences, and be more rewarding for healthcare teams as well.
Lifelong learning in clinical excellence | February 19, 2026 | 2 min read
By Philip Magidson, MD, MPH with Katie DePasquale, MA, Johns Hopkins Medicine
I’m an assistant professor in the Department of Emergency Medicine and the Division of Geriatric Medicine and Gerontology at Johns Hopkins, working to change how we assess and treat older adults in emergency departments. I believe new best practices can meaningfully improve patients’ ED experiences and their health outcomes after they leave. To that end, I’ve forged a collaboration between geriatrics and emergency medicine, and I’m seeing how powerful it can be for improving the care of older adults.
Challenges clinicians face in the ED when caring for older patients
The ED is a challenging setting. Quick decisions must be made, often with limited information and without a full medical history. And it’s also hard on patients, especially those with visual, hearing, or cognitive impairments that often accompany aging.
Yet many healthcare professionals receive little, if any, training specific to the geriatric population. Older adults aren’t biological, physiological, or psychosocial copies of their younger selves. Their lab values, vital signs, and symptom presentations may differ from younger adults. Just as crucially, older adults may have different treatment goals. Despite the large and growing number of geriatric ED patients, our training and best practices aren’t always the most effective for treating this population.
Identifying cognitive impairment in the ED
I’ve collaborated with researchers to find better ways to identify and manage cognitive impairment in the ED. There’s evidence that prior to a formal dementia diagnosis, ED visits may start to increase—more falls, a couple of traffic accidents, a medication misadventure. In isolation, fine; but if a patient has had two traffic accidents, one medication issue, and in the previous 30 years they were never in the ED, why now? If we can identify a cognitive impairment in the ED, then we can address it with the patient’s PCP and/or a referral to a memory clinic.
Supporting families and caregivers
We can also do more to support the family members and care partners of older patients, who are vital to gathering information and shaping treatment plans. Sometimes it’s as simple as having chairs so they can sit and explicitly inviting them into the conversation from the start.
With a shared vision in the ED and in geriatrics that these patients are unique, we can work together to rethink care processes in the ED.
Finally, here are a few practical tips for healthcare professionals in all specialties caring for older patients:
1. Adjust thresholds.
Interpret vitals and labs with age-related norms; beware of atypical presentations.
2. Simplify when appropriate.
Work toward fewer tests and interventions.
3. Engage care partners early.
Provide seating and clear invitations to participate.
4. Identify cognitive red flags.
This includes frequent ED visits for falls, traffic accidents, and medication issues. Refer to memory care as appropriate.
5. Create clear and pragmatic discharge plans with teach-back.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.