Older adults are often misdiagnosed. Specialized emergency services and trained clinicians can help

Misdiagnosis is relatively common in older adults. There are many reasons for this: older adults may have multiple medical conditions, take multiple medications, and diseases can be very different in older people than in younger people. Older adults may have different symptoms, or none at all. And sometimes, healthcare professionals assume that what is bothering the patient is “because of their age.” All of this can lead to older patients being undertreated or overtreated.

Sometimes the consequences are even worse. According to a recent study by researchers at Johns Hopkins University, nearly 800,000 Americans die or are permanently disabled each year because of misdiagnosis.

But as the population of older people grows rapidly, increased attention is being paid to how to treat them successfully.

A special design

At Glen Cove Hospital on Long Island, a third of the people who arrive at the emergency room are over 65.

Dr. Maria Carney is chief of geriatrics and palliative medicine at Northwell Health, the network that includes Glen Cove Hospital. She says an older person who comes to the department may be weak or confused, and it may be their first visit here.

“If you don’t know the person’s baseline condition, if you don’t know that a new medication has been started, if you don’t know that they had a fall a week ago and you can’t get that information because they’re not able to communicate, it’s very difficult to make an accurate diagnosis,” she says.

But this emergency department is specifically designed to accommodate older adults. Since late 2021, it has been accredited as a geriatric emergency department by the American College of Emergency Physicians. It is one of more than 500 hospitals in the country that now have this designation.

In practice, this means you’ll find many subtle improvements in safety and comfort that you won’t find in a regular emergency room.

For one thing, instead of cubicles with loudly drawn curtains – which can carry infections – the patient has his own room with a door and windows that fog up for privacy at the flick of a switch.

The floors are textured to make them less slippery, and instead of harsh fluorescent light streaming in from above, there’s ambient lighting and plenty of daylight streaming in through the windows.

“A lot of times when you’re in the hospital, you don’t know what time it is, and that can contribute to delirium,” Carney says. “So you want to try to prevent delirium,” which can be a problem in older patients.

There are also tools to help with communication. Carney explains that when older patients come in, they may not have their glasses or hearing aids with them, if they use them. She takes an assistive listening device, which looks like a small tape recorder with headphones plugged into it. Any patient who needs a hearing aid can use the headphones while the doctor or nurse speaks into the microphone. The patient room is large, with plenty of room for medical staff to move around and comfortable chairs for family members.

Carney says all of this makes the emergency department a more pleasant place for older patients. With less stress and better communication, there’s a greater chance of getting an accurate diagnosis.

More training needed

At UConn Health in Farmington, Conn., Dr. Patrick Coll, medical director of senior health, says there would be fewer diagnostic errors if more young doctors became geriatricians like he and Carney.

This year, he says, “just over 170 geriatric fellows have been placed in geriatric fellowship programs in the United States. Over a thousand cardiology fellowship positions have been filled.”

Cardiology is essential, of course, but with a rapidly growing population of older adults, especially those over 85, the United States needs more expertise in the area of ​​older adults’ bodies and minds, Coll says.

“If we trained all health care providers to take better care of older adults, I think we would get better care for older adults,” he says. “And I think proper diagnosis would be part of that spectrum of better care.”

Involving nurses

Nurses spend more time with older patients than anyone else, says Allie Tran, a nurse practitioner and principal investigator at MedStar Health Research Institute. She is working on a project to involve nurses in improving diagnosis.

“In talking to nurses, we found that a lot of them don’t see it as part of their scope or role to make a diagnosis,” she says. “You know, they say it’s kind of the doctor’s job.”

She believes that ideally, the nurse, doctor, patient and family members would work together to determine what is wrong. She adds that sometimes a patient will not mention a particular issue until the doctor has left the room, thinking it is not important. She adds that nurses can act as a bridge between the patient and the doctor and make a real difference in diagnosis.

To defend oneself

Today, patients like Karla Stromberger, 80, say they have to advocate for themselves to their doctor when a diagnosis seems wrong.

“Trying to convince that person that there’s something else going on and listening to them is just exhausting,” she says.

Stromberger, a retired physical therapist, was diagnosed with polio in the 1950s. As she aged, she had many health problems related to the disease. But, she says, too often, medical staff don’t consider her polio when evaluating her, and many see her age before her symptoms.

“And they’re like, ‘Well, okay, this is an elderly patient’ — and we’re elderly,” she says. “But some of us are skilled enough to be able to help them understand what’s going on.”

When she can do that, she considers it a victory.