INTRODUCTION
Our population is aging, and our loved ones are growing older. Geriatric Emergency Medicine (GEM) addresses the unique needs of the geriatric patients in the emergency department (ED) patient population. Older adults have different medical and psychosocial needs in the ED than their younger peers as their aging physiology often changes presentations of common diseases. They often have comorbidities, polypharmacy, cognitive impairment, and complex social contexts that make them medically intricate. Thus, their management in the ED often requires a multidisciplinary approach and specialized support, such as geriatric trained professionals, extended diagnostic capabilities, and care coordination. Given aging demographics and limited ED resources, there is a great need to nurture careers in GEM.1 Careers in GEM have exploded in the past two decades with an increase in funded research, GEM divisions, and GEM mentorship. GEM pioneers created GED Guidelines2 which led to the creation and implementation of the of Geriatric ED Accreditation (GEDA.)3 In 2024, there are 500 accredited geriatric EDs. This expansion in geriatric ED accreditation will create a need for highly trained geriatric EM specialists to develop processes, education, and research at each accredited site. This signifies huge career opportunities in GEM as sites need GEM champions.
Medical Students
Medical students should be encouraged to better understand the unmet needs of older adults in emergency settings, including transitions of care, atypical disease presentation, delirium management, and polypharmacy issues. The Geriatric Emergency Department Collaborative (GEDC) has free, interactive online courses available.
Familiarize yourself with the Geriatrics Competencies for Medical Students. These are short primers about geriatric syndromes, including “Mind”, “Mobility”, and “Medications”, that a graduating medical student should learn to take care of older patients.
Get involved with established organizations that have a distinct Geriatric EM focus. Examples include: Society for Academy Emergency Medicine’s (SAEM) Academy of Geriatric EM (AGEM), the Geriatric Emergency Medicine Section (GEMS) of the American College of Emergency Physicians (ACEP), International Federation for Emergency Medicine GEM Special Interest Group (IFEM GEM SIG), and the American Academy of Emergency Medicine (AAEM) Geriatric Interest Group.
Consider becoming a student member of the American Geriatric Society. Members have networking and mentoring opportunities, access to clinical tools, and other benefits.
Consider joining the Gerontological Society of America. They offer several travel stipends for students to attend geriatric-focused scientific conferences and present.
Do an AGEM away rotation.
Find a GEM mentor.
Get involved in a GEM research project.
Apply for the Medical Students Training in Aging Research (MSTAR) – funded and mentored research program in aging.
Residents
Attend SAEM, AAEM, ACEP conferences and join geriatric and/or palliative care interest groups. The American Geriatric Society also has a dedicated Geriatric Emergency Department interest group.
Apply to be an AGEM or GEMS resident representative.
Apply for geriatric emergency medicine fellowships.
For residents trained in a combined Internal Medicine and Emergency Medicine program, consider pursuing an ACGME-accredited Geriatric Medicine Fellowship.
Attend AGEM dinner at the SAEM Annual Meeting and talk to others about what they like/dislike about their careers in GEM.
Fellows
- Opportunities for involvement in the following fellowship tracks:
- Education track: SAEM Clerkship Directors of Emergency Medicine initiatives
- Advanced Research Methodology Evaluation and Design: Medical Education (ARMED MedEd) course
- Designing geriatric curriculum for residents
- Research track:
- Grants for Early Medical/Surgical Specialists’ Transition to Aging Research (GEMSSTAR)
- Masters in Public Health
- Beeson Grant from National Institutes for Aging (NIA)
- Administration track: GEDA Reviewer
- GEMS fellow representative
Attend the SAEM, AAEM, and ACEP geriatric chapter meetings at conferences, as well as conferences hosted by the American Geriatrics Society and the Gerontological Society of America.
Write articles or case reports on common clinical issues faced by older adults in the ED to disseminate knowledge, contribute to the growing body of GEM literature, and support evidence-based practices. Examples of journals with a dedicated GEM section include, the Journal of Geriatric Emergency Medicine, Journal of American Geriatric Society, Annals of Emergency Medicine, Western Journal of Emergency Medicine.
Consider teaching residents and medical students about geriatric-specific conditions.
Attendings
Education: GEDC webinars
Research: Geriatric ED Guidelines, NIA and foundation funded research
Administration: GEDA reviewer, department GEM leader, GEMS policy and reimbursement initiatives
Serve as Journal of Geriatric Emergency Medicine reviewer.
Join or lead Quality Improvement Committees to champion changes in areas such as comfort care measures, implementation of geriatric protocols, and streamlining discharge and follow-up plans.
Embrace the process of Geriatric ED accreditation to guarantee that your ED follows the best practices in geriatric emergency care and is ready to improve the standards of care given to older adult patients. Visit the website for more details.
Nurses
Nurses play a crucial role in Geriatric Emergency Medicine (GEM), often leading initiatives aimed at improving care for older adults. To foster nursing leadership in GEM, the following opportunities can be pursued:
Geriatric Emergency Nursing Education (GENE): A specialized program that equips nurses with the skills needed to address the unique challenges faced by older adults in emergency settings.
Geriatric Resource Nurse (GRN): Nurses can obtain this certification to become leaders in geriatric care, providing expertise and guidance to other staff members in emergency departments.
Nurses Improving Care for Health Systems Elders (NICHE): This competency program empowers nurses to implement best practices in the care of older adults, promoting improved outcomes and patient satisfaction.
Sponsor Role:
There were no sponsors for this work.
Funding:
There was no funding for this work.
Footnotes
CONFLICTS OF INTEREST
The authors have no conflicts to disclose.
Contributor Information
Shan W. Liu, Geriatric Emergency Fellowship Director, Massachusetts General Hospital, Associate Professor of Emergency Medicine, Harvard Medical School.
Angel Li, Assistant Professor of Emergency Medicine, The Ohio State University.
Kei Ouchi, Associate Professor of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School.
Carolina Diniz Hooper, Medical Graduate from Faculdade Ciências Médicas de Minas Gerais.
Esteban Franco Garcia, Department of Geriatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Harvard University, Boston, MA.
Wendy C. Coates, Emeritus Professor of Emergency Medicine, University of California, Los Angeles, David Geffen School Medicine.
REFERENCES
- 1.Website. Thatphet P, Rose T, Kayarian F et al. Impact of Geriatric Emergency Fellowship Training of the careers of Emergency Physicians. Cureus 2021. 13(9); doi: 10.7759/cuerus.17903.eCollection 2021 Sept 2023 https://institutionalrepository.aah.org/cgi/viewcontent.cgi?article=1044&context=jgem [DOI] [Google Scholar]
- 2.American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, Society for Academic Emergency Medicine. Geriatric Emergency Department Guidelines.; 2014. https://books.google.com/books/about/Geriatric_Emergency_Department_Guideline.html?hl=&id=Ex77oAEACAAJ
- 3.Geriatric Emergency Department Accreditation Program (GEDA). https://www.acep.org/geda. Accessed August 4, 2024