Table 3.

Illustrative examples to address prevalent themes and improve ED-to-community care transitions

Theme	Illustrative Examples
1. ED discharge process was abrupt and lacked explanation	Provide streamlined geriatric-friendly (e.g. large font) discharge instructions Consider teach-back methods to ensure comprehension of new prescriptions and reasons to return to an ED Summarize positive and negative laboratory and imaging testing results, with explicit connection back to the chief complaint
2. Barriers to navigating follow-up outpatient clinical care	Relay to the older adult the tangible next step (e.g. primary care follow-up, specialist referral), and who is responsible for that step If available, communicate with the primary care clinician through the electronic health record that the older adult visited the ED and may need a follow-up visit At a health system or departmental level, embrace the expanding use of telemedicine and artificial intelligence to enhance clinician access
3. New physical limitations and fear of completing prior activities	Set expectations with the older adult prior to discharge, regarding the anticipated trajectory with their injury or illness Engage ancillary services (e.g. Physical Therapy) if available in the ED to promote early mobility and maintenance of functional status Collaborate with Case Management as needed to consider the need for home health agency support
4. Hesitancy to accept the potential need for formal and informal family/friend caregiver assistance	During the discharge conversation, normalize the potential need for assistance during the recovery phase of an acute illness or injury Communicate with one member of the informal support network (e.g. family, friends) if not at the ED bedside regarding expected assistance during care transition Use cultural humility in understanding the types of supports that older adults may need based on their social identities, being certain to avoid population generalizations