How to Improve Health Outcomes for Older Americans

One in three older adults is hospitalized after an emergency-department visit and one in five hospitalized persons is discharged to a nursing community — yet doctors seldom screen for dementia, writes Professor Elizabeth Goldberg at Brown University's Alpert Medical School in the Wall Street Journal . She says the United States is poorly equipped to meet the health and social needs of seniors 85 and older, and cases where loved ones are simply dumped at emergency departments is an all too common event. "Unlike younger adults with acute problems, older people tend to come to the emergency room for chronic problems and ambiguous symptoms like fatigue," Goldberg notes. "Those with cognitive impairment often can't articulate their concerns, which leads doctors to order tests and sometimes admit the person to the hospital. This increases healthcare costs." In addition to making dementia screening routine for emergency room arrivals, Goldberg suggests more preventive care, revised Medicare rehabilitation policies, new reimbursement schemes, and new success metrics would greatly improve outcomes. "Primary-care offices that offer same-day sick visits, home visits for bed-bound older adults, or at-home monitoring of conditions could reduce emergency department volumes," she adds.