| Part 1: Reducing Hospitalization and Mortality in Older Adults

| Shalini Kathuria Narang

| Published in April, the first nationally representative study to examine hospital admission and mortality associated with Geriatric Emergency Department (GED) care after an emergency department (ED) visit by older adults in the U.S. highlights the relevance of GED care to acute care outcomes for older adults and the importance of expanding GED reach across diverse populations.

The study pairs GED innovations with broader efforts to increase equitable outpatient access, supporting continuity of care, and reducing biases in care provision across diverse patient populations.

Key Takeaways

• Receiving acute care in a Geriatric Emergency Department (GED) is associated with lower odds of hospital admission and 30-day mortality following an emergency department visit.
• Despite rapid growth in accredited GED sites, the number of older adults receiving care in these settings remains small. Broader implementation may expand the reach across diverse populations.
• First nationally representative study highlights the relevance of GED care to acute care outcomes for older adults.

The emergency department provides critical medical care to older adults, who visit EDs more frequently than younger patients and have almost double the number of ED encounters nationally. Older ED patients often have complex needs and an increased risk of multimorbidity, polypharmacy, dementia, delirium, and falls, complicating ED decision-­making and increasing hospitalization risk. 

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The ED decision to admit an older adult is consequential, as admissions are costly and may expose patients to health care-associated infections, iatrogenic (unintentional medical lapse) complications, functional decline, and subsequent mortality. As the U.S. population ages, the challenge of delivering high-­quality and safe ED care for older adults matters more and more.

Read an interview with the study’s authors

Setting Up Geriatric Emergency Departments

In recognition of the unique medical needs of older adults, the Geriatric Emergency Department (GED) arose two decades ago to address gaps in the delivery of acute care for this population.

Since 2018, the Geriatric Emergency Department Accreditation Program has recognized Emergency Departments (EDs) that provide high-quality care tailored to older adults. GEDs have rapidly spread across the U.S. in recent years. As of early 2026, 612 emergency departments have been GED accredited.

Previous research on GEDs has found mixed results for hospital admissions, ED revisit rates, geriatric consultations, and healthcare cost-­savings. Many studies were single-­site, focused on specific interventions (e.g., transitional care nurses or geriatric syndrome screening) and were limited in generalizability to GED care. Although one nationwide study evaluated process outcomes such as diagnosis of geriatric syndromes, ED length of stay, and revisit rates, there wasn’t much focus on hospital admissions, and the association between GED care and mortality had not been evaluated.

The Study and Its Findings

The study leveraged nationally representative, patient-­ and encounter-­level data to examine the association between older adults receiving acute care in GEDs and two patient-­centered outcomes: hospital admissions and mortality. The study assessed the heterogeneity in these associations across patient subgroups.

The researchers used the 2018–2021 Health and Retirement Study (HRS)-Medicare linked data of adults aged ≥ 65 years and supplemented the data with the American College of Emergency Physicians (ACEP) GED accreditation list and American Hospital Association (AHA) data. 

Receiving acute care in a GED is defined as having an ED visit at a GED in the study. Patient-level analyses were conducted using each individual’s most recent ED visit and associations between receipt of acute care in a GED and outcomes of hospital admission and 30-day mortality, adjusting for patient demographics, socioeconomic status, health conditions, ED visit severity, and hospital-level characteristics.

Among 4563 older adults who had an ED visit, 270 (5.9%) received acute care in GEDs and 4293 (94.1%) in non-GEDs. Patients who received and did not receive GED care were similar in age, sex, education, partner status, dual eligibility, health conditions, and ED visit severity. 

However, compared with those receiving non-­GED care, patients receiving GED care were less likely to be non-Hispanic White or have their ED visit at rural hospitals, and more likely to visit teaching hospitals and hospitals with more than 500 beds. Compared with those treated in non-GEDs, patients treated in GEDs had significantly lower odds of hospital admission and 30-day mortality. 

Also, association with admission was more pronounced among adults aged 65–80 years but not those aged 80 years or older. Lower mortality was also observed among non-Hispanic White individuals, with no significant associations observed among non-­ White patients. 

Why Is GED Care Better?

GEDs incorporate age-­friendly environments, ED staff with geriatric training, and structured care processes that emphasize geriatric assessment and coordination. Emergency medicine staff with geriatric education and dedicated roles (e.g., transitional care nurses) in GEDs may enable more comprehensive evaluation of older adults and closer monitoring.

Furthermore, structured geriatric care processes facilitate earlier identification and management of geriatric syndromes, reduce exposure to harmful interventions (e.g., urinary catheter minimization), and enhance care transitions, which reduce complications, prevent unnecessary admissions, and support safer discharge planning.

The findings that GED care is associated with lower odds of admissions and mortality among non-­Hispanic White but not non-­White patients suggest that structural and contextual factors beyond clinical needs shape its effectiveness. 

Other studies indicate that health system factors such as limited outpatient follow-­up, inadequate access to specialty or primary care, and lack of social support influences physicians’ admission decisions. These barriers are more prevalent among Black and Hispanic older adults, who may face structural disadvantages in accessing timely and continuous care. Limited access to care, resources, and follow-­up engagement among minority populations may also attenuate the association between GED care and mortality. Provider-­ and system-­level biases in care may also contribute. Prior evidence shows Black patients are less likely to have symptoms recognized or receive indicated therapies and often face longer wait times than White patients. Together, these disparities underscore the importance of pairing GED innovations with broader efforts to increase equitable outpatient access, support continuity of care, and reduce biases in care provision across diverse patient populations. 

The study provides national evidence on the association between GED care and lower odds of hospital admissions and mortality, highlighting the relevance of this model to acute care delivery for older adults. Although the number of accredited

GED sites have increased, the number of older adults receiving care in these settings remains small. 

Policy initiatives can further incentivize and expand the reach of GED care. The findings also indicate that the association between GED care and hospital admission varies across populations, with differences in effectiveness likely driven by variability in access to care, availability of social supports outside the ED, and biases in care provision. Equitable outcomes across diverse populations depend on addressing these factors alongside expansion of GED care. 

Shalini Kathuria Narang is a Bay Area-based independent writer and software professional. She writes about health, wellness, education and technology.