COVID-19 in Older Adults: Key Points for Emergency Department Providers

The COVID-19 pandemic revealed critical gaps in how emergency departments manage older patients while also highlighting valuable lessons that remain relevant today, as hospitals and healthcare providers continue to face the threat of emerging infectious disease outbreaks. This article provides practical, evidence-based recommendations for improving patient outcomes, efficiently allocating resources, and facilitating care transitions to help emergency care teams, hospital leaders, and health system policymakers better respond to the complex needs of this vulnerable population.

As of the original publication date of this article, March 18, 2020 — just one week after the World Health Organization declared COVID-19 a pandemic — 7,038 cases of had been reported in the United States and were projected to double every 6.4 days. With older adults at a significantly increased risk from the disease, hospital emergency departments (EDs) were faced with an unprecedented challenge: diagnosing, managing, and coordinating community care of older adults in a rapidly changing situation. 

The authors highlight key considerations for ED staff caring for older patients with COVID-19 symptoms, including:

•  Criteria for testing and unique circumstances for older adults. Although COVID-19 screenings often use fever as an important sign of illness, it may not be a sufficiently sensitive sign in older adults, as it is frequently blunted or absent even in serious infection. When test availability is limited, older adults with fever and/or respiratory symptoms who test negative for influenza should be considered for priority COVID-19 testing.

• Forward triage. Sorting patients prior to ED arrival (aka “forward triage,” typically managed by EMS) is critical for optimizing hospital resources and reducing patient risk. To avoid overwhelming EDs, transfer protocols for older adults may be adapted based on comorbid illness burden or frailty; decisions may change with disease activity and diagnostic and treatment capacity.

• Improving medication management. Older adults have difficulty accessing their medications after discharge. EDs with the resources to provide medications directly to patients can enhance access and eliminate trips to the pharmacy, decreasing the risk of viral spread.

• Emerging treatments. Since older adults are most likely to require critical care, providers should acknowledge the limitations of current therapies and stay informed about evolving treatments.

Additional considerations for ED staff and other healthcare providers and caregivers include:

• Care and transition issues. Emergency providers should offer clear guidance on infection precautions for older adults living at home. For patients with dementia and their caregivers, it is important to provide frequent reminders of hygiene practices. Because older adults are particularly vulnerable during care transitions, ED protocols should include checklists, warm handoffs, and collaboration with outpatient resources, such as skilled nursing facilities, primary care providers and EMS.

• Telehealth. Telehealth visits can minimize the risk of exposure for both patients and healthcare providers and reduce pressure on EDs and other healthcare facilities.

• Resource limitations. The rapid spread of COVID-19 and other rapidly spreading infectious diseases can overwhelm EDs. EDs should plan to separate patients with respiratory illnesses, triage those not requiring emergent evaluation wherever possible, and implement other measures to decrease the risk of viral spread and conserve personal protective equipment.

• Behavioral health and social isolation support. Up to 30% of older adults have age-related cognitive impairment, making it more difficult for them to navigate rapidly evolving situations like a pandemic. Healthcare providers should ensure that health instructions are clear and accessible, and engage family members and caregivers to establish baseline health metrics through check-ins.

The authors include real-world scenarios to illustrate potential cases of COVID in older adults with a variety of medical histories, symptoms, and clinical test results. Each case includes a brief list of questions and evidence-based recommendations to guide ED staff in making a diagnosis and determining a treatment plan.

Read the full article on the Geriatric Emergency Department Collaborative (GEDC) website:

Malone ML, Hogan TM, Perry A, Biese K, Bonner A, et al. COVID-19 in Older Adults: Key Points for Emergency Department Providers. Journal of Geriatric Emergency Medicine. 2020;1:1-11.