Social emergencies in the elderly.

An examination of the social concerns of the elderly reinforces the importance of a thorough social assessment and the availability of skilled staff in an Emergency Department to make appropriate community referrals. The resolution of disposition problems brought about through caregiver exhaustion, patients no longer able to care for themselves in the community, and abandonment by individuals and institutions require a complex array of skills. The serious problem of drug and alcohol abuse among the elderly must be recognized by Emergency Department staff. Physical problems often disguise the existence of a problem of substance abuse. Clinicians in the Emergency Department should evaluate elderly patients using social and family history information in addition to a thorough physical assessment. Elder abuse manifests as physical abuse, psychological abuse, material abuse, and active and passive neglect. The problem is growing, and there is a need for skilled observation and detection of elderly patients presenting for emergency care. As the proportion of the elderly population in this country increases, social policies and program development must reflect these changes. Experts in fields such as gerontology, geriatric medicine, psychiatry, nursing, and social work must make recommendations for changes in the medical and social service delivery systems. The availability of coordinated, comprehensive services for the elderly will expand as the movement toward geriatric treatment centers grows. These centers will provide medical, psychiatric, social, and residential care through the concept of a continuum of care. They will employ a multidisciplinary team of geriatric specialists and include outreach as well as treatment services. Communities with a geriatric treatment center provide a valuable resource for patients identified through Emergency Department visits. The Emergency Department must play an active role in assisting hospitals, area agencies on aging, and other concerned members of the community plan programs for elderly patients with physical and social concerns. While these changes are implemented, the Emergency Department will continue to remain responsive to the social concerns of the elderly through deliberate organizational efforts designed to maintain a high quality of care for elderly patients.