The role of emergency services in health care for the elderly: a review.

The hospital emergency department (ED) has become an important means of access to health care for the elderly. Inadequacies in the current health care system for the elderly are reflected in their high utilization rates of the ED, continuing questions about the appropriateness of elderly ED patients, differences in the ED care offered the elderly versus the young, and poor coordination of care to and from the ED. Evidence of potential misuse of emergency services exists for both the ED and the emergency medical transport (EMS) systems. The increasing number of nursing home patients sent to the ED with nonemergent problems further emphasizes inadequacies of primary care in the nursing home setting. Economic, legal, and ethical issues that have changed the way medicine is practiced in other settings are finally reaching the sector of emergency services. The current and future roles of emergency medicine services, and the impact these issues will have on the practice of emergency medicine, are discussed.