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Meeting ageism in the ED

The author believes emergency nurses can do more to combat discrimination that older adults often face

Oct 01, 2015, By: Carrie Willekes, RN, BScN, GNC(C), MN

Recently, an 82-year-old man presented at the emergency department I work at with chest pain after doing yardwork. The man, who lives independently in the community with his wife, had arrived at the ED for further investigation. I was shocked to find him wearing a brief when I returned from my lunch break. He explained that while tangled in his ECG leads, he had spilled his urinal in the bed and, as a result, had been asked to wear the brief. He joked that the older he grew, the more he had to leave his dignity at the door with each hospital visit. Given that he doesn’t wear a brief at home, we agreed that he should remove it.

I understood what had happened: when patients are older, nurses usually assume that a wet bed means incontinence. But in the ED, we have to take into account the patient’s previous functioning and know the difference between common and abnormal physiological aging processes. I believe this situation was caused by the subtle ageism that is common in some EDs.

Here’s another example: as part of my job, I often have to give reports when patients are transferred to inpatient units. In one particular case, a 70-year-old woman had expressed while she was still in the ED her wish to have every intervention done should she become more unwell while in hospital. I told this to the receiving nurse, who responded, “every patient over the age of 65 should be an automatic no code.” 

This response was unacceptable, for many reasons. Nurses should know that older adults’ symptoms can often be episodic and temporary. They cannot assume that illness or frailty is permanent, no matter how old the patient is. In a similar vein, I have heard frustrated colleagues complain about older adults’ use of the ED, saying such things as “we should be saving the resources for the young” or asking why someone is not in a long-term care home.

EDs have always been the place to come to when help is needed, regardless of the person’s age. Sometimes, younger people are in the ED due to a poorly lived life, yet we treat them with dignity and patience. Why do older adults, whether they have had healthy lives or not, deserve any less from us? I hear grumbling about their use of the ED as “a failure of the health-care system,” as if there is a separate system outside the ED doors. EDs are part of the system, and older adults have every right to use them.

I was blessed while growing up to have a very close relationship with my grandparents and was regularly in the company of their friends, which increased my comfort level around older adults in general. As a new graduate, I was lucky to have an amazing clinical mentor and role model. She had a passion for caring for older adults and set a high standard that I strive to follow in my practice.

I encourage other emergency nurses to embrace the challenges and rewards of working with older adults. We can be leaders in rooting out ageism in our workplaces, where so many health-care encounters begin.

Carrie Willekes, RN, BScN, GNC(C), MN, works in the emergency department of a large urban hospital in Nanaimo, B.C.