Geriatric EM in the Developing World: Challenges and Opportunities
1Emergency Department, Scarborough General Hospital, Tobago, Trinidad Tobago
As the Global population ages, Geriatric Emergency Medicine is becoming more important in all countries, including those of the developing world. The rate of ageing of these populations currently outstrips that of the developed world, and it is estimated that, by 2050, 75% of all people aged 60 years and older will live in the developing world. The ageing of the population presents special challenges to Emergency Physicians in the developing world. While the percentage of older people in these countries is less than in the developed world, resource limitations can pose challenges to the provision of holistic multidisciplinary care to these patients. On the other hand, many of these countries still have strong family bonds with larger extended families, which can provide opportunities for community based care for these patients. It should be noted, however that demographic and socio-economic pressures have eroded these traditional family structures in many developing countries, and many older people in these setting are now vulnerable to isolation and a lack of social support. This gap is not readily filled by governmental or other social care organisations in resource poor settings, where older people are often not seen a a priority to the health and social services in these countries.
With regard to healthcare in general, many hospital specialists in developing countries have limited training in geriatric care, and are not well equipped to provide comprehensive assessment and care to their older patients. This leads to a risk of under-diagnosis and ineffective treatment of these patients, leading to worsening of their health status and increased risk of hospital admission, particularly through the Emergency Services. Many of the concepts that underpin modern day Geriatric Emergency Medicine, such as frailty, polypharmacy, multidisciplinary care and cognitive impairment are not well understood in the developing world and are often ignored in patients who present to the Emergency Department.
The emergence of geriatric emergency medicine as a distinct specialty in the developing world presents opportunities for Emergency Physicians in these regions. There is a real potential to develop robust systems of Geriatric Emergency Care, including training programmes, care pathways and specialist facilities, which can grow with the growing population of older people and be tailored to their specific needs. In addition, developing countries can learn from the successes and mistakes of their colleagues in the developed world, who have already experienced the ageing of their populations and have some knowledge of what is needed to deal with this phenomenon. A collaborative approach between the developed and the developing world would be of great benefit globally, and can help mitigate the challenges posed by our ageing population.