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ARI SHAPIRO, host:

This is MORNING EDITION from NPR News. I'm Ari Shapiro.

STEVE INSKEEP, host:

And I'm Steve Inskeep. Good morning. Today in Your Health we'll look at care for the elderly and for the young. First, a hospital in Maryland is trying to make the emergency room a friendlier place for older patients. They made the ER more quiet, less chaotic. And they've added specialists in geriatrics. NPR's Joseph Shapiro explains why it matters.

JOSEPH SHAPIRO: Think for a moment about the sights and sounds of an emergency room.

(Soundbite of TV show)

Unidentified Man #1: Scalpel.

Unidentified Woman #1: Oh God.

Unidentified Man #2: All right. Why don't you come with me?

Unidentified Woman #2: Five hundred CCs at the right side.

Unidentified Man #3: Ready with the rib spreader.

Unidentified Woman #2: Suction on high.

SHAPIRO: Well, that's how they do it on television, but at Holy Cross Hospital in Silver Spring, Maryland, they've set up an ER that's just for patients 65 and older. And it sounds like this.

Ms. MARCY SMITH (Social Worker, Holy Cross Hospital): Would you like to get in the bed?

Unidentified Man #4 (Patient): No. (Unintelligible)

Ms. SMITH: You're more comfortable sitting in the wheelchair?

SHAPIRO: That's Marcy Smith. She's helping a thin, distinguished-looking 91-year-old man who's just been brought in with a persistent fever. The man had a stroke last summer, and when he speaks his words come out twisted.

Ms. SMITH: Would you like a sheet over you? Are you cold?

Unidentified Man #4: Oh, no.

Ms. SMITH: You're not cold? You're comfortable?

Unidentified Man #4: (Unintelligible)

SHAPIRO: Marcy Smith listens carefully. She's not a nurse. She's a geriatric social worker. And that's something you don't usually find in a regular ER.

Dr. JAMES DEL VECCHIO (Medical Director): This is much closer to reality than any TV show.

SHAPIRO: That's James Del Vecchio, the medical director for the emergency department here. Only infants go to the ER at a higher rate than people 75 and older. Many hospitals now have separate ERs just for kids. But Del Vecchio says this is the first in the country just for older patients. And because it's small and set up just for them, with doctors and staff trained in geriatrics, Del Vecchio says this ER can deal better with the complex medical problems of older patients.

Dr. DEL VECCHIO: Traditionally there'd be more of a focus just on what are you here for today. I think now we've kind of broadened out. We're looking at more than just what are you here for today and kind of looking at the patient as a whole.

SHAPIRO: That's why the geriatric social worker spends time with each patient. For example, many who come here to get checked after a fall then return to a house full of tripping hazards, or they get sent home with a prescription but have no way to get to the pharmacy to fill it. So the social worker will follow up after they go home. By noon all eight exam rooms here are filled with patients who've come with complaints typical of the elderly.

Unidentified Man #5: Take a deep breath for me. Ok?

SHAPIRO: There's a woman who's fainted. One who fell out of bed. Another one who hurt her wrist. One complaining of numbness. And a woman who's having trouble swallowing. Geriatrician Bill Thomas made his reputation as a nursing home reformer. He's a professor at the University of Maryland Baltimore County and he helped Holy Cross in this attempt to rethink the design of the traditional emergency department.

Professor BILL THOMAS (University of Maryland): The physical environment of the emergency room is famous for lack of privacy, for loud, confusing sounds, and for very rapid and changing staff interaction. And what's different in this innovation is now the emergency department is saying we're going to change to meet the needs of the older people, not the other way around.

SHAPIRO: To meet the needs of older patients, lots of little things are different in this ER. Even the soft wood finish on the floor, because Thomas says glare on a floor can fool a person who has fading eyesight to think there's an obstacle in their way.

Dr. THOMAS: Usually emergency rooms have very shiny smooth tile. And the shiny floor surface that seems so clean and sterile in an emergency room is actually dangerous for many older people to walk on.

SHAPIRO: To give privacy and quiet, there are walls between the exam rooms instead of curtains. The nurses use monitoring devices a little bigger than the size of a cell phone instead of tethering patients to big heart monitors that make it hard to move around. Even the mattresses are extra thick. Holy Cross asked older volunteers to come in and try out different ones before they bought these. Older people come to the emergency department with added health issues. Many have trouble hearing, and in a noisy ER, it can be hard to understand what a doctor is saying. Many have dementia, and they can feel anxious when surrounded by strangers. That's why Holy Cross adds more staff to give extra attention.

Dr. THOMAS: If you're waiting and you don't know why you're waiting and what are we waiting for - and so providing a steady flow of information, you know, here's the irony: It's very good for older people, especially people with dementia. But it's actually good for everybody. So, once again, I think good care of older people teaches us how to take good care of everybody.

SHAPIRO: The ER of Holy Cross was set up as a model for treating older patients. But an ER that offers extra attention from nurses and case managers that gives more privacy and even thicker, more comfortable mattresses, that could be a model for any ER for people of all ages.

Joseph Shapiro, NPR News.

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