Author: Isabella Lichen

Comment on Lichen et al. Non-pharmacologic interventions improve comfort and experience among older adults in the Emergency Department. The American Journal of Emergency Medicine 2020.

Older adult 65 years of age and older are 16% of the US population, but they comprise 45% of emergency department (ED) visits. These patients frequently present atypically and have multiple preexisting conditions. The changes in vision and hearing, decline in functional reserve, and cognitive impairment are further exacerbated by the ED environment.

After surveying both senior patients and their ED providers, we identified a gap in compassionate and effective care. In order to enhance elder care in the ED and address this gap, we created a geriatric comfort cart and menu. The menu and cart were created with input from several nurses, physicians, social worker, and physical therapists with experience working with older adults.

The cart provides low-cost, non-pharmacological intervention items:

(1) to improve comfort (e.g., warm blankets, snacks, aromatherapy),

(2) to improve patient communication (e.g., hearing amplifier, reading glasses, hearing aid batteries), and

(3) additional resources, such as access to a physical therapist or a chaplain, large print magazines, coloring books, etc.

The comfort cart and menu were introduced to the Mayo Clinic hospital’s ED on February 14, 2019, and 300 older adults and 100 of their providers were surveyed. Survey results demonstrated that the comfort cart was an effective intervention that improved patients' comfort by facilitating communication, wellbeing, and compassionate care delivery. Among the 73% of surveyed patients who selected comfort cart items for use, 98%, 95%, and 68% somewhat or strongly agreed that comfort cart items improved patient comfort, overall experience, and independence, respectively. Even among patients who declined items in the comfort cart, 88% of them somewhat or strongly agreed that simply knowing the items were available made them feel more comfortable. Among nurses and physicians surveyed, almost all somewhat or strongly agreed that comfort cart items provided patient comfort (97%), improved patient satisfaction (95%), increased ability to care compassionately (87%), and increased patient orientation (83%).

The comfort cart is a low-cost intervention that enhances the care of seniors and can be implemented in other EDs and patient care settings. 

The geriatric cart was made possible through a grant from the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of the Healthcare Delivery Scholar's Program.