My husband and I were seated in our family room when we heard the sirens. Since we live in a canyon, it can be difficult to pinpoint the origin of certain sounds, especially at night. I asked him, “Is that on our street?”

Consumed by the hockey game on TV, he said, “It’s probably the next street over.”

I got up and peered out the window. “I see flashing lights.” I called my friend and neighbor, Sally, who lived a few houses from us. “What’s happening down there? Is it a fire engine?”

Breathless, she said, “No, it’s the paramedics. They’re in front of Dorothy’s house.”

It took me a moment to realize that our 85-year-old neighbor was in trouble. “I’m going down there,” I said.

“Melody’s still sick. I’m stuck here. Let me know what happens.” I hung up the phone, remembering what it was like to have a sick baby with my husband out of town.

As I veered down our driveway, the flashing lights from the ambulance greeted me. The darkness of the October night closed in as I spotted Dorothy’s caregiver in the doorway of the house, her hand covering her mouth, tears streaming from her eyes.

 “Maria, what happened?” I ran to her, my nerves lit up.

Maria choked back sobs. “She not talking right, something is wrong with her. She fell down in the bedroom.”

Male voices clamored from down the hall. “Paramedics?”

Maria nodded.

Sensing her shaking, I put my arm around her. “What do you mean she isn’t talking right?” I wondered if Dorothy had suffered a stroke. She hadn’t been in good health over the last year and now used a walker, Maria always at her side.

Smoky, the gray terrier mix, barked toward the direction of Dorothy’s bedroom. Maria picked him up and held him close to her chest. “She’s not saying the right words. Something is wrong.”

And just then four men dressed in navy blue pants and brown, lace up boots, blew past us, their hands gripping the stretcher with Dorothy lying on her back, her mouth open wide as if gasping for air.

“Get out, move,” one of them yelled at us as they tore down the hallway and out the front door.

I raised my voice, my words directed toward their backs. “Where are you taking her?”

The blond one turned around and said, “Santa Monica UCLA.”

Maria and I watched the paramedics, our eyes glued to Dorothy strapped to the gurney as she was hoisted into the red and white truck.

The dog still under arm, Maria said,  “I called her son.”

“Is he coming down from Sacramento?” I hoped so. I didn’t like the idea of Dorothy being in the hospital without a family member.

“I think so.” Her voice rattled with emotion. “I have to follow the ambulance. I have to know where they’re going.” She released the dog inside, grabbed her purse and keys.

“Maria, you’re leaving Smoky?” I knew she wasn’t going to come back to Dorothy’s house that night, and maybe not the next day either.

She gave me a blank stare, tears combing her eyelashes. “I’m going to stay with Dorothy.”

“I’ll take him, we’ll keep him overnight.” We exchanged cell phone numbers and she thanked me. The expression in her eyes tore through me. “Dorothy’s going to be okay,” I said, although I wasn’t sure she was going to be okay at all. “She’s in good hands. Let’s text each other when you know something.”

I grabbed the dog, watching the taillights of the ambulance disappear into the darkness, Maria following in her Toyota.  I thought to myself, we should all be so lucky to have someone like Maria with us if we’re in our eighties and have no family in town. Dorothy’s husband of forty years had passed away several years before.

Making my way up our driveway, Smoky in my arms, I wondered how many elderly people with medical emergencies end up in the emergency department alone. Dorothy couldn’t speak but she had Maria to talk for her about the onset of symptoms, current medications, medical history, and more. Her son would probably fly down and be there by morning. But what about the older people who don’t have anyone close by and are rushed to over crowded hospitals with multiple medical conditions, on multiple medications, and are unable to communicate what is wrong?

Emergency departments (EDs) are mind numbing for anyone, not to mention for those who might be cognitively impaired. They are scary and overwhelming–the lights, the sounds and smells, the doctors and nurses scrambling to attend to more patients than they can handle.

According to Health Affairs, Transforming Emergency Care for Older Adults, hospitals are already overcrowded, strained to capacity. “Older adults seen in the ED have increasingly complex medical and psychosocial care needs.  Unlike their younger counterparts, they are more likely to have cognitive impairment, falls, depression, and sensory impairment and to be taking multiple medications.” These characteristics complicate the evaluation and management of older adults in the ED.

How is a rushed health care staff in an emergency department supposed to work quickly with an older adult who might not be able to communicate what is necessary for an accurate diagnosis and treatment plan? According to the Annals of Emergency Medicine, older patients account for up to a quarter of all ED visits and experience higher risk of adverse outcomes. 

To address those adverse outcomes and the special needs of older patients is the emergence of geriatric emergency departments. According to The John A. Hartford Foundation, there is a growing number of compassionate emergency physicians with experience in geriatrics who are trying to improve emergency care for older people. The American College of Emergency Physicians, The American Geriatrics Society and others, have created Geriatric Emergency Department Guidelines  for the growing number of geriatric EDs.

But most hospitals still don’t have them.

Geriatric emergency departments are a good step in the right direction. We need more of them. According to the American College of Emergency Physicians, the geriatric ED should be different from other health care settings, complete with non-skid flooring, guardrails and handrails, non-glare lighting, and staffed with medical professionals who are trained in geriatrics. Included in the recommendations are hearing amplification devices, magnifying glasses, clocks, signage with large lettering, and more.

Don’t our grandparents, parents and other seniors deserve emergency care tailored more specifically for their needs? If you’ve ever been with an older loved one in a hospital, you’ll agree that they do.

That night, Dorothy was admitted to a hospital that did not have a geriatric ED. But she received decent care. She was diagnosed with kidney failure and stayed there for three days. Maria was there with her every step of the way, even after the son arrived. Dorothy is back home and doing fairly well. But what happens the next time, and there will be a next time, when she has a medical emergency and she happens to be home alone? I just hope her neighbors, my husband and I included, will be around.