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Embedding specialist geriatricians directly into the emergency department can help identify older adults who can be managed safely outside of an acute hospital stay.
Australia’s population is ageing and health services are feeling the pressure. Older adults now represent a growing proportion of emergency department (ED) presentations. These patients often arrive with multiple conditions, frailty and complex needs that do not always fit within traditional acute care models.
This matters because hospitalisation itself can cause harm. Older adults admitted to hospital face higher risks of hospital acquired complications, deconditioning and functional decline. This can lead to poorer outcomes and higher costs of care.
Geriatric emergency care models
Across Victoria, many health services are trialing new approaches to better support older adults in the ED. One such model is the Geriatrician in the Emergency Department Initiative (GEDI). This service embeds specialist geriatricians directly into the emergency department. Unlike traditional consultation only models, the services prioritises early comprehensive assessment and the diversion of patients away from unnecessary hospital admissions. The aim is to provide person-centred care and identify older adults who can be managed safely outside of an acute hospital stay.
Evidence for Impact
International evidence backs this approach. Studies show that geriatricians working in emergency departments can prevent up to 64% of hospital admissions among frail older adults, while also reducing complications and improving functional outcomes.
Locally, health services have implemented variations of this model with promising results. At Eastern Health in Victoria for example (where the authors work), around 70% of older people who were initially planned for hospital admission have instead been safely managed through alternative pathways within the first nine months of the program. This equates to an average of three patients each day, with roughly half transferred directly to subacute care and the remainder discharged home or to their place of residence with a tailored plan. These plans often include support from hospital outreach programs such as Hospital in the Home, Geriatric Evaluation and Management (GEM) at home or residential inreach services.
These models also reduced bed pressures and costs, freeing up hospital capacity for those who truly need it while reducing healthcare expenditure. The results translate directly into better patient experiences and a more sustainable health service.
Why it works
Traditional models prioritise rapid triage and acute interventions, which do not always align with the needs of frail older adults who often present with multimorbidity and atypical symptoms. By embedding geriatricians in the emergency department, these services ensure that patients receive early specialist input. Geriatricians undertake a comprehensive assessment that considers mobility, function, cognition and social factors to devise a care plan that links them directly to community or subacute services.
Supporting the workforce
These models support the clinical workforce. Emergency Department clinicians report increased confidence in managing older patients, knowing that they can access specialist geriatric expertise at the point of care. Allied health staff are central to assessments and discharge planning, which has helped build stronger interdisciplinary collaboration.
These services also develop future workforce capability. Junior doctors and emergency department staff gain hands on training and experience in geriatric emergency care, equipping them with the skills needed to deliver care in fast paced and high-pressure environments.
It is not just about the illness
Older adults do not just present with a single clinical issue. They bring a combination of health, social and family considerations that must be respected in their decision making.
Patient stories further illustrate the initiative’s impact. One example involving a 76-year-old woman who presented to the emergency department with delirium and mobility issues after recently moving house. Rather than admit her to hospital, she was able to be managed at home with oral antibiotics, withdrawal of inappropriate medications and rapid deployment of GEM at Home services. This stabilised her condition, provided practical support in her new home and avoided the risks of hospitalisation such as worsening delirium. Importantly, her care plan also addressed mobility and functional needs in her new living environment, which had not yet been properly set up for her.
A model of value based healthcare
Geriatric emergency initiatives exemplify value based care. They achieve outcomes that matter to patients while making better use of health system resources. Importantly, these models show that true innovation does not always require new infrastructure or expensive technology. Sometimes it comes from reimagining how and where care is delivered. Ensuring that the right expertise is available in the right place and at the right time.
Next steps
As demand continues to rise, health services across Australia will need to rethink how they care for older adults in emergency settings. Geriatric emergency models (whether GEDI or similar programs), offer a compelling way forward.
They’re not just another service. They’re a new way of thinking about care.
Dr Simon Grof is a geriatrician and clinical director with Eastern Health.
Dr Jonathan Beavers is a geriatrician and clinical service director with Eastern Health.
Dr Katrina Sands is a geriatrician and acting clinical director with Eastern Health.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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