Skip to main content Accessibility help



  • Access


      • Send article to Kindle

        To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

        Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

        Find out more about the Kindle Personal Document Service.

        Preparing the emergency departments for the “Silver Tsunami”
        Available formats

        Send article to Dropbox

        To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

        Preparing the emergency departments for the “Silver Tsunami”
        Available formats

        Send article to Google Drive

        To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

        Preparing the emergency departments for the “Silver Tsunami”
        Available formats
Export citation


Over the next decades, the demographic trends will fundamentally change the makeup of the population served by Canadian emergency departments (EDs). By 2031, the proportion of adults aged over 65 will nearly double,1 and this group could represent more than a quarter of the Canadian population by 2036.2 Older adults already represent a high proportion of ED patients3,4 and have already been identified as disproportionate users of ED resources.5 Considering that access to primary care has been reported to be difficult for 25% of Canadians,6 it is therefore likely that the number of ED consultations will increase with their growing number. Undeniably, the ‘‘Silver Tsunami’’ will greatly impact the urgent care provided to Canadian seniors by ED professionals. It is therefore of utmost importance to evaluate, prepare, and engage in delivering high quality of care to this growing population.

Over the past decade, several health authorities have developed general guidelines to adapt acute older patients care. For example, in 2010, the Ministère de la Santé et des Services Sociaux du Québec launched the approche adaptée à la personne âgée en milieu hospitalier, which aimed to improve healthcare for patients ages 65 and over.7 In the same year, Toronto's Mount Sinai Hospital launched its Acute Care for Elders Strategy,8 which also had the same objective. In 2014, American Geriatric ED guidelines9 were published and endorsed by the Canadian Association of Emergency Physicians, although these broad guidelines were mostly aimed at ED inpatient care and recommended no specific tools.10

Many published studies suggest that even though tools and models have been tested and are available for older patient care, there is still an important gap for their adaptation, implementation, and actual use in EDs.11, 12 This issue of CJEM presents two articles exploring geriatric-friendly ED tools. Following the adaptation of the Canadian Triage and Acuity Scale, which now includes a senior-frailty modifier, Mowbray et al. aimed to investigate the relationship between triage acuity and frailty.13 The authors found no direct association between ED triage and older patients’ frailty status. This could be explained by the fact that frailty is a fairly new concept for the ED professionals and may be difficult to conceptualize in a time-pressure environment. Frail, older adults are at an increased risk for adverse outcomes during and after the ED visit.14 However, even though ED triage is a cornerstone of our Canadian acute care system, senior-friendly triage may not be the only window of opportunity to identify pre-frail or frail older adults at risk of complications in the ED or at discharge.

ED tailored geriatric assessment skills and clinical tools could help orient older patient care. In Afilalo et al., two specific tools were evaluated to predict potential functional decline or return to the ED after discharge: gait speed and grip strength.15 Their results showed that assessing patient walk in a structured 5-m gait speed test can predict a post-ED discharge adverse event, such as functional decline. However, their grip strength results showed no association with functional decline. Other walk tests, such as the Timed Up and Go, have showed similar results regarding the association between walk speed and adverse event,16 leading to believe that mobility assessment should therefore be an important aspect of senior-friendly ED care, and that future research should focus on the continuity of care in frail elders at discharge.

It is without any doubt that all health professionals caring for older patients either before, in, or after the ED will need to rapidly adapt their practice in order to provide high-quality care to meet the more complex needs of this growing population.

Competing interests

None declared.


1.Heffler, S, Levitt, K, Smith, S, et al. Health spending growth up in 1999; faster growth expected in the future. Health Affairs 1999;20(2):193203.
2.Statistiques Canada. Estimations démographiques annuelles: Canada, provinces et territoires; 2012. Available at: (accessed December 3, 2019).
3.Le commissaire à la santé et au bien-être., Les urgences au Québec: Évolution de 2003–2004 à 2012–2013, B.e.A.n.d. Québec, Editor. 2014, Gouvernement du Québec. Available at: (accessed December 3, 2019).
4.McCaig, LF, Burt, CW.National Hospital Ambulatory Medical Care Survey: 2002 emergency department summary. Adv Data 2004;340:134.
5.Legramante, JM, Morciano, L, Lucaroni, F, et al. Frequent use of emergency departments by the elderly population when continuing care is not well established. PLoS One 2016;11(12):e0165939.
6.Desai, MM, Lentzner, HR, Weeks, JD.Unmet need for personal assistance with activities of daily living among older adults. Gerontologist 2001;41(1):82–8.
7.Ministère de la santé et des services sociaux. Approche adaptée à la personne âgée en milieu hospitalier - Cadre de référence; 2011. Available at: (accessed December 3, 2019).
8.Sinha, SK, Bennett, J, Ramsden, R, et al. Delivering improved patient and system outcomes for hospitalized older adults through an Acute Care for Elders Strategy. Healthc Manage Forum 2018;31(4):126–32.
9.American College of Emergency Physicians; American Geriatrics Society; Emergency Nurses Association; Society for Academic Emergency Medicine; Geriatric Emergency Department Guidelines Task Force. Geriatric emergency department guidelines. Ann Emerg Med 2014;63(5):e725.
10.Canadian Association of Emergency Physicians (CAEP). CAEP endorsement process; 2019. Available at: (accessed December 3, 2019).
11.Platts-Mills, TF, Owens, ST, McBride, JM.A modern-day purgatory: older emergency department patients with non-operative injuries. J Am Geriatr Soc 2014;62(3):525–8.
12.Asomaning, N, Loftus, C.Identification of seniors at risk (ISAR) screening tool in the emergency department: implementation using the plan-do-study-act model and validation results. J Emerg Nurs 2014;40(4):357–64.e1.
13.Mowbray, F, Brousseau, A-A, Mercier, E, Melady, D, Émond, M, Costa, AP. Examining the relationship between triage acuity and frailty to inform the care of older emergency department patients: Findings from a large Canadian multisite cohort study. CJEM 2020;22(1):7481.
14.Brousseau, A-A, Dent, E, Hubbard, R, et al. Identification of older adults with frailty in the emergency department using a frailty index: results from a multinational study. Age Aging 2017;47(2):242–8.
15.Afilalo, J, Mottillo, S, Xue, X, Colacone, A, Morais, JA, Delaney, JS, Afilalo, M. Frailty and adverse outcomes in older adults being discharged from the emergency department: A prospective cohort study. CJEM 2020;22(1):6573.
16.Eagles, D, Perry, JJ, Sirois, MJ, et al. Timed Up and Go predicts functional decline in older patients presenting to the emergency department following minor traumadagger. Age Aging 2017;46(2):214–8.