4/18/2023 Review Article 1 | Page The History of Geriatric Emergency Medicine Teresita M. Hogan, MD, Lowell W. Gerson, PhD, Arthur B. Sanders, MD ABSTRACT Excellent emergency care does not happen by chance. The standard emergency approach that excels in the young, fails in older patients. Older adults experience unnecessary morbidity and excess mortality in our emergency departments. This article describes the pursuit of excellent emergency care in the historically challenging older adult population. A pivotal point occurred once emergency physicians recognized older patients as a distinct population in need of unique evaluation and treatment. In the early 1990s, a group of geriatricians, philanthropists, and emergency physicians joined forces to improve older patient care. Geriatric Emergency Medicine (GEM) emerged as a subspecialty as these individuals systematically identified its distinctive knowledge, skills, competencies, literature, champions, research, fellowship programs, service lines, staffing, accredited geriatric emergency departments, and now its own journal. Early GEM advocates recognized that a legion of older patients would overwhelm providers lacking the training and resources to deliver adequate care for the aging population. They created education and grant programs, developed leaders, and overcame barriers of ageism, ignorance, and indifference. A review of this progress can inform new strategies and innovations providing a future of excellence in the emergency care of older adults. INTRODUCTION Emergency Medicine (EM) now identifies older adults as a population with unique needs requiring distinctive diagnostic and treatment pathways. This article describes how EM progressed from the simple recognition of older patient differences to the knowledge and skills defining competency in Geriatric Emergency Medicine (GEM). Leaders and organizations used key funding opportunities to focus early career researchers and educators on older emergency care. EM organizations starting with the Society of Academic Emergency Medicine (SAEM), and the American College of Emergency Physicians (ACEP) soon moved to the full-fledged support of GEM. They created task force sections and academies, updated residency curricula, developed GEM fellowships, and evaluated GEM knowledge. GEM grant funding evolved from a few foundation grants to multiple NIH mechanisms in a portfolio of topics. The publication of clinical care recommendations known as the Geriatric Emergency Department Guidelines (GEDG) led to hospital and system-wide improvements. The GEDG enabled ACEP to define and accredit Geriatric Emergency Departments (GEDs). Accredited GEDs now offer externally validated excellence in the emergency care of older adults. THE EARLY YEARS Bortz described emergencies in senior citizens in 1957. 1 A decade later Stevens discussed geriatric emergencies. 2 The new subspecialty of Pediatric EM developed in the 1980s. Despite these facts, EM pioneers did not recognize or define the specialized knowledge and skills necessary to optimize JOURNAL OF GERIATRIC EMERGENCY MEDICINE Spring 2023 | Volume 4 | Issue 1 Article 2 | Review Article