UC Davis Health recognized for leadership in emergency care for older adults

Philip Gosland

UC Davis Health recognized for leadership in emergency care for older adults

Designation as Age-Friendly Health System Committed to Care Excellence part of national movement, local focus


Philip Gosland worries about going to the hospital. The 85-year-old Roseville resident lives independently with his wife, Judy. But he battles heart failure and falls frequently — a reality that results in occasional trips to the emergency department (ED).

“My biggest fear is not returning home to my wife of 60 years and not having people listen to me because I am older,” Gosland said.

Earlier this year, a leg infection prompted one such visit. But instead of UC Davis Health, paramedics took him to another health system. The experience, according to his family, was distressing.

“No one would tell me where he was for two hours. When I finally found out, they would not let me see him,” recalled Michelle Linenberger, Gosland’s daughter. “He had sepsis, which left him confused. I explained that I was his care provider, but they didn’t want me at his bedside. They wouldn’t even listen to me about the medications he takes or his mobility challenges.”

One week later, when a fall resulted in a trip to the ED at UC Davis Medical Center, the experience was the exact opposite.

“I felt safe at UC Davis and people listened to me. I also was able to have family with me,” Gosland explained. “I was all alone at the other health system’s ED and fearful of not knowing what was going on with my care.”

Gosland is one of the roughly 14,500 patients seen each year in the UC Davis ED. Older adults are living and working longer, redefining later life and managing more chronic conditions than ever before. So, bold approaches are required to provide these patients with exceptional care in the ways that matter most to them.

UC Davis Health is leading the way in making sure that happens. It was recently named an Age-Friendly Health Systems Committed to Care Excellence system for its age-friendly approach in the Emergency Department at UC Davis Medical Center.

“The older adults we see in the ED have increasingly complex medical and psychosocial care needs,” said Katren Tyler, senior physician lead of the emergency care unit and a leader of the health system’s age-friendly work. “While we must assess the primary reason they are here, we must build systems that support a variety of geriatric conditions, so they are not overlooked or ignored.”

Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI), in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA). The goal is to build a social movement so that all care involving older adults considers their unique needs.

An Age-Friendly Health System Committed to Care Excellence is an exemplar in the movement based on the 4Ms framework. This framework includes four essential elements:

  • What Matters: Know and align care with each older adult's specific health outcome goals and care preferences, including, but not limited to, end-of-life care and across settings of care.
  • Medication: If medication is necessary, use age-friendly medication that does not interfere with What Matters to the older adult, Mobility, or Mentation across settings of care.
  • Mentation: Prevent, identify, treat and manage dementia, depression and delirium across settings of care.
  • Mobility: Ensure that older adults move safely every day to maintain function and do What Matters.

Tyler’s team includes two Geriatric Emergency Nurse Initiative Expert (GENIE) registered nurses. They provide older patients with clinical screens focused on the 4Ms. They also coordinate closely with clinical case managers, social workers, physical therapy and any new pharmacy technicians in the emergency department, as well as transitions-of-care navigators.

UC Davis Health’s Vision for Age-Friendly Health Care for Older Adults

Leaders across UC Davis Health are moving proactively to make older adults a priority through a new, systemwide commitment to age-friendly care and services.

Known internally as the Healthy Aging Initiative, the formal, coordinated effort is designed to create an integrated approach to older adults across the lifespan and all care settings at UC Davis Health.

Through measures that increase access to care, decrease the complexity of navigating it, and boost the quality of life for both adults and their family caregivers, the ultimate goal is to help create the healthiest and highest-functioning older adult population in Northern California.

“We are leading a culture shift at UC Davis Health to focus on improving health of older adults across the entire enterprise of this health system,” said David Lubarsky, CEO of UC Davis Health. “The pandemic has shown us that this population is most at risk when care settings are fragmented. We can leverage our strengths as an academic health system to identify innovative, interprofessional approaches to keep adults healthy in their homes and out of the hospital as they age.”

Lubarsky tapped UC Davis School of Medicine Dean Allison Brashear and Stephen Cavanagh, dean for the Betty Irene Moore School of Nursing, to lead the initiative in late 2019. More than 40 experts from multiple disciplines are now involved through a unique collaborative agreement between the UC Davis Alzheimer’s Disease Center, the School of Nursing’s Family Caregiving Institute, and the UC Davis School of Medicine’s departments of neurology, internal medicine, family medicine and emergency medicine.

The goal is to improve the care that families, such as the Goslands, receive.

“Sometimes when you come into health care, they listen for five to 10 seconds and then the care provider is already on their mission,” said Linenberger. “But at UC Davis, they listened to him. They heard him. It felt like they paid attention to what mattered to him, so he could get back home to my mom.”