Caring for older adults in the Emergency Department: a Delphi-based national consensus by the Academy of Emergency Medicine and Care and the Italian Society of Gerontology and Geriatrics

PURPOSE: The number of older adults attending Emergency Departments (EDs) is increasing rapidly in Italy. This trend poses substantial challenges to services that are not structured to address multidimensional needs. Despite the availability of international guidance, implementation of geriatric emergency care models remains inconsistent in Italy. This study aimed to establish a national, inter-specialty expert consensus on priorities for improving geriatric emergency care. METHODS: A two-round Delphi process was conducted involving 32 experts (16 geriatricians and 16 emergency physicians) from two Italian Academic Societies: the Academy of Emergency Medicine and Care, and the Italian Society of Gerontology and Geriatrics. Participants rated 50 items, grouped into 10 statements covering triage, infrastructure, organization, clinical priorities, and care models, using a 5-point Likert scale. Consensus was defined as ≥ 80% agreement or disagreement for each item. RESULTS: Consensus was achieved for 37 of 50 items (74%). Panelists agreed on the need for early identification of frailty and delirium, environmental adaptations within EDs, and multidisciplinary management in ED Observation Units. Disagreement was observed regarding triage models for older adults, the mode of geriatrician involvement in the ED (on-site vs on-call), and staff perceptions on the appropriateness of ED use by older adults. CONCLUSION: This national consensus defines priorities for geriatric emergency care in Italy, while highlighting inter-specialty areas of disagreement. The findings provide a basis for strengthening clinicians' ability to address complex needs and informing the development of geriatric-oriented ED pathways and policies.