Age-Friendly Emergency Department Care for Older People in Viet Nam: From Early Risk Recognition to Safer Clinical Decisions and Care Coordination

AGE-FRIENDLY CARE QUALITY · MEASUREMENT, IMPLEMENTATION & LEARNING

Last reviewed: October 2026

An older woman arrives at a hospital emergency department because she has suddenly become weak and confused. Her initial observations do not fully explain the change, and she struggles to describe what has happened. Her daughter explains that she was walking independently and managing most daily activities just two days earlier. In another emergency department, an older man with several chronic conditions receives treatment for an acute illness. His condition improves, and discharge is being considered, but he remains too weak to walk safely to the bathroom. Elsewhere, a person living with dementia becomes increasingly distressed while waiting in a crowded emergency area, where noise, unfamiliar surroundings and repeated interruptions make communication and assessment more difficult.

These situations illustrate why emergency care for older people sometimes requires more than diagnosing and treating the immediate medical problem. Acute illness remains the priority, but the person's usual function, cognition, medication use, frailty, living circumstances and available support may significantly influence clinical decisions and what happens after emergency treatment.

This is particularly challenging in busy emergency departments. Clinicians need to recognize serious conditions quickly, initiate appropriate treatment and make decisions while managing patients with different levels of urgency. Comprehensive geriatric assessment can provide valuable information, but attempting to complete an extensive assessment for every older patient at the point of arrival would be neither practical nor clinically appropriate.

A more useful approach distinguishes three levels of assessment. Rapid geriatric risk recognition identifies important vulnerabilities that may affect immediate care or disposition. Targeted geriatric assessment examines specific concerns that emerge from the initial evaluation. Comprehensive geriatric assessment (CGA) provides a broader, multidisciplinary evaluation for selected patients whose interacting medical, functional, psychological and social needs require integrated planning.

These three activities are not interchangeable, and they do not need to occur at the same time. The appropriate assessment depends on the patient's clinical condition, the decisions that need to be made and the resources available.

For Viet Nam, this distinction matters as population aging increases the need for emergency services that can respond to complex health and functional needs. Older people may arrive from home, community services, residential care facilities or other hospitals. After emergency treatment, they may require inpatient admission, short-term observation, transfer to another service or discharge with appropriate follow-up.

An age-friendly emergency department should therefore be understood as a model of clinical care and service organization, not simply a separate waiting area, a geriatric consultation service or a collection of screening instruments. Its purpose is to help clinicians recognize the risks that matter without delaying urgent treatment, obtain additional assessments when these are likely to influence decisions, and coordinate appropriate care beyond the emergency encounter.

Emergency Treatment Must Always Come First

The first principle of age-friendly emergency care is that life-threatening and time-critical conditions must be recognized and treated without delay.

An older person experiencing severe respiratory distress, major bleeding, suspected stroke, acute coronary syndrome, shock or another urgent condition requires immediate assessment and treatment according to the relevant emergency protocols. Geriatric screening should never delay resuscitation, necessary diagnostic investigations or other time-critical interventions.

This distinction is important because age-friendly care should not be confused with slower, less intensive or primarily supportive treatment. Appropriate emergency medical care remains the foundation of a high-quality service. Clinical priority should reflect the severity and urgency of the patient's condition. Chronological age alone should not determine who receives treatment first or justify withholding clinically appropriate interventions.

At the same time, acute illness in older people may be more difficult to recognize because the presenting symptoms are not always typical. Some patients report generalized weakness, reduced mobility, falls, confusion or a sudden decline in daily functioning rather than a clearly localized complaint. These findings may reflect infections, metabolic disturbances, neurological events, cardiovascular problems, medication-related effects or other acute illnesses. They are not diagnoses in themselves, but they should not be dismissed simply because the patient is older.

Understanding the person's usual condition is often particularly helpful. Someone who has required assistance with walking for several years has different baseline needs from someone who was independently mobile yesterday but suddenly cannot stand. Similarly, a person with stable cognitive impairment differs from someone who has developed an acute change in attention, awareness or behavior.

Emergency teams should avoid attributing new deterioration to aging, frailty or dementia without considering acute causes. Once immediate threats are being addressed and the patient's condition permits, a brief review of relevant geriatric risks can provide information that influences further assessment, treatment and disposition.

The aim is not to create another mandatory step before emergency treatment. It is to recognize clinically important information at the appropriate point in the patient's care.

What Is a Geriatric Emergency Department Care Model?

Internationally, geriatric emergency medicine has developed around the recognition that emergency departments need processes, staff capabilities and environments that respond to the needs of older adults.

In 2014, the American College of Emergency Physicians (ACEP), American Geriatrics Society, Emergency Nurses Association and Society for Academic Emergency Medicine jointly developed the Geriatric Emergency Department Guidelines. Published in Annals of Emergency Medicine, these guidelines addressed staffing, education, clinical protocols, transitions of care, quality improvement, equipment and the physical environment.

The guidance recognized that emergency care for older people involves more than the presenting diagnosis. Medication-related risks, cognitive changes, functional limitations, social circumstances and the availability of continued care may all influence clinical decisions.

ACEP subsequently developed the Geriatric Emergency Department Accreditation (GEDA) program, which recognizes emergency departments according to their implementation of geriatric-focused processes and organizational capabilities.

The program has three accreditation levels: Bronze (Level 3), Silver (Level 2) and Gold (Level 1). These represent progressively more developed geriatric care initiatives, interdisciplinary coordination, operational policies, performance measurement and organizational support.

Importantly, an age-friendly emergency department does not necessarily require a completely separate physical department. Many improvements can be integrated into an existing emergency service through appropriate staff education, targeted assessment, practical clinical pathways, environmental adjustments and coordination arrangements.

This is relevant to Viet Nam, where emergency departments vary considerably in patient volume, specialist availability, workforce capacity and access to geriatric expertise.

A more recent development is the Geriatric Emergency Department Guidelines 2.0 initiative. A methodology paper published in JACEP Open in 2025 described the use of the GRADE approach to develop more transparent, evidence-informed recommendations addressing important geriatric emergency care domains, including delirium, dementia, falls, frailty, medication safety, palliative care and safeguarding-related concerns.

Individual evidence reviews and recommendations have been published through this initiative, but the work should not be described as one fully completed set of mandatory operating standards.

For example, the delirium guidance published in the February 2026 issue of Academic Emergency Medicine, following online publication in October 2025, developed six conditional recommendations addressing risk stratification, screening and brain imaging. All were based on very low-certainty evidence, illustrating both the progress being made and the limitations of research specifically conducted in emergency departments.

These international developments provide valuable models for Vietnamese healthcare organizations. However, ACEP accreditation and the Geriatric Emergency Department Guidelines are professional references, not mandatory licensing or accreditation requirements under Vietnamese law.

Their practical value lies in helping hospitals organize more reliable emergency care for older people within their actual clinical and operational capabilities.

What Does the Evidence Tell Us About Older Patients in Vietnamese Emergency Care?

Vietnamese research specifically evaluating age-friendly emergency department models remains limited. However, a study published in the Vietnam Journal of Community Medicine on 31 March 2026 provides relevant evidence about the clinical characteristics of older patients receiving emergency and stroke-related care.

The study included 229 patients aged 60 years and older treated at the Emergency and Stroke Department of the National Geriatric Hospital in Hanoi between September 2024 and September 2025. Comprehensive geriatric assessment was performed within 24–48 hours after admission, covering activities of daily living, instrumental activities of daily living, cognition, depressive symptoms, delirium, nutritional status, frailty, fall risk, polypharmacy and comorbidities.

The participants had a mean age of 76.5 years, and 42.8% were aged 80 years or older. Under the study's assessment methods, 76.8% had impairment in activities of daily living, 78.6% had impairment in instrumental activities of daily living, 60.3% had frailty, 31.9% had delirium, 44.1% were at high risk of falls, and 52% met the study's definition of polypharmacy.

Several assessment findings were associated with poorer short-term outcomes, including advanced age, reduced functional ability, delirium, greater frailty and higher fall risk.

These observations are relevant because they show that geriatric conditions may provide important information about care needs among older patients presenting with acute illness. However, the findings must be interpreted within the study's limitations.

The research involved a selected population at a specialist geriatric hospital. Its reported proportions should not be interpreted as prevalence estimates for all older Vietnamese adults attending emergency departments.

Furthermore, CGA was performed within 24–48 hours after admission, not necessarily during the initial triage process. The study therefore does not demonstrate that every older patient should undergo all assessment components immediately upon arrival.

The study was cross-sectional and examined associations with short-term outcomes. Its composite category of poor outcome included death and discharge against medical advice, which are clinically different events. These findings do not establish that conducting CGA caused an improvement in outcomes or that universal assessment would reduce mortality, admissions or emergency department length of stay.

The more defensible conclusion is that clinically important geriatric problems were frequently identified in this selected population and may provide useful information for care planning.

For Viet Nam, the next challenge is translating this knowledge into an emergency department workflow that is clinically meaningful, feasible and consistent with urgent treatment priorities.

Rapid Geriatric Risk Recognition Is Not a Second Triage System

Emergency triage and geriatric risk recognition serve different purposes.

Emergency triage identifies the urgency of the presenting condition and determines how quickly treatment is required. Rapid geriatric risk recognition identifies additional vulnerabilities that may influence clinical decisions, the need for further assessment or the safety of the next care setting.

These activities should complement one another rather than compete for time.

In practice, much of the relevant information can be gathered during ordinary clinical assessment. Once the patient's condition permits, the team may ask about usual mobility, independence in daily activities, previous cognitive function, relevant medications and the support normally available at home.

These questions help distinguish longstanding limitations from new deterioration. A patient who normally walks independently but is now unable to stand may require further investigation or functional assessment before discharge. A patient with established dementia who becomes suddenly inattentive or unusually drowsy may need assessment for delirium and other acute causes.

Information from relatives, caregivers, referral documents or previous medical records can be valuable when the patient cannot provide a reliable history. However, these sources should complement the older person's account whenever the person is able to participate.

Brief screening instruments may support risk recognition, but their purpose and limitations need to be understood.

Internationally, the Clinical Frailty Scale (CFS) and Identification of Seniors at Risk (ISAR) have been studied in emergency populations. The CFS describes frailty in relation to a person's usual health and functional status. It should not be scored solely on temporary deterioration caused by an acute illness. ISAR is intended to help identify older patients at risk of adverse outcomes after emergency care, but it is not a diagnostic instrument and should not independently determine admission or discharge.

A systematic review and meta-analysis published in Age and Ageing in 2017 examined 32 ISAR validation studies involving 12,939 participants. At the commonly studied threshold of two or more points, ISAR demonstrated relatively high sensitivity but low specificity for several adverse outcomes. Its overall predictive accuracy was modest, and studies examining its impact on clinical practice reported mixed findings.

This means that a positive screening result may identify patients needing further attention, but it may also identify people who will not experience the predicted outcome. A negative result does not guarantee that discharge is safe.

For Vietnamese emergency departments, selecting a screening approach should depend on the clinical population, purpose of assessment, workforce capacity and evidence of applicability. Tools developed in other countries should not automatically be assumed to have identical performance or validated thresholds among Vietnamese patients.

The most important principle is that rapid recognition must lead to useful clinical action. Recording another score without changing assessment or care decisions is unlikely to provide meaningful benefit.

Targeted Assessment and Comprehensive Geriatric Assessment Have Different Roles

Comprehensive geriatric assessment is a multidimensional, multidisciplinary process that evaluates an older person's medical, functional, psychological and social circumstances and develops an integrated care plan.

It can be particularly valuable when several interacting problems complicate diagnosis, treatment or disposition. However, CGA requires time, professional expertise and coordination. Attempting to complete the entire process for every older patient during emergency triage would be difficult to justify, particularly in departments managing high patient volumes and time-critical illnesses.

A staged approach is more practical. Rapid risk recognition should first identify whether clinically important geriatric concerns are present. Targeted geriatric assessment should then address the specific issues most likely to influence care.

For example, persistent inability to walk after acute treatment may justify a mobility and transfer assessment. An unexplained change in cognition may require further clinical and cognitive evaluation. Suspected medication-related harm may prompt a focused medication review. Uncertainty about whether the patient can manage essential activities after discharge may require assessment of available support and practical care needs.

Comprehensive geriatric assessment should be considered for selected patients whose needs are sufficiently complex to require coordinated evaluation across several domains. For some people, this may occur during emergency observation. For others, it may be more appropriate after admission to a ward or through a dedicated geriatric consultation service.

The distinction matters: a targeted assessment of one problem should not automatically be described as a complete CGA, while the decision to perform a full CGA should reflect whether the broader evaluation is likely to change the management plan.

Depending on the patient's needs and available resources, assessment may involve emergency physicians, geriatricians, nurses, pharmacists, physiotherapists, occupational therapists, social workers or other appropriately qualified professionals. Not every patient needs every professional. The appropriate team is determined by the clinical questions that remain unresolved.

For patients being considered for discharge, the immediate priority is to obtain the information necessary for a safe disposition decision. For those requiring inpatient treatment, broader assessment may continue after emergency stabilization.

This approach preserves timely emergency care while directing specialist resources toward patients most likely to benefit.

Cognitive Changes and Functional Limitations Should Influence Clinical Decisions

Changes in cognition and function are particularly important because they may alter how symptoms are interpreted and whether a patient can safely return to their previous living environment.

An older person may appear confused, but the team needs to establish whether the change is acute, longstanding or a combination of both. Delirium is characterized by an acute disturbance of attention and awareness that may fluctuate. It should be distinguished from dementia, although the two can coexist. Less obvious presentations, including reduced activity or responsiveness, may also be clinically important.

The GRADE-based Geriatric Emergency Department delirium recommendations published in 2026 discuss several assessment instruments, including the 4AT, brief Confusion Assessment Method, CAM-ICU and other tools suited to particular clinical circumstances.

However, the evidence supporting their use in specific emergency department scenarios remains limited. The recommendations do not establish one universally preferred instrument for every patient or require routine brain imaging in all cases of suspected delirium.

Assessment should follow the clinical presentation, available expertise and appropriate protocols, with particular attention to identifying potentially serious or reversible causes.

Functional assessment should also focus on changes from baseline. Someone who has used a walking aid for years may have different support needs from a person who was independently mobile before an acute illness and now cannot transfer safely from a bed or chair.

New functional deterioration should not automatically be attributed to frailty or aging. Likewise, frailty should provide context for care rather than become a reason to withhold appropriate emergency intervention or assume that admission is unavoidable.

The important operational lesson is that cognitive and functional findings should influence relevant clinical decisions. A brief screening result becomes useful when it triggers appropriate assessment, treatment modification, observation or disposition planning.

Detailed clinical management of delirium, frailty and functional decline is addressed in other HLVN articles. Within this article, their significance lies in how emergency departments organize the recognition of these risks and respond to them appropriately.

The Emergency Department Environment Can Influence Safety

Emergency departments are designed for rapid assessment and treatment, but their physical and sensory environments can be difficult for older people.

Noise, bright lighting, crowded waiting areas, unfamiliar equipment and frequent interruptions may interfere with communication, particularly for patients with hearing loss, visual impairment or cognitive difficulties. Long periods on examination trolleys can also affect comfort, mobility and the ability to meet basic needs.

Age-friendly environmental improvements do not necessarily require constructing a separate unit. Clear signage, accessible toilets, appropriate lighting, suitable seating, mobility aids and efforts to reduce avoidable noise may improve safety and comfort within existing facilities.

However, environmental adaptation must remain consistent with emergency treatment requirements. Clinical monitoring, infection prevention, access to equipment and the ability to respond to deterioration cannot be compromised.

Basic care also deserves attention during prolonged emergency department stays. When clinically appropriate, patients should have access to necessary fluids, food, toileting assistance, safe movement and regular reassessment.

Interventions such as fasting, urinary catheterization and physical restraint require appropriate clinical indications and review. They should not be continued merely for convenience, although necessary medical interventions must not be withheld.

Emergency department boarding presents an additional challenge. When patients remain in the department while waiting for inpatient beds or other services, their clinical and personal care needs continue, even though the initial emergency decision may already have been made.

Older patients with cognitive or functional limitations may need additional observation and support during these periods. Age-friendly emergency care therefore includes the quality of care provided while patients wait, not only the treatment delivered during the initial emergency encounter.

Interdisciplinary Coordination Should Be Guided by Clinical Need

An effective geriatric emergency department model depends on collaboration, but that collaboration should be targeted and practical.

Emergency physicians and nurses remain responsible for the immediate clinical process. Other professionals should become involved when their assessment or intervention is likely to influence treatment or disposition.

A pharmacist may contribute when complex medication regimens, suspected adverse effects or discharge medication changes create significant concerns. A rehabilitation professional may assess mobility when the ability to stand, walk or transfer is central to discharge safety.

A geriatrician may help when several interacting medical and geriatric problems require broader evaluation. Social workers or care coordinators may assist when the main barrier concerns available support, access to services or practical care arrangements.

The availability of these professionals differs between hospitals. Some larger facilities may develop dedicated geriatric emergency teams, while others may rely on consultation with inpatient departments or appropriately organized external services.

The important requirement is a clear referral process. Staff should know which findings justify additional assessment, who is responsible for reviewing the patient and how the results will influence the care plan.

Consultation should be linked to a specific clinical question and an expected decision. Repeated or unnecessary referrals can increase delays without providing equivalent benefit. Where remote consultation is clinically appropriate and permitted, it may support selected assessments or decisions, but it cannot replace urgent interventions or examinations requiring direct professional involvement.

The objective is to use interdisciplinary expertise where it adds value rather than turn every emergency encounter into an extensive multidisciplinary assessment.

Admission, Observation, Transfer and Discharge Require Different Decisions

One of the most important outcomes of emergency care is the decision about what should happen next.

Some older patients clearly require admission because the acute illness needs continued treatment, monitoring or investigation. Others may benefit from a period of observation when the immediate condition is stable but important uncertainties remain. Some require transfer to another facility because the necessary specialist care is unavailable locally, while others can return home with a suitable treatment and follow-up plan.

These decisions should reflect both the acute medical condition and the factors that influence safety after leaving the emergency department.

A patient may no longer require emergency intervention but remain unable to walk safely. Another may be medically stable yet unable to manage a changed medication regimen without assistance. A person living with dementia may have an appropriate discharge plan only when necessary support is available and the relevant caregiver understands the instructions.

However, frailty, dementia or multiple medications should not automatically require hospital admission. Equally, normal initial observations or improvement in the presenting symptoms do not automatically establish that discharge is safe.

Disposition decisions should consider unresolved clinical concerns, baseline and current function, treatment requirements, patient preferences, available assistance and access to necessary follow-up.

The Role of Emergency Observation and Further Assessment

Some healthcare systems use geriatric-focused emergency observation units to provide additional assessment and short-term management without immediate admission to a conventional inpatient ward.

A systematic review and meta-analysis published in the Singapore Medical Journal in April 2026 included 14 studies of geriatric-centered emergency department observation units incorporating comprehensive geriatric assessment.

The review identified several organizational models and reported associations with shorter hospital stays and fewer admissions or readmissions in some analyses. However, the studies varied substantially in design, patient selection, staffing and assessment processes.

Importantly, analyses restricted to studies with comparison groups did not demonstrate statistically significant differences in several outcomes, including mortality, readmission rates and avoided admissions.

These findings suggest potential benefits but do not establish that observation units consistently reduce hospitalization, readmission or mortality in every setting.

For Viet Nam, an observation pathway may be useful when patients need additional clinical reassessment, functional evaluation, medication review or coordination with receiving services. However, the service requires appropriate staffing, monitoring, defined observation arrangements and clear criteria for admission or escalation.

Observation should not become a way of delaying necessary inpatient treatment or keeping patients in an unsuitable emergency environment because beds are unavailable.

The objective should be appropriate disposition, not simply reducing admission numbers.

What Does the Latest Evidence Tell Us About Age-Friendly Emergency Department Interventions?

Evidence about age-friendly emergency care has continued to develop, but findings vary according to the intervention and outcomes examined.

A systematic review published in Age and Ageing in 2017 examined five studies involving 28,434 participants. All five reported lower hospital admission rates after implementing consultant geriatrician-led CGA services in emergency departments, although the magnitude of reductions varied considerably.

The review found less consistent effects on inpatient length of stay and readmissions. The authors also noted that evidence regarding clinical outcomes and the economic viability of these models remained insufficient.

More recently, a quasi-experimental study published in Annals of Emergency Medicine in April 2026 examined an age-friendly emergency department intervention at an academic medical center in the United States.

The study evaluated a modified comprehensive geriatric assessment, or mCGA, for selected patients aged 65 years and older. Eligible patients had Emergency Severity Index levels of 2–5 and attended during hours when the intervention was available.

Researchers compared 1,119 emergency department visits in which patients received the intervention with 1,612 eligible visits that did not receive it. The analysis used propensity-score weighting to account for observed differences between groups.

Patients receiving the intervention had an adjusted probability of inpatient admission that was 11.6 percentage points lower than that of the comparison group. The study did not identify statistically significant associations between the intervention and emergency department length of stay or return visits within 72 hours or 30 days.

These findings are relevant because they suggest that selected geriatric assessment may influence admission decisions without necessarily prolonging emergency care.

However, the study was not a randomized trial. Patients were selected for the intervention by clinical staff, creating the possibility of selection bias and residual confounding despite statistical adjustment.

The findings also came from one academic emergency department with established age-friendly capabilities and experienced practitioners. They should not be generalized directly to every hospital or interpreted as proof that modified CGA caused the observed reduction in admissions.

Furthermore, an absence of statistically significant differences in emergency department revisits does not establish that all potential adverse consequences were excluded.

Together with the 2026 review of geriatric emergency observation units, these findings suggest that targeted geriatric assessment models are promising. Their effectiveness, however, depends on patient selection, the assessment performed, whether findings lead to meaningful action and the services available after the emergency encounter.

For Vietnamese hospitals, the key question is not whether a particular model achieved lower admission rates elsewhere. It is whether an adapted model can improve clinically appropriate decisions, protect patient safety and operate reliably under local conditions.

Safe Discharge Requires a Plan That Can Actually Be Followed

Discharge from an emergency department can be a significant transition for an older person.

The patient may return home with new medication, changes to an existing treatment regimen or temporary limitations in daily activities. Family members may need to provide additional assistance, while follow-up may involve another department or healthcare organization.

A meaningful discharge plan should explain the diagnosis or working diagnosis, treatment provided, important uncertainties, medication changes, warning signs and arrangements for further care.

Instructions should be understandable and appropriate to the person's communication, cognitive and sensory abilities. Someone with hearing impairment may need written information or other communication support. A person with cognitive difficulties may require assistance in understanding and carrying out the care plan, while still being involved in decisions to the extent possible.

Patient or caregiver understanding should be checked rather than assumed. The practical feasibility of the plan also matters. A patient may understand that they need to attend a follow-up appointment but be unable to arrange transport or obtain prescribed medication.

Where follow-up is clinically important or time-sensitive, the emergency department should consider whether a defined referral or coordination arrangement is needed rather than relying entirely on the patient to organize the next step.

Clear responsibility is particularly important when unresolved findings require further investigation or reassessment. A discharge summary that merely advises follow-up may be insufficient when the necessary service has not been identified or the patient cannot reasonably access it.

Emergency departments do not need to deliver all subsequent care themselves, but significant clinical needs should be communicated appropriately, with clear responsibilities for the next stage of care whenever feasible.

An age-friendly discharge is one in which the next step is clinically appropriate, understandable and realistically achievable for the older person.

Autonomy, Consent and Safeguarding Remain Important During Emergencies

Emergency care frequently involves decisions made under time pressure. However, urgency does not remove the need to respect the older person's rights, preferences and dignity.

Whenever possible, patients should receive appropriate information and participate in decisions about assessment, treatment and disposition. Dementia or cognitive impairment should not automatically be treated as proof that a person cannot participate in decision-making. The person's ability to understand a particular decision may depend on the circumstances and the nature of the decision.

When urgent intervention is necessary and ordinary consent arrangements cannot be completed, the applicable Vietnamese legal framework determines how emergency treatment may proceed. The existence of an emergency should not be treated as a blanket exception to all requirements concerning patient rights or consent.

Emergency teams should also remain attentive to possible abuse, neglect or unsafe living circumstances. Unexplained injuries, inconsistent accounts, severe unmet care needs or possible coercion may justify further assessment, but these findings alone do not establish that mistreatment has occurred.

A suitable response requires sensitive inquiry, appropriate documentation, confidentiality and escalation through established clinical and legal processes. The emergency department should not assume that every accompanying family member can safely provide the required care or automatically possesses legal authority to make treatment decisions.

These considerations are relevant because discharge to an unsafe or unsuitable environment may undermine otherwise appropriate emergency treatment.

The aim is to recognize significant safety concerns and connect them with appropriate support without turning every emergency encounter into a full social or safeguarding investigation.

Viet Nam's Legal Framework Supports Timely and Appropriate Emergency Care

Viet Nam has an established legal framework requiring emergency care to be organized and delivered appropriately.

The Law on Medical Examination and Treatment No. 15/2023/QH15, effective from 1 January 2024, is particularly relevant.

Article 60 establishes responsibilities of medical examination and treatment establishments, including organizing timely first aid, emergency care, examination and treatment.

Article 61 governs emergency care at healthcare facilities and outside those facilities. It requires emergency activities to be based on assessment, classification and the application of professional and technical measures appropriate to the patient's condition.

The article also addresses professional consultation, support from other healthcare facilities, remote medical assistance and transfer to appropriate facilities when necessary. In specified urgent circumstances, it allows the relevant authorized professional or hospital leader to make decisions about emergency interventions before the patient's representative has provided consent.

These provisions are important because they establish the primacy of timely, clinically appropriate emergency care. A geriatric assessment pathway should therefore complement existing emergency processes, not delay or replace them.

Vietnamese hospitals also operate within a broader quality-management framework. Ministry of Health Circular No. 19/2013/TT-BYT provides guidance on hospital quality management, including organizational responsibilities and continuous quality improvement.

These principles can support initiatives to improve emergency care for older people, but the Circular does not establish a separate mandatory geriatric emergency department accreditation program.

Ministry of Health Decision No. 1976/QĐ-BYT, issued on 1 July 2026, provides professional guidance on caring for older people at home and in the community. Although relevant to communication and continued support after discharge, it is not a dedicated clinical guideline for hospital emergency departments.

International GEDA criteria and Geriatric Emergency Department Guidelines should therefore be treated as professional references for service improvement rather than automatically binding Vietnamese requirements.

The responsibilities of each healthcare organization depend on its licensed activities, professional competencies and applicable regulations.

When coordination involves identifiable patient information, applicable confidentiality and personal data protection requirements must also be considered, including the Law on Personal Data Protection No. 91/2025/QH15, effective from 1 January 2026, and relevant implementing regulations.

These considerations are particularly important when emergency departments communicate with community providers, rehabilitation services, long-term care facilities or family caregivers. Information sharing should support appropriate care without unnecessary disclosure of sensitive health information.

For Viet Nam, the opportunity is to use existing legal and quality-management foundations to develop an emergency care model that combines timely acute treatment with clinically meaningful geriatric risk recognition and coordination.

Building a Practical Geriatric Emergency Department Care Model for Viet Nam

Developing age-friendly emergency care does not necessarily require every hospital to establish a separate geriatric emergency department.

Many improvements can be integrated into existing services through clearly defined workflows, staff competencies, environmental adjustments and access to appropriate professional support.

A practical model should begin with conventional emergency triage, clinical assessment and stabilization. Immediate treatment remains the priority for patients with urgent or life-threatening conditions.

When the patient's condition permits, relevant geriatric risks should be identified through a brief, focused review. The purpose is to recognize information that may influence treatment or disposition, not to complete an extensive assessment for every older patient.

Findings that could affect clinical decisions should then trigger appropriate targeted assessment. This may involve further medical evaluation, review of cognition, functional assessment, medication review or clarification of the assistance available after discharge.

Patients with several interacting problems may require multidisciplinary CGA, provided that it can be delivered without compromising necessary acute treatment.

The findings should lead to an actionable care plan. This means establishing not only what problems were identified, but also what actions are required, who is responsible and how the results influence disposition.

The next step is deciding whether the patient requires admission, observation, transfer or discharge. The decision should consider the acute illness together with the person's current function, cognition, treatment needs and available support.

When discharge or transfer is appropriate, the receiving provider or caregiver should receive relevant information and clear instructions, with defined follow-up responsibilities where necessary.

Finally, the department should review whether the process functions reliably and whether identified risks lead to meaningful changes in care.

Starting With a Feasible Pilot

For many Vietnamese hospitals, an initial pilot could focus on a defined group of clinically stable older patients, particularly those being considered for discharge or those with an unexplained decline in function following acute treatment.

This population may provide a practical opportunity to determine whether brief geriatric risk recognition identifies problems that would otherwise affect disposition decisions.

The hospital should establish who performs the initial review, which findings require further assessment, who can provide additional expertise and who makes the final clinical decision.

The pilot should avoid introducing several overlapping screening tools without a clear purpose. A single well-understood process that consistently leads to appropriate action may be more valuable than multiple instruments used inconsistently.

As the model develops, the organization can expand its scope based on patient needs, workforce capacity and evaluation findings. The approach should also function during evening shifts, weekends and periods of high attendance. A pathway that works only when one specialist is present may have limited sustainability.

An organizational leader should be accountable for the model, with clinical and nursing responsibilities clearly defined. Staff training should focus on practical competencies such as recognizing changes from baseline, communicating with people who have cognitive or sensory impairments, using selected assessment tools and identifying when further evaluation is necessary.

Governance should also address how the pathway connects with existing emergency protocols, electronic medical records, admission processes and discharge arrangements.

Where appropriate, standardized documentation may help ensure that important findings and decisions are communicated consistently. However, documentation should remain concise and clinically useful. Additional forms that do not change patient care may increase staff workload without improving outcomes.

The goal is not to reproduce every feature of a well-resourced international geriatric emergency department. It is to establish a practical, clinically appropriate process that improves care within the hospital's actual capabilities.

Measuring Age-Friendly Emergency Care Requires More Than Counting Screens

An emergency department may report that it has introduced geriatric screening, trained staff or adapted its environment. These are useful activities, but they do not necessarily demonstrate that older patients are receiving safer care.

Quality measurement should examine whether important risks are recognized, whether the findings influence appropriate decisions and whether care remains reliable after the emergency encounter.

Potential process measures include completion of indicated brief assessments, timely further evaluation when relevant concerns are identified, documented action on significant findings and communication of essential information during transfer or discharge.

The impact on emergency clinical operations is equally important. Introducing geriatric assessment should not create unacceptable delays in triage, resuscitation, time-critical investigations or necessary treatment. Departments should therefore monitor assessment-related delays and staff workload as balancing measures.

Emergency department length of stay and boarding time can provide useful operational information, but they require interpretation. A longer stay may reflect avoidable delay, but it may also involve appropriate observation or necessary assessment. Similarly, a shorter stay is not necessarily evidence of better care if clinically important needs remain unresolved.

Outcome measures may include unplanned emergency revisits, subsequent hospitalizations, adverse events, changes in function and patient or caregiver experience.

These outcomes are influenced by underlying illness, baseline risk and access to continuing care. They should not be interpreted as direct measures of the quality of one emergency assessment without considering those factors.

Readmission or revisit rates should not be used in isolation. A patient returning promptly because they followed appropriate safety advice may have received good care, while a low revisit rate may not reveal problems among people unable to return.

Hospitals should also consider unintended consequences, such as unnecessary consultations, prolonged stays, missed high-risk patients or inappropriate attempts to avoid admission.

For Viet Nam, a small number of clearly defined indicators may be more practical than a complex measurement system that staff cannot maintain reliably.

These are proposed areas for local quality improvement, not a nationally mandated Vietnamese geriatric emergency department indicator set.

The purpose is to understand whether the service recognizes clinically important problems, responds appropriately and makes safer decisions about what happens next.

From Emergency Treatment to Better Decisions About What Happens Next

For an older person arriving with a life-threatening condition, high-quality emergency care begins with immediate recognition and appropriate treatment. For someone whose acute condition has stabilized, quality may also depend on identifying a new loss of mobility, an important cognitive change, a medication-related concern or the absence of support necessary for safe discharge.

For emergency clinicians, the challenge is recognizing these factors without delaying urgent care or creating an assessment process that cannot be sustained. For hospitals, the challenge is organizational: staff need clear responsibilities, practical tools, access to appropriate professional support and reliable arrangements for admission, observation, transfer or discharge.

For older people and their families, the most meaningful outcome may be a clinically appropriate decision and a clear understanding of what needs to happen next.

As Viet Nam adapts healthcare services to an aging population, emergency departments have an important opportunity to strengthen age-friendly care. This does not require separate geriatric emergency units in every hospital. It requires a care model that recognizes when older patients need additional assessment and ensures that the findings influence appropriate decisions.

The distinction between rapid geriatric risk recognition, targeted assessment and comprehensive geriatric assessment is central to making such a model feasible.

Rapid recognition helps the team identify what matters. Targeted assessment addresses concerns that require further evaluation. Comprehensive assessment supports more complex, multidisciplinary decisions when appropriate. Care coordination connects these findings with treatment, disposition and follow-up.

The objective is not to assess every older patient more extensively or reduce hospital admissions at any cost. It is to make timely, evidence-informed decisions that reflect both the acute medical condition and the person's wider health, function and care needs.

An age-friendly emergency department is not defined by how many geriatric screening tools it uses. It is defined by whether it recognizes important risks without delaying emergency treatment, responds appropriately and makes safer decisions about where and how the older person should receive care next.

That is how emergency care can become more responsive, coordinated and reliable for older people across Viet Nam's healthcare continuum.

References

1. American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, Society for Academic Emergency Medicine. Geriatric Emergency Department Guidelines. Annals of Emergency Medicine. 2014;63(5)–e25. DOI: 10.1016/j.annemergmed.2014.02.008.

2. American College of Emergency Physicians. Geriatric Emergency Department Accreditation Program: Accreditation Levels, Criteria and Resources. ACEP.

3. Gunaga S, Carpenter CR, Kennedy M, et al. A Model for Developing Subspecialty Clinical Practice Guidelines: The Geriatric Emergency Department Guidelines 2.0. Journal of the American College of Emergency Physicians Open. 2025;6(6):100247. DOI: 10.1016/j.acepjo.2025.100247.

4. Lee S, Khoujah D, Eagles D, et al. GRADE-Based Clinical Practice Guidelines for Emergency Department Delirium Risk Stratification, Screening, and Brain Imaging in Older Patients With Suspected Delirium. Academic Emergency Medicine. 2026;33(2). DOI: 10.1111/acem.70167.

5. Lee S, Suh M, Ragsdale L, et al. A Systematic Review of Interventions for Persons Living With Dementia: The Geriatric ED Guidelines 2.0. Academic Emergency Medicine. 2026;33(1). DOI: 10.1111/acem.70074.

6. Tran Dinh Thang, Nguyen Ngoc Tam, Vu Thi Thanh Huyen, Nguyen Trung Anh. Comprehensive Geriatric Assessment in Elderly Patients at the Emergency and Stroke Department, National Geriatric Hospital. Vietnam Journal of Community Medicine. 2026;67(3). DOI: 10.52163/yhc.v67i3.4590.

7. Galvin R, Gilleit Y, Wallace E, et al. Adverse Outcomes in Older Adults Attending Emergency Departments: A Systematic Review and Meta-Analysis of the Identification of Seniors At Risk (ISAR) Screening Tool. Age and Ageing. 2017;46(2):179–186. DOI: 10.1093/ageing/afw233.

8. Jay S, Whittaker P, Mcintosh J, Hadden N. Can Consultant Geriatrician Led Comprehensive Geriatric Assessment in the Emergency Department Reduce Hospital Admission Rates? A Systematic Review. Age and Ageing. 2017;46(3):366–372. DOI: 10.1093/ageing/afw231.

9. Wong GWW, Hock M, Tan YY, Ho AFW, Chan JSE. Outcomes of Emergency Department Observation Units for Geriatric Assessment: A Systematic Review and Meta-Analysis. Singapore Medical Journal. 2026;67(4):199–210. DOI: 10.4103/singaporemedj.SMJ-2025-232.

10. Adler-Milstein J, Rosenthal SW, Thombley R, et al. Outcomes Associated With an Age-Friendly Emergency Department Intervention. Annals of Emergency Medicine. 2026;87(4):490–501. DOI: 10.1016/j.annemergmed.2025.07.007.

11. Ellis G, Marshall T, Ritchie C. Comprehensive Geriatric Assessment in the Emergency Department. Clinical Interventions in Aging. 2014;9:2033–2043. DOI: 10.2147/CIA.S29662.

12. National Assembly of Viet Nam. Law on Medical Examination and Treatment No. 15/2023/QH15. Adopted 9 January 2023; effective 1 January 2024.

13. Ministry of Health of Viet Nam. Circular No. 19/2013/TT-BYT guiding the implementation of quality management of medical examination and treatment services in hospitals. 12 July 2013.

14. Ministry of Health of Viet Nam. Decision No. 1976/QĐ-BYT issuing professional guidance on care for older people at home and in the community. 1 July 2026.

15. National Assembly of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. Adopted 26 June 2025; effective 1 January 2026.