Geriatric Emergency Care, Hospitalization, and Mortality Among Older Adults in the United States

Emergency departments are a primary point of contact between older adults and the healthcare system, yet standard emergency care is poorly adapted to the complex needs of geriatric patients. Geriatric Emergency Departments (GEDs) - accredited units that integrate geriatric-trained staff, age-friendly protocols, and post-visit care coordination - have expanded rapidly across the United States, but rigorous evidence on their effectiveness at the national scale remains scarce. This paper provides the first nationally representative estimates of GED effects on hospitalization and mortality among Medicare beneficiaries aged 65 and older. Linking data from the Health and Retirement Study (HRS) to Medicare claims, we estimate multivariable logistic regression models with comprehensive controls for sociodemographic, health, and functional characteristics. We find that older adults treated at a GED were 9.7 percentage points less likely to be hospitalized and 6.1 percentage points less likely to die within 30 days, compared to those treated at a non-GED emergency department. Placebo tests and sensitivity analyses support causal interpretation. However, treatment effect heterogeneity analysis reveals that gains are concentrated among non- Hispanic white patients and adults under age 80; Black and Hispanic older adults exhibit no statistically significant benefit, consistent with persistent disparities in post-discharge care access and social support. These findings suggest that GED accreditation improves downstream health outcomes at scale, but that structural inequities outside the emergency department attenuate benefits for minority patients. Policies targeting both the expansion of GEDs and the broader care infrastructure available to disadvantaged older adults are needed to realize equity gains from the GED model.