How carers can be part of the emergency department team for older adults.
It’s another evening in your rural ED. An older patient arrives, confused. His daughter is there with a handwritten list of his meds. We’re seeing patients like this more often — and it will only become more common as the ageing population doubles over the coming decades. What if, instead of being left on the sidelines, informal carers like this daughter were recognised as part of the team? That’s the question Belinda Nichols, one of our RRECN researchers, explores in her latest published review.
In this study, Nichols and colleagues used an integrative review and thematic analysis to bring together the available evidence. A search of five databases between late 2023 and 2024 turned up ten primary studies on how carers of adults aged 65 and over are included in emergency department care. From these, two key themes emerged: carers as advocates, and carers as outsiders — a clear picture of both the value carers bring and the barriers that keep them at arm’s length.
Carers advocate for better care by sharing a patient’s history, medications and baseline status, and by providing relevant, timely information. They help ensure assessments are accurate, discharges are safe and patients are comforted. To act as advocates, carers need effective communication with healthcare professionals, real opportunities to collaborate in care and decision-making, and access to resources and education to support their role.
But this doesn’t always happen. Inclusion is hindered when access to the patient is restricted by local policies, when communication is ineffective, or when carers are excluded from decisions and left without support. In these situations, carers exist as outsiders — frustrated, unheard, and unable to contribute to care.
This review highlights the importance of care partnerships with informal carers in the ED to deliver high-quality care for older adults with complex needs. It shows both the barriers and facilitators to successful inclusion, and points to the key elements required to promote partnership: collaboration, communication, education and support.
Although the review drew on studies from metropolitan and rural EDs worldwide, the findings are especially relevant in rural and remote settings. With limited resources, recognising and including carers offers a practical way to help maintain safe, patient-centred care.
In rural EDs, carers aren’t just visitors — that daughter with the meds list may be the extra team member we didn’t know we had.
First published in the RRECN Newsletter (September 2025).
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