The designation recognizes emergency departments with specialized expertise, staffing and resources for patients 65 and older, who represent about one-third of all patients treated in Cedars-Sinai’s Emergency Department each year.

“This recognition reflects our commitment to delivering exceptional, patient-centered emergency care for the older adults of our community,” said Claude Stang, RN, executive director of the Cedars-Sinai Emergency Department. “As the No. 1 Medicare provider in California, we care for thousands of older adults every year, and we are dedicated to keeping them safe and healthy.”

Accreditation reviewers cited several programs and features that distinguish Cedars-Sinai’s approach to geriatric emergency care, including the Barry and Rena Plost Senior Emergency Center within the Emergency Department.

“We try to place patients who would benefit from a quieter environment in our senior care unit, where private rooms, dim lighting and reduced noise can help minimize delirium for patients who are susceptible,” Stang said. “Those seemingly small changes can make a meaningful difference for older adults in the Emergency Department.”

Other components highlighted by reviewers included:

• A specialized geriatric nurse assessment team, trained to identify delirium, dementia, fall risk and social determinants of health.
• Integrated physical therapy and pharmacy services, including prescription medication screening, review and reconciliation.
• Senior-friendly amenities, including reserved reclining chairs in the waiting area, improved signage and lighting, handrails, and accessible bathrooms.
• Tender Loving Care volunteers, who are specially trained to provide companionship and comfort for older adult patients.
• A physician who leads ongoing education on geriatric emergency care for physicians and physician assistants.

Level 1 accreditation builds on Cedars-Sinai’s broader commitment to age-friendly care. The health system also has been named an Age-Friendly Health System Committed to Care Excellence, a recognition from The John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States.

“Older adults often have unique medical and social needs that require a different approach to emergency care, that centers around the 4M’s (What Matters Most, Mobility, Medications and Mentation) of age-friendly care,” said Sonja Rosen, MD, chief, Section of Geriatric Medicine at Cedars-Sinai. “As an Age-Friendly Health System, every member of our team plays an important role in ensuring patients receive compassionate, specialized attention from the moment they arrive through a seamless transition to the next stage of their recovery.”

The Emergency Department’s research team also has been active in advancing geriatrics research, publishing on sepsis, brain injury, cardiac biomarkers and observation care. The work helps to inform evidence-based practices that further strengthen care for older adults.

Emergency Department Expansion Underway

The accreditation comes as Cedars-Sinai continues a major expansion of its Emergency Department, an investment designed to increase capacity while supporting the specialized care needs of a growing patient population.

The project will add 16,550 square feet to the department and increase the number of care spaces from 60 to 100.

Sam Torbati, MD, chair and medical director of the Emergency Department, said the project is expected to be completed by the end of 2028.

“Smaller improvements, such as a new laboratory, are expected to open this fall,” Torbati said. “Patients will begin to see more significant changes next summer.”

The first major phase will add 15 acute care beds, eight behavioral health beds to treat patients with mental health needs, six critical care and trauma beds, and a dedicated room designed to care for critically ill children. The expansion also will include new waiting areas, an updated triage space and a redesigned patient entrance to improve capacity and the overall care experience.

“Demand for emergency care continues to grow, and we’re committed to finding new ways to improve the experience and quality of care for our patients,” Torbati said. “The expansion is a significant investment in meeting those needs.”

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Elam, 91, has been retired for 23 years from her job at United Food and Commercial Workers Local 770. And she is thriving, says Elam’s physician, Sonja Rosen, MD, chief of Geriatric Medicine at Cedars-Sinai, because Elam is doing retirement the right way.

“Carrie’s doing many of the things we encourage our patients to do as they age— keeping herself physically healthy and having a full social calendar,” Rosen said.

Statistics from the U.S. Bureau of Labor Statistics show nearly 20% of today’s workforce are 65 or older, up from 10% in the mid-1980s. And many older adults stay in the workforce for health—not financial—reasons. One analysis suggests that retiring earlier is associated with higher mortality, finding an 11% reduction in risk of death for each additional year of work.

So how can today’s older adults slow down or leave their careers without losing their health?

“Retirement from work is not retirement from life,” said Zaldy Tan, MD, MPH, medical director of the Jona Goldrich Center for Alzheimer’s and Memory Disorders at Cedars-Sinai. “It’s not like there is a universal, specific age at which our bodies shut down or our brains slow down to a halt. That is not physiological. This idea of retirement is man-made.”

The key factor, Tan said, is not retirement itself—but what people do after they stop working. Retirees who remain socially and cognitively engaged often experience better physical health, slower biological aging and improved mental wellbeing than those who do not, Tan said.

Elam is a perfect example. Her days still have structure and purpose: volunteering on her church’s fundraising committee, walking in Fox Hills Park, attending the opera and sharing Sunday dinners with family.

“I like to get dressed, give back to my community and make sure I have a full day,” Elam said.

Rosen said that sense of routine and purpose can make a big difference in how people experience retirement.

How to Prepare for a Healthy Retirement  

For many, a job gives more than income—it provides routine, purpose and daily social interaction. When the job disappears, the transition can be challenging, particularly for people whose relationships and activities revolve around the workplace.

“Work is sometimes seen as negative,” Tan said. “But we shouldn’t look at work as evil and vacation or retirement as good. It’s really what you make of both situations.”

Retirement can even improve the health of some—especially those leaving physically demanding or high-stress careers. Rosen said that some of her retired patients find they have more time to focus on exercise, cook healthier meals, spend time outdoors or explore new interests.

But Tan said the transition works best when people prepare for it.

“People spend years preparing to enter the workforce, but retirement requires discipline, too,” he said. “If your friendships and routines are centered on work, you need to start building activities, social connections and interests outside the workplace before you retire so you don’t end up isolated.”

Rosen recommends that people who are considering retiring take stock of where they find meaning in their lives—whether that purpose comes primarily from work or from activities, hobbies and relationships outside the workplace.

“What matters most are a patient’s individual goals and preferences,” Rosen said. “It really depends on the individual and what they find most meaningful in their life.”

For those who do retire, Rosen said maintaining structure and healthy habits is essential. She recommends aiming for at least 150 minutes of cardio each week and strength training twice a week. She also advises retirees to build social activities into their routines, such as volunteering or scheduling regular get-togethers with friends, to stay socially connected.

Mental stimulation is another important piece. Work often provides daily intellectual challenges, and Rosen said retirees benefit from replacing that engagement with activities such as continuing education, mentoring or doing memory exercises.

Elam, for example, reads every day and keeps her mind active with small mental exercises. If she can’t remember the name of something, she runs through the alphabet until a letter triggers her memory.

When Retirement Isn’t the Right Fit

For Christine Maclin, retirement simply wasn’t a good match.

Maclin, now 79, originally retired from her job as a cook at age 69, planning to rest and enjoy her free time. But after six months, she realized she missed the learning and sense of purpose that work provided.

“I mean, how many movies can you go to? How many coffee shops can you go to?” Maclin said. “I love hanging out with my friends, but ultimately I felt like retirement was time wasted.”

She returned to the workforce through a staffing company, first working as a cook for the Magic Castle and the University of Southern California—and later as an associate on the sales floor at Nordstrom. In January 2025, she decided to try something new and took a 10-week course in professional caregiving.

“What Christine has done—finding work and continuing to learn—shows that some patients fare better when they work,” Tan, Maclin’s physician, said.

Now Maclin works twice a week as a personal caregiver—cooking for her client, socializing and helping with errands—while continuing to learn something new every day.

“I like having somewhere to go and having something to do,” Maclin said.

Keeping a Positive Mindset, Retired or Working

Elam and Maclin each attribute their good health to a resilient, positive mindset.

Maclin says occasionally forgetting things is a normal part of life and not something worth getting upset about. Instead of becoming frustrated, she focuses on solving the problem, as she recently did one morning when she couldn’t recall if she had taken her medication.

“Instead of getting angry because you forgot something, solve the problem,” Maclin said. “I decided that after I take my medication, I just turn the container upside down, so I know.”

Elam says she tries to approach the aging process with as much style and grace as possible and avoids worrying prematurely.

Retired or not, she believes the key to staying healthy is simple: “Find activities you enjoy, and always be grateful,” Elam said.

Read more from Stories and Insights: Why Exercise Is Important as You Age

California Academic Geriatrics Institutions

“As clinicians and investigators from an institution that treats more patients over the age of 80 than any other academic medical center in the country, Cedars-Sinai’s aging experts appreciate the opportunity this conference provides to share research and clinical innovations with other academic geriatrics programs in California,” said Sonja Rosen, MD, chief of Geriatric Medicine at Cedars-Sinai, conference co-chair, and a fellow of the American Geriatrics Society and of the American College of Physicians.

Cedars-Sinai is recognized as an Age-Friendly Health System by The John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States. The designation is given to health systems that integrate the “4 Ms”—mobility, mentation, medication safety and what matters most—into care for older patients. This recognition also was recently extended to the Ruth and Harry Roman Emergency Department at Cedars-Sinai Medical Center.

“We are focused on providing older adults with the evidence-backed care they need and deserve, while also conducting research that could one day lay the groundwork for an even more innovative standard of care,” said Sara Espinoza, MD, director of the Center for Translational Geroscience and a Gerontological Society of America fellow.

Cedars-Sinai experts who are attending the meeting and are available for interviews include:

Zaldy Tan, MD, MPH, medical director of the Jona Goldrich Center for Alzheimer’s and Memory Disorders, and director of the Memory and Healthy Aging Program, can discuss his research on reducing Alzheimer’s risk with healthy lifestyle interventions, screening for early cognitive impairment in hospitalized patients, and differences in health outcomes based on dementia status.

Sam Torbati, MD, medical director of the Ruth and Harry Roman Emergency Department, can discuss efficiencies in care of geriatric patients in the ED’s Observation Unit, the performance of high-sensitivity cardiac biomarkers in geriatric populations, and utility of a new three-protein assay in predicting bacterial infections among complex geriatric populations.

Allison Moser Mays, MD, MAS, geriatrician and assistant professor of Medicine, can discuss her research on social isolation, fall prevention, and recruitment of older adults into an online exercise program.

Hiroshi Gotanda, MD, PhD, geriatrician and assistant professor of Medicine, will present his research examining end-of-life care for older adults with dementia by race and ethnicity and physicians' roles. He can also discuss his broader research on the intersection of health policy and dementia care.

Kathleen Breda, MSN, NP, can discuss the Geriatric Fracture Program’s use of nurse-led transitional care to reduce hospital stays for older patients with hip fractures, as well as the Move to Recover Program, which mobilizes older, hospitalized orthopedic patients with complex cases to improve their health outcomes.

Katie Hren, MPH, LCSW, associate director of Cedars-Sinai’s Community Connect Program, can discuss the program’s effectiveness in screening and managing social determinants of health in older adults.

To schedule an interview, contact: Kelsie Sandoval at Kelsie.sandoval@cshs.org or 562-631-1169.

Sonja Rosen, MD, chief of Geriatric Medicine at Cedars-Sinai, said older adults can be especially sensitive to heat.

“Older adults who have chronic lung or heart conditions or diabetes can be especially vulnerable,” she said. “It’s a good idea to check in on any older adults you know. Cooling centers are open throughout L.A. County and can bring great relief in the heat.”  

Sam Torbati, MD, co-chair of the Department of Emergency Medicine at Cedars-Sinai, said,  “It’s important to stay hydrated and avoid overexertion. Once you start feeling the effects of heat exhaustion, you need to take action to cool down. Cold baths, fans, air conditioning, drinking cold water—all will help.”

Heat exhaustion occurs when the body sweats so much that it loses water and sodium. When that happens, the body can no longer regulate its temperature. Symptoms include a rapid heart rate, profuse sweating, muscle cramping, dizziness, headache and nausea. If the body temperature reaches 103 degrees, heatstroke—a medical emergency—can occur, causing confusion, seizures and loss of consciousness.

Rosen and Torbati are available for interviews.

To arrange an interview, contact: Soshea Leibler | 213-215-8000 | soshea.leibler@cshs.org

“This season can be particularly difficult for older adults who don't have as many social connections, or are hindered by physical limitations, because of all the messaging around us that emphasizes activity and connectedness,” said Sonja Rosen, MD, chief, Section of Geriatric Medicine at Cedars-Sinai.

The Surgeon General of the United States has described loneliness and isolation as an epidemic affecting 50% of the population and associated with a higher risk for cardiovascular disease, dementia, stroke, depression, anxiety and death.

“Loneliness and isolation, part of what we call ‘social determinants of health,’ are established risks for poor health and early death, especially for aging adults. The health risks are equivalent to smoking  up to 15 cigarettes a day,” said Cedars-Sinai geriatrician Allison Moser Mays, MD, MAS.  “But we also know that being more socially connected can actually decrease the risk of mortality by as much as 50%.”

Hearing loss, memory impairment, the inability to drive safely and other functional changes that can come with age impact the desire or ability to attend holiday gatherings and can exacerbate feelings of loneliness and anxiety.

“We see a lot of our patients not want to go out as much because they are unable to communicate well. Large gatherings of family or friends or just going out to a restaurant with others can be very stressful if they are straining to hear or have difficulty following conversations. They may prefer to stay at home and isolate rather than feel out of place or anxious,” said Mays, an assistant professor of Medicine.

Grief and loss can also be significant drivers of social isolation and loneliness as people age.

“This can be a particularly difficult time of the year for anyone who has experienced loss or who doesn't have that sense of community they wish they had. And that really is what defines loneliness—not having the social connections that you want,” Mays said.

Geriatricians at Cedars-Sinai routinely discuss loss and grief during patient visits and can provide referrals to social workers or grief support groups.

“If you know that an individual is feeling lonely, if they've shared that they wish they weren’t so alone and want help, then see if there are hurdles that are keeping them isolated, such as lacking transportation or feelings of grief and loss. Find out what you can do to help them,” said Rosen, a professor of Medicine.

Ways to Support Older People During the Holiday Season

1. Initiate: Check in more often with older family members and friends and gently ask how they are doing and offer support. A phone call can go a long way in nurturing connectedness.
2. Invite: Consider inviting them to smaller, more intimate, gatherings if functional limitations are an issue. Welcome them without pressuring them to fit into your plans.
3. Listen: Actively listen when they want to talk, even if it is a difficult conversation.
4. Accommodate: Discuss an activity or simple pleasure they would enjoy rather than insisting they participate in planned events.
5. Grieve: Loss is felt deeply during the holidays. Pay attention and let them know you are there to listen. Meet them where they are and do not force activities they may be anxious about.

Cedars-Sinai’s Leveraging Exercise to Age in Place (LEAP) is an evidence-based exercise program proven to decrease loneliness, social isolation and the fear of falling in older adults.

“We’ve found that purpose-driven activity is a good way to form community. In our LEAP program exercise classes, some of the participants were only coming 40% of the time, but they still felt they had a sense of community and connection to the class,” Mays said.

Loneliness and social isolation do not have to be the theme of this holiday season.

“A lot of people are embarrassed to ask for help. They’re embarrassed to be alone. But they need to know that most of us struggle with the same things at one time or another. We are all part of the same community. There is help and comfort, and we can be there for one another,” Rosen said.

Read more on the Cedars-Sinai Blog: Anxiety in the Golden Years: What You Should Know

Flu season started early in the Southern Hemisphere, which typically gives experts some clues as to what we’ll experience here in the U.S. To avoid getting caught off guard, it’s important to get the flu shot in September or October, said infectious disease specialist Soniya Gandhi, MD, MPH, associate chief medical officer at Cedars-Sinai.

“Even a typical flu season can be deadly and can cause significant hospitalization,” Gandhi said, pointing to 58,000 deaths in the U.S. and more than half a million hospitalizations—all caused by last year’s flu. “We should do what we can to protect ourselves—and others—with the best tool we have: the flu vaccine.”

Cedars-Sinai primary care physicians and pediatricians are now offering flu shots to patients during regularly scheduled visits. Patients who have been treated by a Cedars-Sinai primary care provider in the past 16 months can schedule a vaccination appointment online through My CS-Link at clinics in Beverly Hills, Marina del Rey, Santa Monica, Los Feliz, Playa Vista and Tarzana.

In addition to the flu, COVID-19 and the respiratory syncytial virus (RSV) could again spike at the same time, triggering a “tripledemic,” Gandhi said. Last year, that same triple punch filled emergency departments across the country and strained children’s hospitals with young patients, who are vulnerable to RSV—a virus that can be serious, if not deadly, for infants and older adults.

But there’s a silver lining this year. In addition to the flu vaccine, new RSV shots are available for babies and adults over 60, and a new COVID-19 booster is coming this fall.

“These new shots and vaccines could really help protect us and our community during the upcoming season,” Gandhi said. “We need to preserve capacity in hospitals for those patients who really need that care.”

Help for Youngest and Oldest

RSV causes mild cold-like symptoms in most people, but it’s the leading cause for hospitalization among infants in the U.S. In babies, the virus can cause mild illness or it can cause dangerous inflammation in a child’s tiny airways.

“There's really no way to predict how your child would do even if they're completely healthy,” said Priya Soni, MD, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s. “If they do end up having a horrible course with RSV, they will likely need to be hospitalized for oxygen support, fluids and other supportive measures.”

Most children in the U.S. will be infected with RSV within the first year of their life, and almost all infants will have been exposed to the virus by the time they're 2 years old.

But parents of infants have a new way to protect their children. The U.S. Food and Drug Administration (FDA) recently approved an immunization—a monoclonal antibody treatment called nirsevimab-alip (Beyfortus)—that can be given as a single-dose shot to newborns and infants during their first RSV season. Children up to 19 months old who remain vulnerable to severe disease in their second RSV season also can get the shot.

Soni said she “100%” recommends the immunization because of strong clinical trials that yielded positive results.

The FDA also recently approved a Pfizer RSV vaccine for women who are 32-36 weeks pregnant to protect their infants at birth. The same vaccine also was approved for adults 60 and older, as was another vaccine from pharmaceutical company GSK.

For older adults, the Centers for Disease Control and Prevention (CDC) recommended these new vaccines only for those who are at highest risk of severe RSV, such as patients with asthma, diabetes or heart failure. Although both vaccines are considered safe, a very small number of cases of Guillain-Barre syndrome—a condition in which a person’s immune system attacks their peripheral nerves—were reported after vaccination.

More data is needed to determine whether these episodes may have been unrelated to the vaccine, according to the CDC. But the significant risk RSV poses to some older adults could outweigh the very low risk of developing potential side effects.

Sonja Rosen, MD, section chief of Geriatric Medicine at Cedars-Sinai, said that for now,  she recommends the RSV vaccine for older patients with lung disease, or for those who are otherwise immunosuppressed and therefore at higher risk for severe illness. “Patients should speak with their physician and make an informed decision about whether this shot is right for them,” Rosen said.

New Twist on the COVID-19 Booster

The new COVID-19 booster has been updated to include a sub-variant of Omicron called XBB, which was the predominant strain at the time the shot was approved by the FDA this summer.  The vaccine should provide protection from all the strains circulating in the U.S. right now, Gandhi said.

Thanks to the new booster, antiviral medications like Paxlovid and at-home tests, Gandhi is grateful that “we're in a very different position in 2023.” She encouraged the public to take advantage of the booster when it becomes available this fall, to keep themselves and their loved ones safe, especially when gathering throughout the fall and winter holidays.

“We know immunity wanes after the administration of the booster and that many individuals may not have had a booster for quite some time,” Gandhi said. “I think it will be incredibly important, particularly in those populations that are vulnerable to COVID illness, hospitalization and potentially even death, to ensure that they get the updated booster in a timely fashion.”

She said it’s safe to get the COVID-19 and flu vaccines together. For older adults who determine with their physician that the RSV shot is right for them, they should get that immunization alone and two weeks apart from the other vaccines, if possible, Gandhi said. 

Read more on the Cedars-Sinai Blog: Flu—When to Go to the ER

By 2030, there will be more than 70 million people over the age of 65 in the U.S., according to the U.S. Census Bureau. Because of a shortage in geriatricians, most of the healthcare for older adults in the U.S. will be provided by physicians in other specialties.

To address that gap, Cedars-Sinai and other age-friendly health systems create programs that focus on the “4Ms”: what matters most to older patients, patient mentation (mental functioning), patient mobility and medication safety. "By doing so, really in any program, we're going to help ensure that we're providing optimal care for our older patient population without necessarily having a geriatric provider directly providing that service,” Rosen told Ansari.

A good example, Rosen said, is Cedars-Sinai’s Geriatric Fracture Program, a collaboration of the Department of Orthopaedics and the Geriatric Section of Cedars-Sinai’s Department of Medicine. This program focuses on decreasing time to surgery for older adults who come to the hospital after experiencing a significant fracture, and ultimately decreasing their length of stay, Rosen told Ansari. When enrolled patients leave the hospital, clinicians follow up to assess the patient's bone health and develop strategies for future fall prevention.

In a recent study of the program, authors examined the health records of patients 65 and older with non-spine traumatic fractures who were cared for by physicians at Cedars-Sinai Medical Center. Investigators compared data from 746 patients who participated in the Geriatric Fracture Program with data from 852 patients who were not enrolled in the program.

The findings, published in a Health Services Research special issue on aging, showed that patients enrolled in the Geriatric Fracture Program experienced 2.12 fewer days in the hospital, a significant difference. Hospitalization also cost an average of about $5,000 less for program participants compared with patients not in the program. 

“We really focused on how to make sure that when patients leave the hospital, they still have their bone health … and strategies for future fall prevention have been addressed so that these things don’t happen again,” Rosen said.

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