Satheesh Gunaga DO1,2,3 , Christopher R. Carpenter MD, MSc4 aura Kennedy MD, MPH5,6 Lauren T. Southerland MD, MPH7
Alexander X. Lo MD, PhD8 Sangil Lee MD, MS9 , Kirby Swan DO1,3 , Fabrice Mowbray PhD, RN10, Rachel M. Skains MD, MSPH11,
Teresita M. Hogan MD12, Martin F. Casey MD, MPH13, Kei Ouchi MD, MPH6,14, Naomi R. George MD, MPH15, Kerstin de Wit MBChB, MD, MSc16,
Cameron J. Gettel MD, MHS17,18, Katherine Selman MD19, Luna C. Ragsdale MD, MPH20,21, Anita N. Chary MD, PhD22,
James D. van Oppen BMBS, PhD23, Glenn Arendts MBBS, PhD2, Charles L. Maddow MD25, Katherine M. Hunold MD, MPH7
,Katren R. Tyler MD26, Danya Khoujah MBBS, MEHP27, la Hwang MD, MPH17,28,29, Shan Liu MD, SD5,6
Abstract 
The original consensus–based Geriatric Emergency Department (GED)
Guidelines, published in 2014, established a framework of core principles for
delivering high-quality, age-appropriate emergency care for older adults. In
response to significant advances in geriatric emergency medicine research and
evolving clinical priorities, we developed the GED Guidelines 2.0 to ensure
continued relevance, clinical utility, and evidence-based rigor. This concept
paper describes the systematic and iterative process undertaken to update the
guidelines, including the formation of multidisciplinary working groups and the
application of the Grading of Recommendations Assessment, Development,
and Evaluation (GRADE) methodology. Unlike the original GED Guidelines, our
approach prioritized methodological transparency, formalized evidence
grading, and consensus building grounded in systematic reviews and metaanalyses. We describe the identification, recruitment, and collaboration of
multidisciplinary clinical and academic experts working together to improve
the care of older adults in the emergency department. Through this multidisciplinary effort, key geriatric domains were selected, priority topics identified,
and systematic reviews and meta-analyses conducted to generate a robust
evidence base for future guideline and policy development. The GED Guidelines 2.0 represents the first emergency medicine (EM) subspecialty guideline
effort to fully adopt the GRADE framework, offering a novel blueprint for
future EM guideline development.
Keywords: emergency medicine, geriatrics, aged, evidence-based medicine, practice guidelines as topic, health services for the aged, program development
