INTRODUCTION Many Southeast Asian (SEA) countries are facing the issue of an ageing population.1 Singapore and Thailand already have aged populations, while countries such as Malaysia and Indonesia are rapidly transitioning to aged status in the next few years. This demographic shift highlights an urgent need to promote active ageing across the region and to address the gaps in healthcare policies, education and service delivery for older adults.1 Geriatric Emergency Medicine (GEM) plays a crucial role in the acute care of older adults. Since its emergence 30 years ago, the field has grown substantially, often through collaboration between geriatricians and emergency physicians, and is now an integral part of emergency care worldwide.2,3 This commentary focuses on key developments in GEM within four fast-ageing populations in Southeast Asia—Singapore, Thailand, Malaysia and Indonesia. REGIONAL DEVELOPMENTS Singapore Singapore’s population is ageing rapidly. The country is projected to become a ‘super-aged’ society by 2026, with more than one in five residents expected to be aged 65 years or older.4 This demographic shift will significantly impact emergency departments (EDs), as more older adults seek urgent care, are admitted to hospitals and often have longer stays. A local study has shown that residing in public rental housing was a significant determinant of ED utilisation, especially for those who were lonely and had difficulty coping.5 To manage this, Singapore has developed a holistic and multidisciplinary GEM approach to manage older adults in the ED more effectively, facilitating appropriate allied health referrals and supporting personalised discharge planning. Training in GEM in Singapore began in late 2006 at Tan Tock Seng Hospital, and the first patient was treated in April 2007. Since then, semi-annual seminars have been conducted for doctors and nurses from various hospitals, and GEM services have been introduced in other hospitals. Today, all eight public hospital EDs in Singapore have dedicated GEM teams and programmes.6 In 2022, a group of GEM doctors, with support from the then President, established the Section of GEM within the College of Emergency Physicians, Academy of Medicine Singapore. The group focused on education through sharing best practices, organising national seminars, and improving training for emergency medicine residents, doctors, nurses and allied health professionals. Singapore’s section representatives actively participate in international GEM initiatives through the International Federation of Emergency Medicine (IFEM) GEM Special Interest Group (SIG), and contribute to international guidelines and research on caring for older patients in the ED.7 Research in GEM began in 2009 and has since expanded, showing that GEM multidisciplinary teams—comprising nurses, case managers, therapists and geriatricians—improve patient outcomes and reduce acute hospital usage for older adults in the ED.8,9,10 Recent research includes ED interventions for fall and fracture prevention10,11,12 and a health services evaluation showing the cost-effectiveness of GEM interventions and their positive impact on patients’ quality of life.13 Future efforts will focus on benchmarking and applying implementation science to ensure a high standard of GEM service across Singapore, as well as collaboration with regional partners to improve older adult care. Thailand The development of GEM in Thailand has become increasingly important due to the country’s rapidly ageing population, with those aged 60 and over surpassing the 13.6 million mark this year.14 There has been a concerted effort to better address the complex, multifactorial conditions that often characterise older adults’ healthcare needs, such as cardiovascular disease, diabetes mellitus and dementia, all of which necessitate specialised care during emergencies. In addition, older patients may present with atypical symptoms of common medical emergencies, complicating both diagnosis and treatment.15 Since 2018, emergency physicians interested in GEM and palliative care at four academic hospitals, namely Vajira, Srinakarin, Lerdsin and Ramathibodi hospitals, have formed an SIG and actively contribute to academic conferences. In 2023, the Thai College of Emergency Physicians officially established the Geriatric–Palliative SIG and has gradually expanded its membership to private and public general hospitals. The Thai GEM SIG is represented in the IFEM GEM SIG, which has provided valuable guidance and benchmarking. The SIG has focused on enhancing the knowledge of emergency healthcare providers, incorporating the GEM syllabus into several hospitals’ postgraduate emergency medicine programmes in 202216 and the undergraduate medical curricula at public universities. In addition, some hospitals in Thailand have established specialised units or triage protocols for geriatric patients. Vajira Hospital and Lerdsin Hospital have Geriatric Emergency Units that focus on specific needs of older adults, such as regional nerve block for hip and rib fractures, fall prevention, polypharmacy management and frailty management, with the goal of improving patient outcomes, reducing unnecessary hospital admissions and preventing functional decline during hospitalisation. Samithivej Srinakarin Hospital has implemented geriatric triage protocols17,18,19 and other hospitals have also adopted ED multidisciplinary teams to ensure a more holistic approach in managing older patients. There has also been a rise in GEM research focusing on the management of common geriatric emergencies such as falls,20,21 palliative care,22,23,24 fractures, pain management,25,26 sepsis and cardiac events,27 as well as the development of protocols that consider both acute care and long-term health outcomes. Collaborative efforts between local hospitals, universities and international organisations are ongoing to develop evidence-based guidelines. Malaysia Malaysia’s population is ageing at an unprecedented pace. In 2019, older adults made up 6.7% of the country’s population; by 2030, more than 15% of Malaysians will be aged 60 years and above, officially conferring it the ‘aged nation’ status. Such a transformation carries profound implications for healthcare, social support and national policy planning. In a study by Mohd Mokhtar et al.,28 common factors associated with inpatient admissions among older adults in Malaysian EDs included the presence of multiple chronic comorbidities, functional dependency and acute medical illnesses such as infections, cardiovascular events and falls with injuries. Older persons who were frail or had inadequate home support were also more likely to require hospitalisation, highlighting the complex interplay of medical, functional and social factors driving hospital admissions. In 2017, emergency physicians established a GEM SIG within the College of Emergency Physicians, Academy of Medicine Malaysia. The SIG collaborated with the Malaysian Society of Geriatric Medicine to improve training and care protocols, and develop elderly-friendly EDs. SIG members gradually received fellowships and geriatric diplomas from Singapore and local universities. In 2020, an official postgraduate GEM syllabus was incorporated and GEM topics were incorporated in undergraduate medical programmes. However, the progress of GEM in the country has been slow due to limited resources and administrative support. Issues such as an increasing number of older adults getting intubated in ED despite poor outcomes have been identified,29 along with prolonged ED length of stay, overcrowding and inadequate resources.28 There is a growing recognition that international and regional collaboration and benchmarking are vital to Malaysia’s progress in improving best practices and standards of GEM. The SIG has engaged with IFEM GEM SIG and Singapore Section for GEM. Since then, the SIG has successfully conducted GEM talks, forums, and workshops across various states in Malaysia. Indonesia Indonesia projects that by 2035, 11% of its population (approximately 28 million people) will be aged ≥65 years. Although the country has established a National Action Plan for Older Persons (RAN Kesehatan Lanjut Usia), which guides integrated geriatric health services across primary care, the plan does not contain ED-specific provisions or protocols.30 Thus, there is a need for more specific, standardised training in geriatric competencies within the undergraduate and postgraduate curricula, including for emergency medicine trainees.31 Recent research in GEM has focused on geriatric screening tools,32 and the newly established Indonesia College of Emergency Medicine could serve as a key vehicle to advance the various areas of GEM. CROSS-BORDER COLLABORATIONS In August 2025, a Memorandum of Understanding was signed between the Malaysia GEM SIG, Singapore Section for GEM and Indonesia College of Emergency Medicine to collaborate through joint educational programmes and training, as well as the development of clinical guidelines. This trilateral initiative could serve as a foundational step towards broader Association of Southeast Asian Nations (ASEAN)-wide cooperation, ensuring that emergency care systems in emerging emergency medicine communities are better equipped to deliver timely, appropriate and dignified care to a growing population of older adults. CONCLUSION This commentary highlights the development of GEM in Singapore, Thailand, Malaysia and Indonesia. The development of GEM is closely linked to the pace of population ageing, the establishment of GEM SIGs within national emergency medicine colleges, and the extent of regional and international collaboration. Strengthening partnerships among SEA nations may be pivotal in accelerating GEM development and enhancing the quality of emergency care for older adults across the region. Future research should review how each country manages acutely ill older adults, with particular attention to geriatric syndromes such as delirium, falls and polypharmacy. In addition, issues related to infrastructure, resource allocation and continuum of care—from EDs and acute hospital settings to step-down and community-based rehabilitation—should be explored collectively to inform regional strategies for improving outcomes in this vulnerable population. Acknowledgement Artificial intelligence (ChatGPT4) was used to enhance readability and language. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Zakaria et al. (Sat,) studied this question.