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Background Over one‐half of older adults are discharged to the community after emergency department (ED) visits, and studies have shown there is increased risk of adverse health outcomes in the immediate post‐discharge period. Understanding the experiences of older adults during ED‐to‐community care transitions has the potential to improve geriatric emergency clinical care and inform intervention development. We therefore sought to assess barriers experienced by older adults during ED‐to‐community care transitions. Methods We conducted a qualitative analysis of community‐dwelling cognitively intact patients aged 65 years and older receiving care in four diverse EDs from a single U.S. healthcare system. We constructed a conceptual framework a priori to guide the development and iterative revision of a codebook, used purposive sampling, and conducted recorded, semi‐structured interviews using a standardized guide. Two researchers coded the professionally transcribed data using a combined deductive and inductive approach and analyzed transcripts to identify dominant themes and representative quotations. Results Among 25 participants, 20 (80%) were women and 17 (68%) were white. We identified four barriers during the ED‐to‐community care transition: (1) ED discharge process was abrupt with missing information regarding symptom explanation and performed testing, (2) navigating follow‐up outpatient clinical care was challenging, (3) new physical limitations and fears hinder performance of baseline activities, and (4) major and minor ramifications for caregivers impact an older adult's willingness to request or accept assistance. Conclusions Older adults identified barriers to successful ED‐to‐community care transitions that can inform the development of novel and effective interventions.

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Objective Falls are a leading cause of injury‐related emergency department (ED) visits and may serve as a sentinel event for older adults, leading to physical and psychological injury. Our primary objective was to characterize patient‐ and caregiver‐specific perspectives about care transitions after a fall. Methods Using a semistructured interview guide, we conducted in‐depth, qualitative interviews using grounded theory methodology. We included patients enrolled in the Geriatric Acute and Post‐acute Fall Prevention Intervention (GAPcare) trial aged 65 years and older who had an ED visit for a fall and their caregivers. Patients with cognitive impairment (CI) were interviewed in patient–caregiver dyads. Domains assessed included the postfall recovery period, the skilled nursing facility (SNF) placement decision‐making process, and the ease of obtaining outpatient follow‐up. Interviews were audio‐recorded, transcribed verbatim, and coded and analyzed for a priori and emergent themes. Results A total of 22 interviews were completed with 10 patients, eight caregivers, and four patient–caregiver dyads within the 6‐month period after initial ED visits. Patients were on average 83 years old, nine of 14 were female, and two of 14 had CI. Six of 12 caregivers were interviewed in reference to a patient with CI. We identified four overarching themes: 1) the fall as a trigger for psychological and physiological change, 2) SNF placement decision‐making process, 3) direct effect of fall on caregivers, and 4) barriers to receipt of recommended follow‐up. Conclusions Older adults presenting to the ED after a fall report physical limitations and a prominent fear of falling after their injury. Caregivers play a vital role in securing the home environment; the SNF placement decision‐making process; and navigating the transition of care between the ED, SNF, and outpatient visits after a fall. Clinicians should anticipate and address feelings of isolation, changes in mobility, and fear of falling in older adults seeking ED care after a fall.

Objectives: We aimed to describe recent technologic advances in the three domains of dementia care, falls, and home supports; summarize existing literature on usability; and identify knowledge gaps. Methods: A comprehensive search of five databases for recent peer-reviewed publications was conducted in May 2020. Independent reviewers performed title/abstract review, full-text screening, data extraction, and study characteristic summarization. Results: Out of 2,696 citations, 151 articles were retrieved for full-text evaluation, after which 54 studies were included in this scoping review. For each domain, different technologies are available to enhance the health and well-being of older adults; many users deemed them usable and useful. Technologies targeted improving function, psychosocial and cognitive status, home safety, and caregiver burden. Barriers to widespread uptake include privacy concerns, suboptimal user experience, and willingness to accept assistance. Conclusion: Technologic innovations directed toward dementia care, fall detection, and ambient-assisted living can aid older adults “aging in place.”