Care Experiences of Older People in the Emergency Department: A Concurrent Mixed-Methods Study

Abstract

The growing population of older people has increased demand to meet their complex healthcare needs, including in emergency departments (EDs). This study explored the experiences of people aged 65+ in Irish EDs, involving secondary analysis of quantitative and qualitative data from the 2019 National Inpatient Experience Survey (NIES). Experiences in the ED and overall hospital experiences were dichotomized as poor to fair or good to very good. Logistic regression was used to model quantitative data. Free text comments relating to EDs were thematically analyzed. Of 12,343 survey participants, 4,442 (39.9%) were aged 65+ years and used the ED. Longer waiting times, completion of the questionnaire by another person either with or on behalf of the patient, and having both a medical card and private health insurance were predictors of poor to fair ED experiences. Patients aged 85+ years were more likely to report good to very good ED experiences. Poor experiences in the ED were associated with poorer overall hospital experiences (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.76 to 2.73, p < .001). Thematic analysis revealed that long waiting times and unpleasant waiting conditions, including lack of communication, privacy, and personal care were important challenges encountered in the ED, with some older patients noting their preference for separate ED services. There is a need to reduce waiting times and integrate user perspectives in the planning, organization, and delivery of ED care to improve experiences and quality of care for a growing older population.

Emergency care for older people living with frailty: patient and carer perspectives

“…The findings reported from this study are consistent with previous research on the experiences of emergency care for older people which emphasise the importance of information and communication, staff attitudes, waiting times and physical/environmental needs in shaping those experiences 2–4 15–18. These aspects of care have also been identified as instrumental in determining the experiences of adult patients generally in the ED 19–21.…”

Initial Development of a Patient-Reported Experience Measure for Older Adults Attending the Emergency Department: Part II—Focus Groups with Professional Caregivers

“…However, participants reported that crowding and corridor care were commonly encountered and presented barriers to achieving the desired standards of care. Such concerns are likely to be well-founded, with the effect of ED crowding on mortality and patient experience being well documented in the literature [4,28].…”

“…Understanding vulnerabilities in patient experience may also be used to drive meaningful improvements in care [2]. The existing literature places emphasis on the importance of communication, managing wait times and providing a 'frailty-friendly' environment [3,4]. A meta-synthesis of patient experience in the emergency department (ED) proposes a needs-based framework for optimising patient experience, focusing on communication, care, waiting, physical, and environmental needs [5].…”

Transitional Care Based e-Health Program for Older Muslim Thai Adults with Chronic Obstructive Pulmonary Disease After Hospital Discharge: A Feasibility Study

“…According to projections, the percentage of people 60 years and older will rise from 13% in 2010 to 33% in 2040, 1 which causes issues in the demand for health care. 2 Previous studies have shown that 10-26% of older adults have experienced emergency department (ED) visits, 3 8.2% have visited the ED more than five times a year, and individuals over dyspnea from COPD at a large public hospital in the deep south of Thailand in the five years since 2016 gradually increased. 6 Approximately a third of patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD) returned to the ED within 30 days of discharge, similar to other countries.…”