What are the goals of care for older people living with frailty when they access urgent care? Are those goals attained? A qualitative view of patient and carer perspectives

Phelps, Kay; Regen, Emma; Oppen, James David van; Riley, Peter; Lalseta, Jagruti; Martin, Graham; Mason, Sue; Conroy, Simon

doi:10.1016/j.ienj.2022.101189

Cited by 18 publications

(29 citation statements)

References 24 publications

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“…In the acute care context, a number of policy initiatives have called for a greater focus on the delivery of evidence-based care for older people with urgent care needs, notably CGA 27–29 31 35. Despite these policy initiatives, the delivery of CGA for older people in acute care remains highly variable and suboptimal,38 and service and patient outcomes remain persistently poor 10 12 13 18 39. In response, the AFN was initiated to apply quality improvement at scale to improve outcomes for older people with acute care needs.…”

Section: Methodsmentioning

confidence: 99%

“…Consequently, many older people living with frailty are admitted to hospitals across the world with crises such as falls, fractures or delirium 9–11. Patient experience12 13 and outcomes following crisis admission to hospital are poor,10 13 with data from many countries showing high rates of inpatient harm, readmission (often relating to inadequate assessment and care during the index admission14–17) and institutionalisation 18–20…”

Section: Introductionmentioning

confidence: 99%

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Did the Acute Frailty Network improve outcomes for older people living with frailty? A staggered difference-in-difference panel event study

2023

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ObjectivesTo evaluate whether the Acute Frailty Network (AFN) was more effective than usual practice in supporting older people living with frailty to return home from hospital sooner and healthier.DesignStaggered difference-in-difference panel event study allowing for differential effects across intervention cohorts.SettingAll English National Health Service (NHS) acute hospital sites.ParticipantsAll 1 410 427 NHS patients aged 75+ with high frailty risk who had an emergency hospital admission to acute, general or geriatric medicine departments between 1 January 2012 and 31 March 2019.InterventionMembership of the AFN, a quality improvement collaborative designed to support acute hospitals in England deliver evidence-based care for older people with frailty. 66 hospital sites joined the AFN in six sequential cohorts, the first starting in January 2015, the sixth in May 2018. Usual care was delivered in the remaining 248 control sites.Main outcome measuresLength of hospital stay, in-hospital mortality, institutionalisation, hospital readmission.ResultsNo significant effects of AFN membership were found for any of the four outcomes nor were there significant effects for any individual cohort.ConclusionsTo realise its aims, the AFN might need to develop better resourced intervention and implementation strategies.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Did the Acute Frailty Network improve outcomes for older people living with frailty? A staggered difference-in-difference panel event study

2023

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“…Details of older adults’ discharge destinations reported in the included studies is provided in supplementary file 4 . Of the 10 studies, five studies did not put any constraint on cognitively impaired older adults being included in the study [ 27 – 29 , 31 , 35 ]. Eight studies recruited older adults with any diagnosis, one study recruited only those who had two or more chronic diseases [ 27 ] and one recruited only those with frailty [ 35 ].…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

“…Six of the 10 included studies reported experiences of older adults’ readmission to the ED shortly after being discharged to the community [ 28 , 31 – 33 , 35 , 36 ]. In one study older adults noted that they had greater trust in the care they received in the ED than the care they received from their own GP [ 32 ].…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Older adults experience of transition to the community from the emergency department: a qualitative evidence synthesis

Condon,

Griffin,

Fitzgerald

et al. 2024

BMC Geriatr

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Aim Older adults comprise a growing proportion of Emergency Department (ED) attendees and are vulnerable to adverse outcomes following an ED visit including ED reattendance within 30 days. Interventions to reduce older adults’ risk of adverse outcomes following an ED attendance are proliferating and often focus on improving the transition from the ED to the community. To optimise the effectiveness of interventions it is important to determine how older adults experience the transition from the ED to the community. This study aims to systematically review and synthesise qualitative studies reporting older adults’ experiences of transition to the community from the ED. Methods Six databases (Academic Search Complete, CINAHL, MEDLINE, PsycARTICLES, PsycINFO, and Social Science Full Text) were searched in March 2022 and 2023. A seven-step approach to meta-ethnography, as described by Noblit and Hare, was used to synthesise findings across included studies. The methodological quality of the included studies was appraised using the 10-item Critical Appraisal Skills Programme (CASP) checklist for qualitative research. A study protocol was registered on PROSPERO (Registration: CRD42022287990). Findings Ten studies were included, and synthesis led to the development of five themes. Unresolved symptoms reported by older adults on discharge impact their ability to manage at home (theme 1). Limited community services and unresolved symptoms drive early ED reattendance for some older adults (theme 2). Although older adults value practical support and assistance transporting home from the ED this is infrequently provided (theme 3). Accessible health information and interactions are important for understanding and self-managing health conditions on discharge from the ED (theme 4). Fragmented Care between ED and community is common, stressful and impacts on older adult’s ability to manage health conditions (theme 5). A line of argument synthesis integrated these themes into one overarching concept; after an ED visit older adults often struggle to manage changed, complex, health and care needs at home, in the absence of comprehensive support and guidance. Discussion/ conclusion Key areas for consideration in future service and intervention development are identified in this study; ED healthcare providers should adapt their communication to the needs of older adults, provide accessible information and explicitly address expectations about symptom resolution during discharge planning. Concurrently, community health services need to be responsive to older adults’ changed health and care needs after an ED visit to achieve care integration. Those developing transitional care interventions should consider older adults needs for integration of care, symptom management, clear communication and information from providers and desire to return to daily life.

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“…A PROM for this population and setting should measure the outcomes which users consider important. Recent qualitative research has consistently confirmed the holistic nature of acute healthcare outcome goals for older people living with frailty (7)(8)(9). Research to operationalize these goals toward measurement classified outcomes as "autonomy" (information, security, and control) and "function" (physical, psychosocial, and symptom relief) (10).…”

Section: Introductionmentioning

confidence: 98%

Co-creation of a Patient-Reported Outcome Measure for Older People Living with Frailty Receiving Acute Care (PROM-OPAC)

Oppen

Coats

Conroy

et al. 2023

Journal of Patient Experience

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Older people living with frailty emphasize autonomy and function as acute healthcare outcome goals. Existing Patient-Reported Outcome Measures (PROMs) measure function but do not comprehensively address autonomy. This initial development of a novel autonomy outcome measure used co-creation and cognitive interviews, working toward a PROM for Older People living with frailty receiving Acute Care (“PROM-OPAC”). Novel item question stems and responses considering autonomy were devised with lay research partners. Items were examined for content by lay volunteers, and then selected based on relevance, completeness, and accessibility. Retained items were cognitively tested with patient participants. Item selection considered content validity and feasibility and was undertaken collaboratively with lay research partners. The study involved 3 lay research partners and 4 further lay collaborators throughout all stages, and 14 patient participants were recruited for the cognitive interviews. Twenty-two novel items were appraised. Seven were selected for retention. This preliminary PROM-OPAC comprised 7 items to measure autonomy and was intended for administration alongside a function measure to capture meaningful acute healthcare outcomes. Development will continue with quantitative testing and validation.

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What are the goals of care for older people living with frailty when they access urgent care? Are those goals attained? A qualitative view of patient and carer perspectives

Cited by 18 publications

References 24 publications

Did the Acute Frailty Network improve outcomes for older people living with frailty? A staggered difference-in-difference panel event study

Did the Acute Frailty Network improve outcomes for older people living with frailty? A staggered difference-in-difference panel event study

Older adults experience of transition to the community from the emergency department: a qualitative evidence synthesis

Co-creation of a Patient-Reported Outcome Measure for Older People Living with Frailty Receiving Acute Care (PROM-OPAC)

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