Elderly Patients Perceptions of Care in Emergency Department n
Date First Published:
August 3, 2016
Last Updated:
August 11, 2016
Report by:
Chen Wen Ngua, Clinical Fellow (University Hospital of Wales)
Search checked by:
Ian Sammy, University Hospital of Wales
Three-Part Question:
In [elderly patients attending the Emergency Department (ED)], does [the experience of patients in the ED] correlate with [their expectations of the service provided]
Clinical Scenario:
An 80-year-old man presents to ED with a mechanical fall. He has sustained a minor head injury and complains of left hip pain. On further questioning, he had three recent falls in the past week. He mentions that he is not coping at home. Investigations reveal no evidence of intracranial injury or bony injury to the hip. You wonder if the service has met with his expectations, and dealt with the underlying problems he presented with.
Search Strategy:
Google Scholar interface on world wide web.
Pubmed interface on world wide web.
Pubmed interface on world wide web.
Search Details:
(((((((elderly OR geriatric OR older OR aged)) AND (satisfaction$ OR perception$ OR perspective$ OR experience$))) AND (("emergency department$" OR "emergency unit$" OR "emergency service$” OR prehospital OR ambulance$))) AND Humans[Mesh] AND English[lang])) AND (elderly[Title] OR geriatric[Title] OR older[Title])
Outcome:
144 papers of which 7 were relevant to the question posed.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Perceptions of emergency care by the elderly: results of multicenter focus group interviews Baraff, L. J., Bernstein, E., Bradley, K., Franken, C., Gerson, L. W., Hannegan, S. R., … Wolfson, a B. 1992 US | Five focus groups (each having five to 13 members, aged 65 or older who had received ED care in the past year) |
Qualitative study – Focus group interviews on elderly patients’ experiences during their visits to the ED with moderators asking open-ended questions pertaining to selected aspects of ED visit experience |
Staff Interactions | Negative comments centered on the process of communication of staff with patients | The focus groups were formed based on patients’ geographical limitations; most lived in care homes. Some of the visits to the ED were not recent. |
| ED Environment | Emergency departments were too cold and were not offered blankets | ||||
| Waiting Period | Participants reported that they spent a considerable amount of time in the ED, much of it waiting for care. However they understood as this was an unscheduled visit and that more critically ill patients are treated first | ||||
| Transportation | Trouble with transportation if they were not escorted. | ||||
| Elderly patients’ perceptions of care in the emergency department Watson, W. T., Marshall, E. S., & Fosbinder, D. 1999 US | 12 patients, aged 66 or older, who presented with conditions requiring immediate care, discharged within 2 hours of their ED arrival |
Qualitative descriptive study – interviews on elderly patients’ experiences during their visits to the ED |
Needs for information | Elderly patients want to be informed about their condition and the entire process of their care | Small sample size. Single center. |
| Waiting period | Majority felt the waiting time were too long. They wished to be informed about the reason they are waiting | ||||
| Perceptions of professional competence and caring service | 25% of them felt humour is an important component during communication to create a better rapport | ||||
| Factors associated with older patients’ satisfaction with care in an inner-city emergency department Nerney, M. P., Chin, M. H., Jin, L., Karrison, T. G., Walter, J., Mulliken, R.,Friedmann, P. D. 2001 US | 778 patients, aged 65 or older, who completed questionnaires during their presentation to an inner-city ED. |
Prospective Survey of older patients attending the ED– included questions on demographic characteristics, medical history, health related quality of life and a follow up satisfaction survey |
Overall rating of ED care on a 5-point Likert scale of “excellent”, “very good”, “good”, “fair”, or “poor | 40% “Excellent” 30% “Very good” 2% “Poor” | Single center. Many refused the questionnaires – potential selection bias |
| Older patients awaiting emergency department treatment Kihlgren, A. L., Nilsson, M., Skovdahl, K., Palmblad, B., & Wimo, A. 2004 Sweeden | 20 patients, aged 75 years or over who presented to the ED – observed and interviewed |
Prospective Qualitative study – Observation followed by interview. Observation focused on care given, accompanying relatives and the environment. Interviews were on older patients’ experiences in the ED, using open-ended questions. |
ED Settings | Participants felt there was a lack of privacy, and the beds were very hard and uncomfortable. | Small sample size. |
| Waiting Period | They felt abandoned during the waiting period and worried if the staffs had forgotten them. They also felt the waiting times were too long and they were not informed of the anticipated duration of the waiting times. They were afraid to leave the examination/waiting room to look for a toilet or a telephone as the doctor might come. | ||||
| Following the patient journey: Older persons’ experiences of emergency departments and discharge Richardson, S., Casey, M., & Hider, P. 2007 New Zealand | 82 patients, aged 80 years or over who presented to emergency departments and were likely to be admitted to one of the designated medical wards |
Mixed quantitative and qualitative methods, including an audit and interview Audit focused on assessing area workload and acuity in particular nursing-to-patient ratio at particular time and area Interviews were semi-structured with open-ended questions on the admission, transfer and discharge experience of patients |
Admission Process | Patients felt they were under informed regarding their admission, but they also appeared unconcerned about this. | Limited to patients that are admitted to specific medical wards. |
| Waiting Period | Despite long waiting times, the majority of patients showed acceptance of the situation and a rationalization of relative “need” which led to acquiescence | ||||
| Older peoples’ experience of accessing emergency care Considine, J., Smith, R., Hill, K., Weiland, T., Gannon, J., Behm, C., McCarthy, S. 2010 Australia | 27 patients, aged 65 years or over, from 3 EDs |
Prospective qualitative study – Observations and Interviews with patients or their carers on their experience of care provided in the ED |
Waiting Period | Some felt the waiting times were too long, especially the time spent on the ambulance trolley Others felt the wait was warranted as there were other patients who were more unwell | Small sample size. Interviews took into account current visits as well as previous visits to the ED |
| During and beyond the triage encounter: Chronically ill elderly patients’ experiences throughout their emergency department attendances Olofsson, P., Carlström, E. D., & Bäck-Pettersson, S. 2012 Sweeden | 14 patients, aged 70 years or over who had visited ED more than three times in the past 12 months |
Qualitative study - interviews using open-ended questions focusing on older patients’ experiences in the ED |
General experience | Sincere interest from the nurse during triage contributed to a respectful relationship A perceived lack of interest in patients contributed to frustration and disappointments | Small sample size. Questions asked were too general. No specific area of experience were examined. |
Author Commentary:
The above studies included 2 surveys, while the rest were qualitative studies, using semi-structured interviews, focus groups or observational techniques. Recurring themes emerged as part of elderly patients’ expectations during their visits to the emergency department. These included the need for more information regarding their diagnosis, investigations and reason for admission or discharge. While waiting times were also identified as an issue, older patients were more understanding in relation to this, if they knew what they are waiting for and were given an approximate estimate of how long they might have to wait.
Bottom Line:
These studies identified some of the expectations of older patients attending the ED. More work is needed to determine to what extent these expectations are being met and what interventions can be implemented to improve the experience of older patients in the ED.
References:
- Baraff, L. J., Bernstein, E., Bradley, K., Franken, C., Gerson, L. W., Hannegan, S. R., … Wolfson, a B. . Perceptions of emergency care by the elderly: results of multicenter focus group interviews
- Watson, W. T., Marshall, E. S., & Fosbinder, D.. Elderly patients’ perceptions of care in the emergency department
- Nerney, M. P., Chin, M. H., Jin, L., Karrison, T. G., Walter, J., Mulliken, R.,Friedmann, P. D. . Factors associated with older patients’ satisfaction with care in an inner-city emergency department
- Kihlgren, A. L., Nilsson, M., Skovdahl, K., Palmblad, B., & Wimo, A. . Older patients awaiting emergency department treatment
- Richardson, S., Casey, M., & Hider, P. . Following the patient journey: Older persons’ experiences of emergency departments and discharge
- Considine, J., Smith, R., Hill, K., Weiland, T., Gannon, J., Behm, C., McCarthy, S.. Older peoples’ experience of accessing emergency care
- Olofsson, P., Carlström, E. D., & Bäck-Pettersson, S.. During and beyond the triage encounter: Chronically ill elderly patients’ experiences throughout their emergency department attendances