Older patients’ perspectives on factors contributing to frequent visits to the emergency department: a qualitative interview study

Abstract

Background Older patients are at high risk of unplanned revisits to the emergency department (ED) because of their medical complexity. To reduce the number of ED visits, we need more knowledge about the patient-level, environmental, and healthcare factors involved. The aim of this study was to describe older patients’ perspectives and experiences before and after an ED visit, and to identify factors that possibly contribute to frequent ED revisits. Methods This was a qualitative description study. We performed semi-structured individual interviews with older patients who frequently visited the ED and were discharged home after an acute visit. Patients were enrolled in the ED of a university medical centre using purposive sampling. Interviews were recorded, transcribed, and coded independently by two researchers. Theoretical analysis was used to identify recurring patterns and themes in the data. Interviews were conducted until thematic saturation was reached. Results In-depth interviews were completed with 13 older patients. Three main themes emerged: 1) medical events leading to feelings of crisis, 2) patients’ untreated health problems, and 3) persistent problems in health and daily functioning post discharge. Participants identified problems before and after their ED visit that possibly contributed to further ED visits. These problems included increasing symptoms leading to feelings of crisis, the relationship with the general practitioner, incomplete discharge information at the ED, and inadequate follow-up and lack of recovery after an ED visit. Conclusions This qualitative study identified multiple factors that may contribute to frequent ED visits among older patients. Older patients in need of acute care might benefit from hospital-at-home interventions, or acute care provided by geriatric emergency teams in the primary care setting. Identifying frailty in the ED is needed to improve discharge communication and adequate follow-up is needed to improve recovery after an acute ED visit.

Emergency department‐to‐community care transition barriers: A qualitative study of older adults

“…Our work builds upon the extant literature by elucidating salient and generalizable barriers experienced by older adults experiencing ED‐to‐community care transitions. Prior qualitative research has relied on staff perceptions of older adults, 30 focused on modifiable reasons for ED utilization rather than ED‐to‐community care transitions, 31 or assessed the implementation of a specific program targeting a specific population 32 . Furthermore, prior research has identified barriers to successful ED‐to‐community care transitions across all ages, 33 with emphasis placed specifically on follow‐up compliance, ED navigators, and telephone calls, and the last being similarly called upon by older adults in this work.…”

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

“…It was probably my own insecurity, I was confused, and I just did not remember things well. That was really disturbing and worrying” [ 32 ].…”

“…I do not see any progression in my recovery and I expected that. Because, until now...so far things are not so positive” [ 32 ].…”

Older Adult Patients in the Emergency Department: Which Patients should be Selected for a Different Approach?

“…This is reflected in the hospitalization, return rates, and deaths in older adults compared with those in younger patients. Approximately 10%–23% of older patients return unexpectedly within the first month, 14 ) and up to 25% of older adults return to the ED within 3 months. 11 ) Within 3 months of discharge, 12.4% of the older patients die, 18.3% are hospitalized, and 2.6% subsequently enter a nursing home.…”