You are here

Article Text

Article menu

Download PDFPDF

Systematic review
What older people want from emergency care: a systematic review
  1. https://twitter.com/J_vanOppenJames David van Oppen1,2,
  2. Lisa Keillor2,
  3. Áine Mitchell2,
  4. Timothy John Coats2,3,
  5. Simon Paul Conroy1
  1. 1 Department of Health Sciences, University of Leicester, Leicester, UK
  2. 2 Emergency Department, University Hospitals of Leicester NHS Trust, Leicester, UK
  3. 3 Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
  1. Correspondence to Dr James David van Oppen, Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK; jvo3{at}leicester.ac.uk

Abstract

Objectives To evaluate the expectations and preferred outcomes from emergency care among older people or their caregivers.

Methods A review protocol was registered. Medline, Embase, CINAHL, PsychInfo, BNI, AgeInfo and the Cochrane Database of Systematic Reviews were searched in their full date ranges to September 2018. Included articles were hand-searched for further citations. Citations were screened for (1) older people aged over 65 years, (2) ED settings and (3) reporting expectations or preferred outcomes for emergency care (as opposed to experience or satisfaction). Quality appraisal and data extraction of eligible articles were undertaken by two reviewers. Themes were synthesised through content analysis and described narratively.

Results Older people wished to have prompt waiting times, efficient care, clear communication and comfortable environments. They had additional and unique expectations for holistic care and support in decision-making. The ED provoked a sense of vulnerability among older people who were likely to have had frailty.

Conclusion The lack of dominant themes among included studies suggests that older people should be treated as individuals rather than a homogenous group. Establishing individuals’ preferred outcomes could improve person-centred care.

PROSPERO registration number CRD42018107050.

  • emergency department
  • aged
  • geriatrics
  • frailty
  • quality

https://doi.org/10.1136/emermed-2019-208589

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    What this paper adds

    What is already known on this subject?

    • Patients’ healthcare expectations influence their subsequent experience and satisfaction. Understanding these could support individualised and person-centred care.

    • Previous reviews have reported the majority of ED patients to prioritise communication and timeliness above other aspects of care.

    • Older people have specific and complex needs that may be poorly served in fast-flowing EDs; they may have unique expectations for their healthcare and concerns about being in the ED.

    What this study adds?

    • This systematic review of both qualitative and quantitative studies demonstrates that like, younger patients, older people want efficient, comfortable, and informative ED care.

    • Older patients feel vulnerable in the ED and hope to receive holistic care and to be supported and involved in decision-making.

    Background

    Systematic reviews investigating emergency care experiences and satisfaction find that patients consider informative and compassionate communication and relief of pain to be the fundamentally important elements of ED care.1–3 Experience and satisfaction are influenced by patients’ expectations, which can be subdivided to health outcome goals, healthcare preferences and health priorities.4

    Healthcare preferences can be difficult to explore, with recall bias, evolving or changing perspectives over time, and fears of jeopardising treatment presenting methodological challenges. Due to their higher prevalence of cognitive impairment and communication barriers, these perspectives may be even harder to obtain from older people and particularly those living with frailty, who are among the most vulnerable of ED users.5 These people often have non-specific illness presentations and complex physical, psychological and social needs, which may be poorly served by fast-flowing ED care. There is some evidence that older people may respond better to interventions based on communication and elicitation of their priorities for multidisciplinary care rather than to technological innovation.6 7

    Patient satisfaction improves when professionals understand their patients’ expectations.8 Expectations among a cohort of predominantly younger ED patients included timeliness, cleanliness and communication above many other aspects of care.9 There is less research reporting expectations for emergency care among older people and their carers.10 Those living with frailty are known to have poorer outcomes from acute care,11 and so may well have specific concerns and expectations. Understanding these could facilitate an individualised and tailored approach to person-centred care for older people.

    This review summarises published evidence for expectations and preferred outcomes from ED care among older people.

    Methods

    Search strategy

    The full protocol was registered with PROSPERO. The search strategy was informed by a review of reviews in the field and the assistance of a medical librarian. The full date ranges of the Cochrane Database of Systematic Reviews, Medline, Embase, CINAHL, PsycInfo, BNI and AgeInfo databases were searched with exploded MeSH headings and relevant keywords, restricted to English language. Search terms were adjusted for each database; indicative terms are presented in online supplementary appendix 1. Databases were searched from inception to 20 September 2018, and references were managed using Endnote software. The reference lists of included full-texts were hand-searched for additional papers.

    Supplemental material

    Eligibility

    Duplicate articles were removed. One reviewer (JvO) screened all titles and abstracts, and then identified eligible full texts using predefined inclusion criteria (table 1). The outcome of interest was healthcare expectations, which were defined as the preferred outcomes that older people hoped to gain during their ED attendance. Where these could be inferred from the later perceptions of experience and satisfaction (respectively occurring during or after ED attendance), these studies were included. We excluded systematic reviews, having completed a preparatory review of reviews.

    View this table:
    Table 1

    Inclusion and exclusion criteria

    A 25% random sample of citations were screened by a second reviewer (LK); Cohen’s kappa statistic was calculated for inter-rater reliability.

    LK second-screened all identified full texts. Cohen’s kappa statistic was again calculated, and disagreements resolved through consensus with a third reviewer (AM). Reasons were recorded for exclusion of ineligible articles at the full-text stage online supplementary appendix 2.

    We deviated from our protocol, in which we stated that we would include only those studies with participants who had frailty as defined by clinical judgement or scoring tool. We found no articles which codified frailty in-keeping with recent developments in emergency medicine, for example, by using the Clinical Frailty Score. The majority of studies used age as a pragmatic eligibility criterion, while some recruited patients with proxy markers of frailty including multiple comorbidities, frequent ED attendances or residence in a care home. Up to a quarter of participants could be expected to have had frailty,12 although the proportion may be under-represented in these studies that mainly excluded patients with cognitive impairment.

    Quality appraisal

    Quantitative and qualitative full-texts were appraised by two reviewers using the mixed-methods appraisal tool.13

    Data extraction and synthesis

    Two reviewers independently extracted data from each article into a standardised form online supplementary appendix 3. Qualitative content analysis was undertaken,14 by assigning and categorising identifiers to text instances in the manuscripts. Categories were grouped and reviewed until themes emerged among people’s reported perceptions, which the reviewers then discussed until consensus was reached. A meta-analysis was not planned; the reviewers were familiar with recent literature and anticipated identifying qualitative studies or heterogeneous quantitative methods.

    Results

    Study selection

    Following deduplication, 7233 citations were identified from database searches. Seven thousand one hundred and thirty-five articles were excluded during title and abstract screening (Figure 1). Of 98 full-texts, 16 were excluded for ineligible populations, 6 for non-ED settings and 23 (predominantly conference proceedings) had ineligible publication type or insufficient data for extraction and appraisal. Healthcare expectations were not established in 27 papers. Hand-searching reference lists of eligible manuscripts yielded 25 further citations, although none satisfied criteria for inclusion. Inter-rater agreement for citation exclusion in the 25% sample was perfect (k=1). Agreement for full text exclusion was also strong (k=0.83).

    Figure 1
    Figure 1

    Study selection flowchart.

    Overview of included studies

    Twenty-six papers published between 1992 and 2018 were included. There were no studies of older people attending hospitals in Africa, Asia and South America. Six studies prospectively explored older patients’ expectations for emergency care (table 2). Four used qualitative interview methods15–18 and two analysed interview or survey data quantitatively.19 20 Healthcare preferences were determined from 20 further papers (reporting 19 studies) which had experience-based or satisfaction-based outcomes (table 3). For example, older people reporting feeling controlled and ignored21 was interpreted as their preference to be included in decision-making processes. Researchers used qualitative interviews21–32 and focus groups,33–35 quantitative analyses of survey36–38 and interview data,39 and a mixed-methods study of audit and interview data.40 Sample sizes ranged from 729 to 2115,36 with a total sample of 5116 participants.

    View this table:
    Table 2

    Older people’s healthcare expectations reported from prospective investigation

    View this table:
    Table 3

    Expectations inferred from reported experience or satisfaction

    Quality appraisal of included studies

    No studies were excluded based on quality assessment. Star ratings (tables 2 and 3) indicate whether MMAT criteria were reported; emphasis during synthesis reflected the rationale behind studies’ quality ratings and whether they directly reported preferred healthcare outcomes. Quality appraisal was limited by some studies’ availability only as conference abstracts.20 31 34 35

    In five of six studies which directly explored preferred outcomes, data collection was carried out within 1 month of the ED attendance. Arendts et al 19 surveyed the expectations of care home residents who had not necessarily received emergency care, potentially reducing the recall bias introduced by subsequent experiences. Of these studies, those graded as stronger presented justifying evidence for their thematic construction,15 17 18 whereas weaker gradings were assigned to studies with limited reporting of their methods, qualitative framework, or outcomes and implications.16 20 Most of these studies excluded patients with significant cognitive impairment,15–19 limiting generalisability to many older people with frailty.

    Of 20 papers where expectations were derived from context, 6 ensured representation of people with impaired capacity by including consultees,23 28 35 38 39 while 4 studies excluded patients with cognitive impairment.21 33 37 40 The stronger studies in this group again integrated data supporting the researchers’ observations,21–23 while others had small or restricted samples25 26 28 29 36 or significant lead-time following ED attendance.27 33

    Synthesis: older people’s preferred outcomes for emergency care

    The frequency of themes among included studies (table 4) shows that older people did not report one single dominant set of preferred outcomes. Rather, various expectations were found by researchers in different study populations in different settings. Perceived expectations for care may vary with people’s health context and the urgency of their condition. The heterogeneity in our results reiterates the need to treat older people as individuals rather than as a uniform group.

    View this table:
    Table 4

    Explored themes of older people’s preferred outcomes

    Efficient and comprehensive care

    Older people and their carers wanted a comprehensive and easily accessible ED service.15 18 They reported negative perspectives when care was rushed or lacked a holistic approach.30 35 While people often accepted long waiting times15 and made concessions for busy staff,18 they wanted regular updates and explanations for delays.17 32 If the reasons for longer waits were not explained, subsequent satisfaction was reduced.19 38 Two studies reported that older people expected to be fully assessed, investigated and to receive an accurate diagnosis.16 18

    Older people attending with trauma valued a holistic approach to care, prioritising the management of their chronic conditions and transitions between care providers in addition to being able to return to their preinjury baseline.31

    Sensitivity towards vulnerability

    Those older people who were likely to have had frailty were afraid of being alone in the ED.19 They were afraid of their illness15 and of losing independence,34 and felt that they had nowhere else to seek care.15 Older people wanted ED staff to take time to explain the likely trajectory of illness, and to use reassurance, courtesy and humour during interactions.17 18 32 They expected their clinician to be aware of their advance directives and preferences for end of life care, and wanted to discuss these in the ED.20

    Older people and their carers expected a suitable physical environment for care during their attendance.27 28 They noted the importance of providing for physical needs17 18 32 37 39 such as comfortable trolleys or beds, dimming lights, toileting, access to food and drink, and orientation around the department. Carers were clear that EDs should provide adequate staffing and an optimised environment for basic nursing care, specifically suggesting treating older people in a separate space away from the noisy and busy general ED.27

    ​Person- (and family-) centred holistic care and information provision

    Older people expected consideration of their personal healthcare priorities. These included relief of symptoms (in particular of pain)19 38 39 and improving their quality of life.34

    Older people generally wished to take an active role in decision-making but may have lacked the necessary information or understanding.17 18 Insufficient or poorly-understood explanations about diagnosis or discharge were associated with older people feeling less satisfied with their care.39 One study suggested that older people experienced different treatment in healthcare discussions because of their age or frailty: individuals with indications for intensive care transfer were rarely asked for their opinions about admission, and were less likely to be asked if they had cognitive impairment.36 Patients can only be involved in decision-making if professionals consider their views38; this may require common communication barriers to be overcome, which include visual or hearing problems, cognitive impairment and language.1

    Carers also wanted to receive more information and be actively involved in healthcare discussions.18 27 28 Familiar caregivers’ or relatives’ presence in the ED was important to both older patients and their carers alike.28 Encouraging family presence can improve interaction,33 as they may act as patient advocates18 40 or help to overcome some of a person’s communication barriers.

    Discussion

    Older people’s healthcare preferences included efficiency, information provision and environmental comfort; these concepts feature as National Patient Survey Programme domains and would appear valid among older people. Clear communication and explanation were also expected.3 The included studies did not, however, report an expectation for plain language. This is in contrast with research in younger populations,9 perhaps reflecting older people’s familiarity with medical conditions. Older people wanted short waiting times, but also appeared resilient and tolerated (and perhaps expected) longer waits—particularly if delays were explained.32 33

    Older people had some unique healthcare expectations. These were more common in studies that included people with stereotypical markers of frailty, although the available evidence did not specifically stratify frail populations. Older people who were more likely to be frail had health outcome goals of symptom relief and return to premorbid baseline. They felt vulnerable, anxious and wanted reassurance in the ED. They were afraid of the uncertain trajectory of their illness, and of symptoms such as pain. They also feared being ignored by healthcare professionals, and needed supporting as active participants in care. To our knowledge, studies in younger populations have not identified these themes.

    Strengths and limitations

    We used a qualitative systematic review approach to integrate patients’ views and perceptions into communicable themes. The risk of neglecting primary literature articles was minimised by searching multiple databases. Although three-quarters of citations were initially screened by only one reviewer, there was strong inter-rater agreement for the double-screened sample and full-texts.

    We assigned greater focus to those studies which directly evaluated preferred healthcare outcomes. Findings are limited by the different objectives and methods of different research groups, and are limited to those perceptions which have been captured in literature reports. Extrapolation of expectations from patients’ experiences should be interpreted cautiously.

    None of the studies of older people’s expectations for emergency care used a validated frailty assessment method as a recruitment inclusion criterion or to stratify outcomes. We therefore deviated from our protocol and included study populations based on age alone. Some studies included participants who had attributes stereotypically associated with frailty, including multiple comorbidities, residence in a care home, or frequent use of emergency care. Most excluded individuals who had cognitive impairment, so our findings may not be generalisable to that significant proportion of older people. Prospective investigation of the views of people living with frailty, and comparison of healthcare expectations between older and younger people is warranted to confirm our findings.

    Summary and implications for practice

    Few studies have investigated expectations of treatment and concerns among older people receiving emergency care. There is no evidence about whether the presence or degree of frailty alters older people’s expectations for emergency care. There was substantial heterogeneity in the approaches employed. Research was predominantly qualitative, and of limited methodological quality. There was no single dominant set of expectations apparent from our analysis. Recurring themes gave some indication that older people receiving emergency care had health outcome goals of symptom-relief and return to premorbid baseline. Healthcare preferences included active communication, involvement in decision-making, inclusion of familiar caregivers and holistic approaches that minimise their sense of vulnerability.

    Systems developing geriatric emergency medicine services will wish to support better person-centred care. Partnered healthcare (the involvement of consumers in shared decision-making) includes understanding and planning delivery of patients’ preferred healthcare outcomes. Patient-reported outcomes measures (PROMs) can capture these outcomes of interest and can be a powerful mechanism to change practice and focus care on that which is most important to patients. At the individual patient level, PROMs can drive improvements in diagnosis, communication and prioritisation of needs.41 At the population level, PROMs can be used for research, benchmarking and fed-back to providers to inform service improvements. There is no existing evidence-based outcome measure for older people with urgent care needs. Our review confirms the importance of establishing the needs of individual people rather than the ‘older patients’ group.

    Acknowledgments

    The authors thank Dr Mary Edmunds Otter (University of Leicester) and Dr Louise Preston (University of Sheffield) for methodological advice.

    References

    1. ↵
      2. Shankar KN ,
      3. Bhatia BK ,
      4. Schuur JD
      . Toward patient-centered care: a systematic review of older adults’ views of quality emergency care. Ann Emerg Med 2014;63:529–50.doi:10.1016/j.annemergmed.2013.07.509
      OpenUrlCrossRefPubMed
    2. ↵
      2. Hoon LS ,
      3. Mackey S ,
      4. Hong-Gu H
      . Elderly patients’ experiences of care received in the emergency department: a systematic review. JBI Libr Syst Rev 2012;10:1363–409.doi:10.11124/jbisrir-2012-52
      OpenUrl
    3. ↵
      2. Gordon J ,
      3. Sheppard LA ,
      4. Anaf S
      . The patient experience in the emergency department: a systematic synthesis of qualitative research. Int Emerg Nurs 2010;18:80–8.doi:10.1016/j.ienj.2009.05.004
      OpenUrlCrossRefPubMed
    4. ↵
      2. Naik AD ,
      3. Dindo LN ,
      4. Van Liew JR , et al
      . Development of a clinically feasible process for identifying individual health priorities. J Am Geriatr Soc 2018;66:1872–9.doi:10.1111/jgs.15437
      OpenUrl
    5. ↵
      2. Banerjee J ,
      3. Conroy S ,
      4. Cooke MW
      . Quality care for older people with urgent and emergency care needs in UK emergency departments. Emerg Med J 2013;30:699–700.doi:10.1136/emermed-2012-202080
      OpenUrlFREE Full Text
    6. ↵
      2. Hogan TM ,
      3. Malsch A
      . Communication strategies for better care of older individuals in the emergency department. Clin Geriatr Med 2018;34:387–97.doi:10.1016/j.cger.2018.04.004
      OpenUrl
    7. ↵
      2. Blaum CS ,
      3. Rosen J ,
      4. Naik AD , et al
      . Feasibility of implementing patient priorities care for older adults with multiple chronic conditions. J Am Geriatr Soc 2018;66:2009–16.doi:10.1111/jgs.15465
      OpenUrl
    8. ↵
      2. Curran J ,
      3. Cassidy C ,
      4. Chiasson D , et al
      . Patient and caregiver expectations of emergency department care: a scoping literature review. Int Emerg Nurs 2017;32:62–9.doi:10.1016/j.ienj.2016.07.001
      OpenUrl
    9. ↵
      2. Cooke T ,
      3. Watt D ,
      4. Wertzler W , et al
      . Patient expectations of emergency department care: phase II – a cross-sectional survey. CJEM 2006;8:148–57.doi:10.1017/S1481803500013658
      OpenUrlPubMed
    10. ↵
      2. Melady D
      . Geriatric emergency medicine: Research priorities to respond to ‘The Silver Boom’. CJEM 2018;20:327–8.doi:10.1017/cem.2018.397
      OpenUrl
    11. ↵
      2. Keeble E ,
      3. Roberts HC ,
      4. Williams CD , et al
      . Outcomes of hospital admissions among frail older people: a 2-year cohort study. Br J Gen Pract 2019;69:e555–60.doi:10.3399/bjgp19X704621
      OpenUrlAbstract/FREE Full Text
    12. ↵
      2. Clegg A ,
      3. Young J ,
      4. Iliffe S , et al
      . Frailty in elderly people. Lancet 2013;381:752–62.doi:10.1016/S0140-6736(12)62167-9
      OpenUrlCrossRefPubMedWeb of Science
    13. ↵
      2. Hong Q ,
      3. Pluye P ,
      4. FbreguesS , et al
      . Mixed methods appraisal tool (MMAT), version 2018. Industry Canada: Canadian Intellectual Property Office, 2018.
    14. ↵
      2. Elo S ,
      3. Kyngäs H
      . The qualitative content analysis process. J Adv Nurs 2008;62:107–15.doi:10.1111/j.1365-2648.2007.04569.x
      OpenUrlCrossRefPubMedWeb of Science
    15. ↵
      2. Goodridge D ,
      3. Stempien J
      . Understanding why older adults choose to seek non-urgent care in the emergency department: the patient's perspective. CJEM 2019;21:243–8.doi:10.1017/cem.2018.378
      OpenUrl
    16. ↵
      2. Hunold KM ,
      3. Pereira GF ,
      4. Jones CW , et al
      . Priorities of care among older adults in the emergency department: a cross-sectional study. Acad Emerg Med 2016;23:362–5.doi:10.1111/acem.12885
      OpenUrl
    17. ↵
      2. Majerovitz SD ,
      3. Greene MG ,
      4. Adelman RD , et al
      . Older patients' understanding of medical information in the emergency department. Health Commun 1997;9:237–51.doi:10.1207/s15327027hc0903_3
      OpenUrl
    18. ↵
      2. Stein-Parbury J ,
      3. Gallagher R ,
      4. Fry M , et al
      . Expectations and experiences of older people and their carers in relation to emergency department arrival and care: a qualitative study in Australia. Nurs Health Sci 2015;17:476–82.doi:10.1111/nhs.12220
      OpenUrl
    19. ↵
      2. Arendts G ,
      3. Jan S ,
      4. Beck MJ , et al
      . Preferences for the emergency department or alternatives for older people in aged care: a discrete choice experiment. Age Ageing 2017;46:124–9.doi:10.1093/ageing/afw163
      OpenUrl
    20. ↵
      2. Smith A ,
      3. Manfredi RA ,
      4. Gharehdaghi P , et al
      . Care conundrum in the emergency department: the gap between clinician awareness and patient expectations about advance directives. Acad Emerg Med 2017;24.
    21. ↵
      2. Bridges J ,
      3. Nugus P
      . Dignity and significance in urgent care: older people’s experiences. J Res Nurs 2010;15:43–53.doi:10.1177/1744987109353522
      OpenUrl
    22. ↵
      2. Considine J ,
      3. Smith R ,
      4. Hill K , et al
      . Older peoples’ experience of accessing emergency care. Aust Emer Nurs J 2010;13:61–9.doi:10.1016/j.aenj.2010.05.001
      OpenUrl
    23. ↵
      2. Kihlgren AL ,
      3. Nilsson M ,
      4. Skovdahl K , et al
      . Older patients awaiting emergency department treatment. Scand J Caring Sci 2004;18:169–76.doi:10.1111/j.1471-6712.2004.00266.x
      OpenUrlCrossRefPubMedWeb of Science
    24. ↵
      2. Lyons I ,
      3. Paterson R
      . Experiences of older people in emergency care settings. Emerg Nurse 2009;16:26–31.doi:10.7748/en2009.03.16.10.26.c6851
      OpenUrlPubMed
    25. ↵
      2. Meyer J ,
      3. Bridges J ,
      4. Spilsbury K
      . Caring for older people in acute settings: lessons learned from an action research study in accident and emergency. NT Research 1999;4:327–39.doi:10.1177/136140969900400503
      OpenUrl
    26. ↵
      2. Spilsbury K ,
      3. Meyer J ,
      4. Bridges J , et al
      . Older adults' experiences of A&E care. Emerg Nurse 1999;7:24–31.doi:10.7748/en1999.10.7.6.24.c1296
      OpenUrlPubMed
    27. ↵
      2. Morphet J ,
      3. Decker K ,
      4. Crawford K , et al
      . Aged care residents in the emergency department: the experiences of relatives. J Clin Nurs 2015;24:3647–53.doi:10.1111/jocn.12954
      OpenUrl
    28. ↵
      2. Nikki L ,
      3. Lepistö S ,
      4. Paavilainen E
      . Experiences of family members of elderly patients in the emergency department: a qualitative study. Int Emerg Nurs 2012;20:193–200.doi:10.1016/j.ienj.2012.08.003
      OpenUrlPubMed
    29. ↵
      2. Nydén K ,
      3. Petersson M ,
      4. Nyström M
      . Unsatisfied basic needs of older patients in emergency care environments - obstacles to an active role in decision making. J Clin Nurs 2003;12:268–74.doi:10.1046/j.1365-2702.2003.00737.x
      OpenUrlCrossRefPubMedWeb of Science
    30. ↵
      2. Olofsson P ,
      3. Carlström ED ,
      4. Bäck-Pettersson S
      . During and beyond the triage encounter: chronically ill elderly patients’ experiences throughout their emergency department attendances. Int Emerg Nurs 2012;20:207–13.doi:10.1016/j.ienj.2012.03.006
      OpenUrlPubMed
    31. ↵
      2. Padrez KA ,
      3. Carr BG ,
      4. Delgado MK , et al
      . 220 improving care for injured older adults: a qualitative study of providers and patients. Ann Emerg Med 2014;64:S79.doi:10.1016/j.annemergmed.2014.07.247
    32. ↵
      2. Watson WT ,
      3. Marshall ES ,
      4. Fosbinder D
      . Elderly patients' perceptions of care in the emergency department. J Emerg Nurs 1999;25:88–92.doi:10.1016/S0099-1767(99)70152-2
      OpenUrlCrossRefPubMed
    33. ↵
      2. Baraff LJ ,
      3. Bernstein E ,
      4. Bradley K , et al
      . Perceptions of emergency care by the elderly: results of multicenter focus group interviews. Ann Emerg Med 1992;21:814–8.doi:10.1016/S0196-0644(05)81027-3
      OpenUrlCrossRefPubMed
    34. ↵
      2. Dresden SM ,
      3. McCarthy DM ,
      4. Engel KG , et al
      . 214 GEDI WISE: Geriatric Emergency Department Patients’ Priorities for Health-Related Quality of Life - A Qualitative Study. Ann Emerg Med 2014;64:S77.doi:10.1016/j.annemergmed.2014.07.241
    35. ↵
      2. Lawlor G ,
      3. O'Keeffe J ,
      4. Carey T , et al
      . Older people’s experience of using an emergency department. Irish Journal of Medical Science 2011;180:S349.
    36. ↵
      2. Le Guen J ,
      3. Boumendil A ,
      4. Guidet B , et al
      . Are elderly patients’ opinions sought before admission to an intensive care unit? results of the ICE-CUB study. Age Ageing 2016;45:303–9.doi:10.1093/ageing/afv191
      OpenUrlCrossRefPubMed
    37. ↵
      2. Liu B ,
      3. Taylor DM ,
      4. Ling SL-Y , et al
      . Non-medical needs of older patients in the emergency department. Australas J Ageing 2016;35:174–9.doi:10.1111/ajag.12265
      OpenUrl
    38. ↵
      2. Nerney MP ,
      3. Chin MH ,
      4. Jin L , et al
      . Factors associated with older patients’ satisfaction with care in an inner-city emergency department. Ann Emerg Med 2001;38:140–5.doi:10.1067/mem.2001.114304
      OpenUrlCrossRefPubMedWeb of Science
    39. ↵
      2. McCusker J ,
      3. Cetin-Sahin D ,
      4. Cossette S , et al
      . How Older Adults Experience an Emergency Department Visit: Development and Validation of Measures. Ann Emerg Med 2018;71:755–66.doi:10.1016/j.annemergmed.2018.01.009
      OpenUrl
    40. ↵
      2. Richardson S ,
      3. Casey M ,
      4. Hider P
      . Following the patient journey: older persons' experiences of emergency departments and discharge. Accid Emerg Nurs 2007;15:134–40.doi:10.1016/j.aaen.2007.05.004
      OpenUrlCrossRefPubMed
    41. ↵
      2. Marshall S ,
      3. Haywood K ,
      4. Fitzpatrick R
      . Impact of patient-reported outcome measures on routine practice: a structured review. J Eval Clin Pract 2006;12:559–68.doi:10.1111/j.1365-2753.2006.00650.x
      OpenUrlCrossRefPubMedWeb of Science

    Footnotes

    • Contributors JDvO and SPC planned the review. JDvO, LK and AM extracted and analysed data. All authors contributed to the narrative synthesis and manuscript drafting.

    • Funding JDvO was supported by an NIHR Academic Clinical Fellowship. LK and AM were Geriatric Emergency Medicine Fellows at University Hospitals of Leicester NHS Trust.

    • Disclaimer The funders had no role in this review.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.