Article Text
Abstract
Background Little is known about how frailty impacts on older people’s experiences of emergency care, despite patient experience being essential to providing person-centred care. This qualitative study reports on the experiences of older people with frailty in the ED and their and their carers’ preferences for emergency care.
Methods Older people (aged 75+ years) who were at least mildly frail and/or their carers, with current or recent experience of emergency care, were recruited from three EDs in England between January and June 2019. Data were collected via semi-structured in-depth interviews which explored participants’ views on their recent experience of emergency care and their priorities and preferred outcomes. Interviews were audio-recorded, transcribed verbatim and analysed following the principles of the Framework approach.
Results Forty participants were interviewed: 24 patients and 16 carers who, between them, described ED attendances for 28 patients across the three sites. Often informed by previous negative experiences, there was a strong desire to avoid conveyance to EDs, and a sense of helplessness or acquiescence to attend. Although staff attitudes were on the whole seen as positive, the ED experience was dominated by negative experiences relating to very basic issues such as a lack of help with eating, drinking, toileting and discomfort from long waits on hard trolleys. Participants reported that communication and involvement in decision making could be improved, including involving next of kin, who were viewed as critical to supporting vulnerable older people during sometimes very protracted waits.
Conclusion Frailty reflects a vulnerability and a need for support in basic activities of daily living, which EDs in this study, and perhaps more widely, are not set up to provide. Changes at the levels of clinical practice and service design are required to deliver even the most basic care for older people with frailty in the ED environment.
- frailty
- qualitative research
- emergency care systems
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. The quotes (data) are included in the text, but the transcripts are not available given the risk of breach of confidentiality.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. The quotes (data) are included in the text, but the transcripts are not available given the risk of breach of confidentiality.
Footnotes
Handling editor Mary Dawood
Twitter @J_vanOppen, @ProfSueMason
Contributors SC conceived the original idea for the study and secured funding. SC, ER, KP, JDvO, PR and JL contributed to the protocol. Recruitment of study participants was undertaken by the following staff: MA and (Nottingham), LM, JW, VW, AD and TC (Leicester) and the team at Kettering. ER ad KP undertook the interviews and led data analysis supported by SC, JDvO, PR and JL. ER drafted the manuscript and all authors contributed substantially to its development and revision. SC is the guarantor for the study.
Funding This research was funded by the National Institute for Health Research, Health Services and Delivery Research (17/05/96).
Disclaimer The views expressed are those of the author(s) and not necessarily of the NIHR or the Department of Health and Social Care.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the 'Methods' section for further details.
Provenance and peer review Not commissioned; externally peer reviewed.
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