Table 2

Older people’s healthcare expectations reported from prospective investigation

Study country pub type	Recruited population	Funding Appraisal tool and rating appraisal comments	Design	Outcome themes
Study country pub type	Recruited population	Funding Appraisal tool and rating appraisal comments	Design	Efficient and comprehensive care	Person-centred holistic care and information provision	Sensitivity towards vulnerability	Headline message
Arendts et al 19 Australia Journal—Primary	Before ED attendance n=414. Community care facility residents.	Australian Research Council MMAT—Quant desc *** Excluded significant proportion of target population (cognitive impairment).	Survey (discrete choice experiment).	Would be less satisfied with longer wait, when time spent alone, and with complications. More satisfied when symptoms relieved.			Context-specific but strong preference for ED transfer, with preferences for shorter waits, less time alone and higher symptom relief.
Goodridge and Stempien15 USA Journal—Primary	During attendance n=115. Patients >65 years triaged as non-urgent.	University of Saskatchewan MMAT—Qualitative **** Thematic construction presented with a small amount of evidence.	Interviews, inductive analysis.	Specialised care provision.		No accessible or available alternatives when conditions non-urgent. Attendances due to fear of illness.	Older people use the ED seeking comprehensive and accessible care.
Hunold et al 16 USA Journal—Primary	During attendance n=185. Patients aged >65 years.	MMAT—mixed *** Qualitative framework vague. Appropriate quantitative method	Response weight Interviews, framework analysis.	Elements of successful visit: evaluation and treatment, timely care, good service.	Elements of successful visit: communication.	Elements of successful visit: environment.	Patients prioritised directed and efficient assessment.
Majerovitz et al 17 USA Journal—Primary	During attendance n=71. Patients >60 >3 hours in ED, or carers.	MMAT—Quant desc **** Excluded cognitively impaired patients. Daytime recruitment.	Semi-structured interviews, framework analysis.		>50% patients with incomplete understanding of their condition and treatment. 40% carers dissatisfied with level of communication.	25% patients cited problems with personal care in the ED. 42% cited problems with the ED environment.	Older people want to be active patients, but often lack information about their condition or treatment.
Smith and Manfredi20 USA Conference abstract	During attendance n=248 OP>65 or caregivers.	MMAT—Quant desc ** Limited reporting of methods and implications.	Survey.		40% wanted to discuss advance directives with their doctor (only 7% were asked).	82% patients felt their ED provider should know about their end-of-life preferences.	Most older people want clinicians to be aware of their care preferences. Many are not asked about their wishes in the ED.
Stein-Parbury et al 18 Australia Journal—Primary	<1 month from discharge n=10 OP>65 accompanied by carer, living independently.	University of Technology, Sydney MMAT—Qualitative ***** Small and relatively limited sample. Rich data integrated.	Semi-structured interviews, interpretive analysis.	Expected to have their condition fully assessed and tested, and to receive a diagnosis.	Lack of communication regarding condition and processes within the ED. Carers cite the requirement to be assertive in advocacy.	Persistent or worsening symptom trajectory preceding ED attendance. ED commonly poorly accessible from car.	Older peoples’ and carers’ needs for information are often unmet.