A qualitative study of emergency physicians’ perspective on the emergency journey of older patients

The rapid increase in the global population of older adults has created a growing workload demand on emergency services as the older population poses special clinical and workflow difficulties for staff compared to younger patients. The present study is a qualitative one that examines emergency physicians with respect to their experiences with older patients throughout their emergency service care. We interviewed 16 emergency medicine specialists employed by a tertiary hospital by means of a semi-structured questionnaire and then analyzed the obtained data using thematic content analysis. We detected four main themes: (1) the equilibrium between patient age and frailty during triage decisions (2), difficulties surrounding patient communication and history (information) taken from the patients (3), diagnostic versatility, and (4) management and successive stages of patient care. According to physicians, frailty was more important in determining the urgency of a patient’s clinical presentation than his/her age. Difficulties in communication complicated physical examination, and atypical signs and symptoms commonly caused more tests and imaging modalities to be ordered, likely stemming from concerns surrounding patient safety and medico-legal liability. Treatments for older adults were administered on an individual basis, taking into consideration potential organ dysfunction, tailoring medication and fluid doses for individual patients. Hospitalization rates were higher among older patients when a lack of social support was perceived. Although the results of the present study stress the important upsides of the decision-making process in acute care, they also determined important shortcomings regarding the planning of transition-of-care and long-term management plans for the older patients. The findings of the present study suggest that there is a need to establish emergency medicine practices benefiting aged people, communication protocols with a structured hierarchy, collaboration between different disciplines, and political action to take social factors into consideration while implementing clinical decision-making processes.