Need assessment for palliative and supportive care and associated factors among older adults in the emergency department

Palliative and supportive care (PSC) improves quality of life for patients with life-limiting illnesses, yet over 60% of hospitalized patients have unmet PSC needs and only 14% of those who need it receive appropriate care. Iran’s rapidly aging population is projected to reach 31.4 million older adults by 2050, increasing the burden of chronic conditions. The emergency department (ED) serves as a critical setting for identifying older adults with PSC needs; however, underrecognition, time constraints, and lack of screening protocols hinder timely care. Evidence on PSC needs among older Iranian ED patients remains limited. This study aimed to assess PSC needs and identify associated factors among Iranian older adults admitted to ED. This descriptive cross-sectional study was conducted from March to June 2024 in the emergency department of Shahid Beheshti Hospital, Kashan, Iran. Convenience sampling enrolled 366 hospitalized older adults (≥ 65 years) with at least one chronic disease. Data were collected using a demographic/clinical questionnaire and the Persian-translated SPICT™, administered by the main researcher. Data analysis was conducted using SPSS version 26. Multivariable binary logistic regression was used to identify factors associated with PAC needs. PLS-SEM was also performed for the formative measurement model of the SPICT. Of the 387 older adults, 73.4% were identified as having palliative and supportive care needs. Most participants were aged 65–74 years (73.4%), male (59.2%), and living with a spouse (81.4%), while 67.4% had multiple underlying diseases. In multivariable logistic regression analysis, a higher number of hospitalizations during the previous year (OR = 4.35, 95% CI: 3.43–5.51; P = 0.001), multiple underlying diseases (OR = 8.43, 95% CI: 5.15–13.78; P = 0.003), and cardiopulmonary conditions (OR = 6.73, 95% CI: 4.13–10.96; P = 0.010) were significantly associated with higher odds of palliative and supportive care needs. A significant proportion of hospitalized older adults required palliative and supportive care, particularly those with multimorbidity, frequent hospitalizations, and cardiopulmonary conditions. Despite clinical overlap among these factors, they can serve as practical screening triggers when used in combination. The absence of sociodemographic associations supports clinical indicator-based screening, though type II error cannot be excluded. Given the single-center design and convenience sampling, findings require validation in larger multi-center studies. Nurses in triage roles are well-positioned to initiate routine screening and coordinate interdisciplinary palliative care when complex needs are detected. Not applicable.