When needs exceed systems: a mixed-methods study of clinicians’ perceptions of supportive care for older patients in emergency departments

Older adults presenting to emergency departments (EDs) have complex and multidimensional care needs that extend beyond acute illness management. This study examined clinicians’ perceptions of older patients’ supportive care needs and available system support and explored how clinicians experienced and responded to the discrepancy between them. An explanatory sequential mixed-methods design was used. In the quantitative phase, emergency clinicians completed a study-specific questionnaire assessing perceived supportive care needs and system support. A Need–Support Discrepancy Score was calculated, and participants were operationally classified into low-, moderate-, and high-discrepancy groups. In the qualitative phase, participants from the high-discrepancy group were purposively recruited for semi-structured interviews. The interview data were analyzed thematically, and quantitative and qualitative findings were integrated through a joint display and interpretation. A total of 296 clinicians participated in the quantitative phase. The high-discrepancy group had the highest Total Perceived Need Score and the lowest System Support Score (both p < 0.001). Fifteen clinicians participated in the qualitative phase. Four themes were identified: divergent orientations in older-patient care, complex and evolving care needs, the gap under system constraints, and adaptive responses shaped by capability. Under time pressure and competing priorities, clinicians prioritized immediate physiological risks, and supportive care was often compressed into essential tasks. Professional role and clinical experience shaped how clinicians prioritized, communicated, and adapted care. The findings suggest that the perceived need–support discrepancy reflected difficulty translating recognized needs into feasible care under system constraints rather than a lack of clinician awareness. Improving geriatric emergency care may require workflow-integrated structures and practical support that enable clinicians to address multidimensional needs consistently, rather than relying on individual effort alone. Not applicable.