Journal
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
Volume 70, Issue 11, Pages 3152-3162Publisher
WILEY
DOI: 10.1111/jgs.17950
Keywords
barrier; care transition; emergency department; older adults; qualitative
Categories
Funding
- American Board of Emergency Medicine National Academy of Medicine Anniversary Fellowship
- Emergency Medicine Foundation
- John A. Hartford Foundation
- National Center for Advancing Translational Sciences [KL2TR000140]
- National Institute on Aging [P30AG021342, R03AG073988, R33AG058926, R61AG069822]
- Society for Academic Emergency Medicine Foundation
- West Health Institute
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This study aims to assess the barriers experienced by older adults during the transition from the emergency department to community care. Through interviews with 25 participants, it was found that there were barriers such as incomplete information during the discharge process, difficulties in navigating follow-up outpatient care, new physical limitations and fears, as well as the impact of caregivers.
Background Over one-half of older adults are discharged to the community after emergency department (ED) visits, and studies have shown there is increased risk of adverse health outcomes in the immediate post-discharge period. Understanding the experiences of older adults during ED-to-community care transitions has the potential to improve geriatric emergency clinical care and inform intervention development. We therefore sought to assess barriers experienced by older adults during ED-to-community care transitions. Methods We conducted a qualitative analysis of community-dwelling cognitively intact patients aged 65 years and older receiving care in four diverse EDs from a single U.S. healthcare system. We constructed a conceptual framework a priori to guide the development and iterative revision of a codebook, used purposive sampling, and conducted recorded, semi-structured interviews using a standardized guide. Two researchers coded the professionally transcribed data using a combined deductive and inductive approach and analyzed transcripts to identify dominant themes and representative quotations. Results Among 25 participants, 20 (80%) were women and 17 (68%) were white. We identified four barriers during the ED-to-community care transition: (1) ED discharge process was abrupt with missing information regarding symptom explanation and performed testing, (2) navigating follow-up outpatient clinical care was challenging, (3) new physical limitations and fears hinder performance of baseline activities, and (4) major and minor ramifications for caregivers impact an older adult's willingness to request or accept assistance. Conclusions Older adults identified barriers to successful ED-to-community care transitions that can inform the development of novel and effective interventions.
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