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. 2022 Feb 25;22(1):156.
doi: 10.1186/s12877-022-02798-x.

What matters most in acute care: an interview study with older people living with frailty

James David van Oppen  1   2 , Timothy John Coats  3   4 , Simon Paul Conroy  5 , Jagruti Lalseta  6 , Kay Phelps  7 , Emma Regen  7 , Peter Riley  6 , Jose Maria Valderas  8 , Nicola Mackintosh  7
Affiliations

What matters most in acute care: an interview study with older people living with frailty

James David van Oppen et al. BMC Geriatr. .

Abstract

Background: Healthcare outcome goals are central to person-centred acute care, however evidence among older people is scarce. Older people who are living with frailty have distinct requirements for healthcare delivery and have distinct risk for adverse outcomes from healthcare. There is insufficient evidence for whether those living with frailty also have distinct healthcare outcome goals. This study explored the nature of acute care outcome goals in people living with frailty.

Methods: Healthcare outcome goals were explored using semi-structured patient interviews. Participants aged over 65 with Clinical Frailty Score 5-8 (mild to very severe frailty) were recruited during their first 72 hours in a UK hospital. Purposive, maximum variation sampling was guided by lay partners from a Patient and Public Involvement Forum specialising in ageing-related research. Qualitative analysis used a blended approach based on framework and constant comparative methodologies for the identification of themes. Findings were validated through triangulation with participant, lay partner, and technical expert review.

Results: The 22 participants were aged 71 to 98 and had mild to very severe frailty. One quarter were living with dementia. Most participants had reflected on their situation and considered their outcome goals. Theme categories (and corresponding sub-categories) were 'Autonomy' (information, control, and security) and 'Functioning' (physical, psychosocial, and relief). A novel 'security' theme was identified, whereby participants sought to feel safe in their usual living place and with their health problems. Those living with milder frailty were concerned to maintain ability to support loved ones, while those living with most severe frailty were concerned about burdening others.

Conclusions: Outcome goals for acute care among older participants living with frailty were influenced by the insecurity of their situation and fear of deterioration. Patients may be supported to feel safe and in control through appropriate information provision and functional support.

Keywords: Emergency medicine; Frailty; Geriatrics; Patient satisfaction; Person-centred care.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Framework of acute healthcare outcome goals among older people living with frailty
See this image and copyright information in PMC

References

    1. Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: A systematic review of causes, consequences and solutions. PloS one. 2018;13(8):e0203316-e. doi: 10.1371/journal.pone.0203316. - DOI - PMC - PubMed
    1. Singler K, Christ M, Sieber C, Gosch M, Heppner HJ. Geriatrische Patienten in Notaufnahme und Intensivmedizin. Der Internist. 2011;52(8):934–938. doi: 10.1007/s00108-011-2804-9. - DOI - PubMed
    1. Keeble E, Roberts HC, Williams CD, Van Oppen J, Conroy SP. Outcomes of hospital admissions among frail older people: a 2-year cohort study. Br J Gen Pract. 2019;69(685):e555–ee60. doi: 10.3399/bjgp19X704621. - DOI - PMC - PubMed
    1. Considine J, Berry D, Rasmussen B, Hutchinson AM, Rawson H, Jordan P, et al. Impact of emergency department length of stay on anxiety and comfort in older people. International Emergency Nursing. 2021;56:100974. doi: 10.1016/j.ienj.2021.100974. - DOI - PubMed
    1. Fletcher AE, Price GM, Ng ESW, Stirling SL, Bulpitt CJ, Breeze E, et al. Population-based multidimensional assessment of older people in UK general practice: a cluster-randomised factorial trial. Lancet. 364:9446, 1667–77. - PubMed

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