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. 2022 Jul 1;23(4):579-588.
doi: 10.5811/westjem.2022.4.56115.

A Qualitative Study of "What Matters" to Older Adults in the Emergency Department

Cameron J Gettel  1   2 , Arjun K Venkatesh  1   2 , Hollie Dowd  3 , Ula Hwang  1 , Rockman F Ferrigno  4 , Eleanor A Reid  1 , Mary E Tinetti  5   6
Affiliations

A Qualitative Study of "What Matters" to Older Adults in the Emergency Department

Cameron J Gettel et al. West J Emerg Med. .

Abstract

Introduction: The "4Ms" model - What Matters, Medication, Mentation, and Mobility - is increasingly gaining attention in age-friendly health systems, yet a feasible approach to identifying what matters to older adults in the emergency department (ED) is lacking. Adapting the "What Matters" questions to the ED setting, we sought to describe the concerns and desired outcomes of both older adult patients seeking ED care and their treating clinicians.

Methods: We conducted 46 dyadic semi-structured interviews of cognitively intact older adults and their treating clinicians. We used the "What Matters" conversation guide to explore patients' 1) concerns and 2) desired outcomes. We then asked analogous questions to each patient's treating clinician regarding the patient's priorities. Interviews were professionally transcribed and coded using an inductive approach of thematic analysis to identify emergent themes.

Results: Interviews with older adults lasted a mean of three minutes, with a range of 1-8 minutes. Regarding patients' concerns, five themes emerged from older adults: 1) concern through a family member or outpatient clinician recommendation; 2) no concern, with a high degree of trust in the healthcare system; 3) concerns regarding symptom cause identification; 4) concerns regarding symptom resolution; and 5) concerns regarding preservation of their current status. Regarding desired outcomes, five priority themes emerged among older adults: 1) obtaining a diagnosis; 2) returning to their home environment; 3) reducing or resolving symptoms; 4) maintaining self-care and independence; and 5) gaining reassurance. Responding to what they believed mattered most to older adult patients, ED clinicians believed that older adults were concerned primarily about symptom cause identification and resolution and primarily desired a return to the home environment and symptom reduction.

Conclusion: This work identifies concerns and desired outcomes of both older adult patients seeking ED care and their treating clinicians as well as the feasibility of incorporating the "What Matters" questions within ED clinical practice.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. Dr. Gettel is supported by the National Center for Advancing Translational Science (TL1TR00864) and the Research Education Core of the Claude D. Pepper Older Americans Independence Center at Yale School of Medicine (P30AG021342). Dr. Venkatesh is supported by the American Board of Emergency Medicine National Academy of Medicine Anniversary fellowship and previously by the Yale Center for Clinical Investigation (KL2TR000140) from the National Center for Advancing Translational Science. Dr. Hwang is supported by the National Institute on Aging (R33AG058926, R61AG069822), by the John A Hartford Foundation, and the West Health Institute. Dr. Tinetti is supported by the John A. Hartford Foundation, the Gordon and Betty Moore Foundation, and the Robert Wood Johnson Foundation. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation or approval of the manuscript. There are no conflicts of interest to declare.

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