Person-centred decisions in emergency care for older people living with frailty: principles and practice

James David van Oppen^{1

2}, Tim Coats², Simon Conroy³, Sarah Hayden⁴, Pieter Heeren^{5

6}, Carolyn Hullick^{7

8}, Shan Liu^{9

10}, Jacinta Lucke¹¹, Bill Lukin^{12

13}, Rosa McNamara^{14

15}, Don Melady¹⁶, Simon P Mooijaart^{17

18}, Tony Rosen¹⁹, Jay Banerjee^{2

4}

Affiliations

¹ Centre for Urgent and Emergency Care Research, The University of Sheffield, Sheffield, UK james.vanoppen@doctors.org.uk.
² College of Life Sciences, University of Leicester, Leicester, UK.
³ MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK.
⁴ Emergency Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
⁵ Faculty of Medicine and Life Sciences, Healthcare & Ethics Research Group, UHasselt, Hasselt, Belgium.
⁶ Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Flanders, Belgium.
⁷ Australian Commission on Safety and Quality in Healthcare, Sydney, New South Wales, Australia.
⁸ The University of Newcastle Australia, Callaghan, New South Wales, Australia.
⁹ Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹⁰ Harvard Medical School, Boston, Massachusetts, USA.
¹¹ Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, Netherlands.
¹² Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
¹³ The University of Queensland, Brisbane, Queensland, Australia.
¹⁴ Emergency Department, St Vincent's University Hospital, Dublin, Ireland.
¹⁵ University College Dublin, Dublin, Ireland.
¹⁶ Department of Family and Community Medicine, Schwartz Reisman Emergency Medicine Institute, Toronto, Ontario, Canada.
¹⁷ Department of Internal Medicine, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands.
¹⁸ LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands.
¹⁹ Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA.

PMID: 39060102
DOI: 10.1136/emermed-2024-213898

Review

Person-centred decisions in emergency care for older people living with frailty: principles and practice

James David van Oppen et al. Emerg Med J. 2024.

. 2024 Oct 23;41(11):694-699.

doi: 10.1136/emermed-2024-213898.

Authors

Affiliations

¹ Centre for Urgent and Emergency Care Research, The University of Sheffield, Sheffield, UK james.vanoppen@doctors.org.uk.
² College of Life Sciences, University of Leicester, Leicester, UK.
³ MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK.
⁴ Emergency Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
⁵ Faculty of Medicine and Life Sciences, Healthcare & Ethics Research Group, UHasselt, Hasselt, Belgium.
⁶ Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Flanders, Belgium.
⁷ Australian Commission on Safety and Quality in Healthcare, Sydney, New South Wales, Australia.
⁸ The University of Newcastle Australia, Callaghan, New South Wales, Australia.
⁹ Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹⁰ Harvard Medical School, Boston, Massachusetts, USA.
¹¹ Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, Netherlands.
¹² Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
¹³ The University of Queensland, Brisbane, Queensland, Australia.
¹⁴ Emergency Department, St Vincent's University Hospital, Dublin, Ireland.
¹⁵ University College Dublin, Dublin, Ireland.
¹⁶ Department of Family and Community Medicine, Schwartz Reisman Emergency Medicine Institute, Toronto, Ontario, Canada.
¹⁷ Department of Internal Medicine, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands.
¹⁸ LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands.
¹⁹ Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA.

PMID: 39060102
DOI: 10.1136/emermed-2024-213898

Abstract

Older people living with frailty are frequent users of emergency care and have multiple and complex problems. Typical evidence-based guidelines and protocols provide guidance for the management of single and simple acute issues. Meanwhile, person-centred care orientates interventions around the perspectives of the individual. Using a case vignette, we illustrate the potential pitfalls of applying exclusively either evidence-based or person-centred care in isolation, as this may trigger inappropriate clinical processes or place undue onus on patients and families. We instead advocate for delivering a combined evidence-based, person-centred approach to healthcare which considers the person's situation and values, apparent problem and available options.

Keywords: emergency departments; ethics; frailty; geriatrics.

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Conflict of interest statement

Competing interests: The authors declare holding or having held voluntary leadership roles in geriatric emergency medicine special interest groups in Europe: European Society of Emergency Medicine (JvO, PH, JAL) and European Geriatric Medicine Society (SM, SC); North America: Geriatric Emergency Department Collaborative (DM) and Society for Academic Emergency Medicine (SWL, TR); and internationally: International Federation for Emergency Medicine (CH, RM, DM).

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Person-centred decisions in emergency care for older people living with frailty: principles and practice

Affiliations

Person-centred decisions in emergency care for older people living with frailty: principles and practice

Authors

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources