"What Matters" in the Emergency Department: A Prospective Analysis of Older Adults' Concerns and Desired Outcomes

Abstract

Objective: To describe "What Matters" to older adults seeking emergency department (ED) care and to identify patient characteristics associated with meeting desired outcomes.

Background: As part of the 4Ms framework, identifying "What Matters" has been captured across healthcare settings, yet limited attention has been directed to older adults in the ED.

Methods: We performed a secondary analysis of a multicenter prospective observational study. The study enrolled 1013 patients aged 65 and older during an ED encounter and performed 90-day follow-up interviews. The primary outcome was the quantification of "What Matters" (concerns and desired outcomes) to older adults during emergency care. As secondary outcomes, we assessed concerns at day 90, if desired outcomes were met at follow-up, and patient characteristics associated with outcome achievement by estimating multivariable logistic regression models.

Results: Older adults reported specific concerns at the time of the ED visit including: (1) symptom identification and/or persistence (31.4%), (2) ability to take care of oneself (19.4%), and (3) end-of-life (17.8%). Desired outcomes expressed by participants included: (1) getting well and symptom resolution (72.0%), (2) obtaining a diagnosis (25.7%), and (3) functional independence (19.5%). At day 90 follow-up, concerns remained similar to the initial ED visit, and the majority of participants (66.2%) achieved their desired outcome. Frailty (adjusted odds ratio = 0.56, 95% CI: 0.38-0.83, P < 0.01) was associated with older adults not meeting their desired outcomes.

Conclusions: Older adults identified a variety of concerns during emergency care, and two-thirds reported that desired outcomes were met at longitudinal day 90 follow-up.

FIGURE 1

Concerns at baseline ED visit and at 90-day follow-up. Note–An example interpretation is as follows: Of respondents that identified a baseline ED visit concern as the “ability to take care of oneself” (#1 on the y-axis), 70 of those participants remained with that same concern at longitudinal 90-day follow-up, whereas 25 participants were concerned about “obtaining medications and managing chronic conditions,” 22 participants were concerned about “end of life,” etc. The concern at the 90-day follow-up could be either old (present on day 0) or new (absent on day 0). ED indicates emergency department.

FIGURE 2

Forest plot of exposures and their association with an older adult meeting their desired outcome by 90 days after emergency care. ADL indicates activities of daily living; IADL, instrumental activities of daily living; OR, odds ratio; PCP, primary care provider.