![]() ![]() We performed a qualitative description study, to provide a rich description of older patients’ perspectives and experiences before and after their visit to the ED and to identify possible contributing factors to unplanned revisits. We utilized the Standards for Reporting of Qualitative Research, the criteria for reporting qualitative research (COREQ), and the best practice guidelines to generate and report our findings. The aim of this study was to describe the perspectives and experiences of older patients before and after a visit to the ED and to identify why these patients may have to return unexpectedly to the ED. Given the complexity of these factors and the interaction between them, a qualitative approach is well suited for exploring this phenomenon. Developing effective interventions to prevent unplanned ED visits requires in-depth knowledge of patient-related, environmental, and healthcare-related factors. Interventions focusing on discharge planning, transitional care, and phone calls after discharge have not effectively reduced ED revisits. The development of effective interventions to reduce ED visits among older patients is challenging. However, geriatric syndromes often remain undiagnosed or undertreated, which increases the need for further ED visits. Geriatric syndromes like cognitive and functional impairment, falls, and malnutrition are highly prevalent among older patients and may explain the need for frequent visits to the ED. The complex care needs and unique challenges of older patients presenting to the ED often involve geriatric syndromes. Moreover, older patients are at high risk of unplanned revisits more than 50% are discharged home from the ED and approximately 10 to 23% have to return unexpectedly within the first month. Older patients that frequently visit the ED have multiple chronic conditions, more severe illness, and more complex care questions. More than 18% of all emergency department (ED) visitors in the United States, like many other countries, are older than 65 years and the number of older patients presenting to overcrowded EDs is increasing. Identifying frailty in the ED is needed to improve discharge communication and adequate follow-up is needed to improve recovery after an acute ED visit. Older patients in need of acute care might benefit from hospital-at-home interventions, or acute care provided by geriatric emergency teams in the primary care setting. This qualitative study identified multiple factors that may contribute to frequent ED visits among older patients. These problems included increasing symptoms leading to feelings of crisis, the relationship with the general practitioner, incomplete discharge information at the ED, and inadequate follow-up and lack of recovery after an ED visit. Participants identified problems before and after their ED visit that possibly contributed to further ED visits. Three main themes emerged: 1) medical events leading to feelings of crisis, 2) patients’ untreated health problems, and 3) persistent problems in health and daily functioning post discharge. In-depth interviews were completed with 13 older patients. Interviews were conducted until thematic saturation was reached. ![]() Theoretical analysis was used to identify recurring patterns and themes in the data. Interviews were recorded, transcribed, and coded independently by two researchers. Patients were enrolled in the ED of a university medical centre using purposive sampling. We performed semi-structured individual interviews with older patients who frequently visited the ED and were discharged home after an acute visit. This was a qualitative description study. The aim of this study was to describe older patients’ perspectives and experiences before and after an ED visit, and to identify factors that possibly contribute to frequent ED revisits. To reduce the number of ED visits, we need more knowledge about the patient-level, environmental, and healthcare factors involved. Older patients are at high risk of unplanned revisits to the emergency department (ED) because of their medical complexity. ![]()
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