Abstract
BackgroundHealth-related quality of life (HRQoL), encompassing social, emotional, and physical wellbeing is an important clinical outcome of medical care, especially among geriatric patients. It is unclear which domains of HRQoL are most important to geriatric patients and which domains they hope to address when using the Emergency Department (ED). The objective of this study was to understand which aspects of HRQoL are most valued by geriatric patients in the ED and what expectations patients have for addressing or improving HRQoL during an ED visit.MethodsThis was a qualitative focus group study of geriatric ED patients from an urban, academic ED in the United States with > 16,500 annual geriatric visits. Patients were eligible if they were age > =65 years and discharged from the ED within 45 days of recruitment. Semi-structured pilot interviews and focus groups were conducted several weeks after the ED visit. Participants shared their ED experiences and to discuss their perceptions of the subsequent impact on their quality of life, focusing on the domains of physical, mental, and social health. Latent content and constant comparative methods were used to code focus group transcripts and analyze for emergent themes.ResultsThree individuals participated in pilot interviews and 31 participated in six focus groups. Twelve codes across five main themes relating to HRQoL were identified. Patients recalled: (1) A strong desire to regain physical function, and (2) anxiety elicited by the emotional experience of seeking care in the emergency department, due to uncertainty in diagnosis, treatment, and prognosis. In addition, patients noted both (3) interpersonal impacts of health on quality of life, primarily mediated primarily by social interaction, and (4) an individual experience of health and quality of life mediated primarily by mental health. Finally, (5) patients questioned if the ED was the right place to attempt to address HRQoL.ConclusionsPatients expressed anxiety around the time of their ED visit related to uncertainty, they desired functional recovery, and identified both interpersonal effects of health on quality of life mediated by social health, and an individual experience of health and quality of life mediated by mental health.
Highlights
Health-related quality of life (HRQoL), encompassing social, emotional, and physical wellbeing is an important clinical outcome of medical care, especially among geriatric patients
Geriatric Emergency Department Innovation (GEDI) aim to decrease adverse events such as falls, infection, and delirium. They address the persistent, unmet, health-related needs which are common among geriatric patients in the Emergency Department (ED). [3, 5, 16] GEDIs are often evaluated with respect to their ability to optimize health care delivery, and in turn, reduce unnecessary repeat ED visits and re-hospitalization
Three subjects participated in pilot interviews, and 31 subjects participated in one of 6 focus group sessions
Summary
Health-related quality of life (HRQoL), encompassing social, emotional, and physical wellbeing is an important clinical outcome of medical care, especially among geriatric patients. EDs were not traditionally designed for older adults [2] They are loud, chaotic, and care focuses on rapid triage and diagnosis of the acute issue, rather than addressing underlying issues such as multi-morbidity and polypharmacy which are common in geriatric patients [2]. [3, 5, 16] GEDIs are often evaluated with respect to their ability to optimize health care delivery, and in turn, reduce unnecessary repeat ED visits and re-hospitalization Though these metrics are important measures of health services use, they are insufficient to understand the impact of GEDIs on patient-centered outcomes such as health-related quality of life (HRQoL)
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