Older adults’ perceptions of disposition decisions from the emergency department

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Karen Valcheff (Creator)
The University of North Carolina at Greensboro (UNCG )
Web Site: http://library.uncg.edu/
Nancy Hoffart

Abstract: Background and Significance. It is necessary to improve patient outcomes with older adults who present to the emergency department (ED). Patient-centered care strives to improve older adult outcomes from the ED. However, appropriate disposition decisions with older adults are becoming increasingly complex and challenging to achieve. Purpose. The purpose of this study was to explore the perceptions of older adults as to their disposition from the emergency department, the decision making process, and their engagement in that process. It also explored factors that older adults identify as important when making a disposition decision from the emergency department. This study utilized a conceptual Three-Talk Shared Decision Making model to guide the study. Methods. The research design utilized in the study was a descriptive qualitative approach. Recently discharged older adults treated in the emergency department agreed to a telephonic interview. Audiotapes were transcribed and thematically analyzed to identify codes, patterns, and themes. Findings. The study’s analysis revealed that the process of the Three-Talk Shared Decision Making model was not evident for this sample of older adults seeking care in the ED. Participants identified only one option regarding their disposition from the ED. Consequently, the participants did not identify the process of option talk. The emergent themes, emotional reactions, helplessness, and provider empathy provided insight into how older adults perceive their disposition decision. The three factors participants perceived as vital to them before making a disposition decision were safety, pain relief, and a definitive diagnosis. Discussion and Recommendations. The study revealed that older adults want to be heard regarding their treatment and disposition decisions. The study identified the importance of provider education when deciding treatment or disposition decisions with the older adult. It revealed a need to promote the utilization of the Three-Talk Shared Decision Making Model to improve patient-centered care and ED disposition outcomes. Recommendations include future qualitative studies to be conducted with both the older adult and provider’s perception of the ED visit. Additional strategies and skills are warranted to enhance shared decision making in the ED with the growing aging population. With the recent SARS-CoV-2 pandemic, older adults are at high risk for increased ED visits, and the decision making process may become increasingly complicated as this population continues to age.

Additional Information

Language: English
Date: 2021
Aged, Elderly, Disposition, Frailty, Emergency department, Transition, Comorbidities
Older people
Hospitals $x Emergency services
Records $x Management
Decision making in old age
Patient-centered health care

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