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Emergency departments in England not setup to meet up basic care needs of frail the elderly

elderly patient hospital
Credit: Unsplash/CC0 Public Domain

Emergency departments in England are not set up to meet up the essential care needs of frail older patients, suggest the findings of a little qualitative study published online in the Emergency Medicine Journal.

Treatment with dignity and respect, clear and timely explanations of what’s happening and what’s wrong, and the chance to truly have a say within their careall key tenets of patient-centered careoften appear to be missing, the feedback suggests.

Changes in clinical practice and service design must meet up with the needs of a substantial and growing amount of coping with , concludes a linked editorial.

Frailty identifies reduced capacity to recuperate from medical issues, coupled with a dependence on help with basic activities of everyday living. It is a consequence of cumulative physiological decline connected with aging.

Relatively little is well known, however, concerning the impact of frailty on older people’s experiences of and preferences for emergency care.

In a bid to discover, the researchers completed in-depth interviews with 24 the elderly (75+) coping with frailty and 16 of these caregivers with current or recent connection with emergency care in three separate hospital emergency departments in England between January and June 2019.

The interview sample aimed to reflect frailty, age, sex, ethnicity, mental capacity, host to residence, mode of arrival (ambulance or independent), whether observed in “major” or “minor” emergency departments, and on different days of the week and various times of your day.

Over two-thirds (68%) were women; 43% were aged 7584; and over half (57%) were aged over 85. Most were white British: 12 had frailty scores of 5 (mild); the others had scores of 6-7 (moderate to severe).

A fall was the principal reason behind emergency department attendance for 1 in 3; other common conditions included breathing difficulties, heart disease, stomach/back pain or confusion.

Feedback showed that the interviewees were very reluctant to be studied to a crisis department, often due to previous negative experiences, and fear they wouldn’t turn out again, plus they felt helpless/resigned when attendance couldn’t be avoided.

Staff attitudes were, overall, viewed as very caring and reassuring. But interviewees were less thinking about their experiences of very basic care.

These included devoid of usage of or being helped to consume or drink, including several patients with diabetes; little advice about toileting; and long uncomfortable waits on hard trolleys.

25 % of the interviewees said that they had waited 12 or even more hours in the emergency department before being admitted to a ward.

Interviewees felt that communication and involvement in decision-making could possibly be improved, including involving next of kin, who have been considered critical to supporting vulnerable the elderly during sometimes very protracted waits.

And interviewees weren’t always clear whom that they had seen or whom they had a need to speak to should they had queries. Staff didn’t always remember to speak slowly and clearly to make sure that information was received and understood either.

A calm, quiet environment also emerged being an important preference on the list of interviewees, with noisy busy departments proving particularly challenging for them.

It is a small study, involving patients/caregivers at only three sites, so might not be typical of emergency departments throughout England, note the authors.

However they explain, “Our research shows that frailty can lead to a specific vulnerability in [emergency departments] if physical (environment, personal comfort, waiting) and emotional (sense of dignity, communication, involvement, family support) needs aren’t met.”

Emergency department care must be more “frailty friendly,” they state.

“As the [emergency department] environment and waiting times could be harder to improve, healthcare professionals might help older people coping with frailty when you are mindful of these comfort, physical needs, the flow of information and the significance of patient/caregiver involvement. Indeed, within an environment where waiting times could be extending, the significance of an individual centered environment becomes sustained.

“More broadly and given the challenges of more fundamental changes to the fabric of the [emergency department] and the pressures with this portion of the healthcare system, policy makers and practitioners have to consider service development changes when giving an answer to the requirements of the elderly coping with frailty requiring urgent and emergency care,” they conclude.

In a linked editorial, Mary Dawood, of Imperial College NHS Trust, London, and Rosa McNamara, of St Vincent’s University Hospital, Dublin, Ireland, explain that the amount of over-60s is defined to attain 1.4 billion by 2030 and 2.1 billion by 2050, as the amount of over-80s is likely to quadruple to 395 million through the same period.

“Frailty specifically can be an emerging and immediate global public health concern which includes significant implications for clinical practice in emergency medicine,” they write.

The study findings poignantly show that “the elderly have exactly the same desires and needs as younger people utilizing the : to be treated with dignity, to be respected, to be paid attention to also to have regular communication with staff.

“To your shame, these interviews have drawn into sharp focus precisely how disenfranchised and marginalized frail the elderly feel when working with our services. Unlike younger, fitter patients, they’re less able or inclined to complain or voice dissatisfaction when their needs aren’t being met.

“We urgently have to think about and rectify this, redesigning our services for several our patients, remember the requirements of the elderly, although similar, are a lot more urgent and the effects of not setting it up right, much larger.”

They conclude, “The elderly are not requesting special treatment or a thing that is unrealistic or undeliverable; they simply desire to matter which is what all our patients expect and expect inside our [emergency departments].”



More info: Emergency look after older people coping with frailty: patient and carer perspectives, Emergency Medicine Journal (2022). DOI: 10.1136/emermed-2022-212420

Citation: Emergency departments in England not create to meet up basic care needs of frail the elderly (2022, September 6) retrieved 6 September 2022 from https://medicalxpress.com/news/2022-09-emergency-departments-england-basic-frail.html

This document is at the mercy of copyright. Aside from any fair dealing for the intended purpose of private study or research, no part could be reproduced minus the written permission. This content is provided for information purposes only.

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