Older Adults' Experiences of Emergency Department Admission Decisions: A Qualitative Study in a Public Safety Net Hospital

Authors

• Anita N Chary
• Annika Bhananker
• Beatrice Torres
• Victoria Sofia Martell
• Manish N Shah
• Aanand D Naik

Language

English

Publication Date

5-1-2025

Journal

Journal of General Internal Medicine

DOI

10.1007/s11606-024-09250-3

PMID

39654000

PMCID

PMC12052630

PubMedCentral® Posted Date

12-9-2024

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Hospital admission is a significant event in the healthcare trajectory of older adults (age 60 +). Numerous harms such as delirium, falls, and adverse medication events can arise that outweigh the benefits of admission. Little is known about how older adults feel about being hospitalized or what they think admission will achieve for them. These issues are particularly important to understand in socioeconomically disadvantaged patients, who have poor access to outpatient care and higher hospitalization rates.

Methods: We performed semi-structured interviews with emergency department (ED) patients aged 60 and older who were being admitted. The study site was a public hospital serving a socioeconomically disadvantaged, predominantly Hispanic and Black patient population. Interviews focused on experiences of the admission decision, expectations of hospitalization, and health outcome goals. We coded data using an inductive approach.

Results: Twenty-seven older adults were interviewed about their experiences. Most participants belonged to minoritized racial or ethnic groups (70%, n = 19), and 41% (n = 11) spoke Spanish as their primary language. Approximately one-third were admitted for ambulatory care-sensitive conditions, i.e., conditions that can be managed in the outpatient setting to prevent hospitalization. Four themes emerged: (1) participants felt that clinicians made admission decisions for, rather than with, them; (2) participants sought to avoid admission due to family caregiving and work obligations; (3) participants with chronic conditions viewed their admission as resulting from poor access to care over the longer term; (4) participants expected hospitalization to improve their chronic symptom burden, mobility, and abilities to perform activities of daily living.

Conclusions: Older adults' expectations of hospitalization exceed stabilization of acute illness. Hospital admission of older adults presents an opportunity for shared decision-making and communication about likely outcomes of hospitalization. Incorporating patient-centered outcomes into admission decisions may help align care with older adults' priorities in the ED.

Keywords

Humans, Male, Female, Aged, Emergency Service, Hospital, Qualitative Research, Middle Aged, Safety-net Providers, Aged, 80 and over, Patient Admission, Hospitals, Public, Decision Making, Hospitalization

Published Open-Access

yes

Recommended Citation

Chary, Anita N; Bhananker, Annika; Torres, Beatrice; et al., "Older Adults' Experiences of Emergency Department Admission Decisions: A Qualitative Study in a Public Safety Net Hospital" (2025). Faculty, Staff and Student Publications. 4131.
https://digitalcommons.library.tmc.edu/uthmed_docs/4131