Exploring older people’s experiences of urgent and emergency care: an interpretative phenomenological study

Background: Older people are the largest patient user-group of NHS care and yet we know little of their use and experience of urgent and emergency care systems, in particular Emergency Department (ED) provision. Older people are admitted to hospital more frequently, have longer lengths of stay and occupy more bed days than other patient groups Objectives of Study: To understand older people’s experiences of urgent and emergency care from individuals’ perspectives To identify how the context of care influences older people’s experiences of urgent and emergency care Data Collection Methods: Qualitative, two stage study with one to one interviews with 10 older people and focus groups with health care professionals from an NHS hospital in the East of England Analysis: Data collected was analysed using interpretative phenomenological analysis with older people and thematic analysis with health care professionals. Results: Five super-ordinate themes were identified: (1) Conflict with legitimacy; (2) A Need for Safety; (3) Attentiveness to Need; (4) Crisis of Identity and (5) Disempowering self. The findings illustrate the need for validation by staff that older people are legitimate users of urgent and emergency care. Little acts of kindness made them feel cared for and knowing staff being there for them helped participants feel safe in the ED environment. Increased vulnerability exacerbated loss of personal agency and sense of self-worth. Finally, feelings of inferiority, resulted in the relinquishing of control and holding back from being involved in their care. Health care professionals struggled to meet the needs of older people under the organisational constraints and the environment of care in which they work. Conclusion: Older people need to be treated as a distinct group within urgent and emergency care services. The role of relational skills and validation cannot be underestimated and facilitates a sense of connectedness and belonging. Health care professionals need time to care to provide patient centred and holistic care they aspire to