What Matters” in the Emergency Department

A Prospective Analysis of Older Adults’ Concerns and Desired Outcomes

Datos Bibliográficos

ID9101036
AutoresTonya Chera (Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, autor de correspondencia), Mary E Tinetti (0000-0003-0940-9702, Yale University), Mary Tinetti (Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT), Jasmine Travers (0000-0003-3327-5062, New York University), James Galske (0000-0002-1328-0131, Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, autor de correspondencia), Alladi Venkatesh (0000-0002-8248-0567, Yale University, autor de correspondencia), Arjun K Venkatesh (Department of Emergency Medicine, Yale School of Medicine, New Haven, CT), Lauren Southerland (Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH), Lauren T Southerland (0000-0002-3561-8332, The Ohio State University Wexner Medical Center), Scott M Dresden (0000-0002-9250-3320, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL), Colleen McQuown (Geriatric Research Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH), Colleen M McQuown (0000-0002-8627-9094, Geriatric Research Education and Clinical Center, autor de correspondencia), Cameron J Gettel (0000-0002-6249-1023, Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, autor de correspondencia)
Año2024
Volumen62
Número12
PáginasS50-S56
Fecha de publicación2024-12-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000002053
PMID39514495
OpenAlexW4404166224
IdiomaEN
Citas recibidas1
Referencias citadas28

OBJECTIVE: To describe "What Matters" to older adults seeking emergency department (ED) care and to identify patient characteristics associated with meeting desired outcomes. BACKGROUND: As part of the 4Ms framework, identifying "What Matters" has been captured across healthcare settings, yet limited attention has been directed to older adults in the ED. METHODS: We performed a secondary analysis of a multicenter prospective observational study. The study enrolled 1013 patients aged 65 and older during an ED encounter and performed 90-day follow-up interviews. The primary outcome was the quantification of "What Matters" (concerns and desired outcomes) to older adults during emergency care. As secondary outcomes, we assessed concerns at day 90, if desired outcomes were met at follow-up, and patient characteristics associated with outcome achievement by estimating multivariable logistic regression models. RESULTS: Older adults reported specific concerns at the time of the ED visit including: (1) symptom identification and/or persistence (31.4%), (2) ability to take care of oneself (19.4%), and (3) end-of-life (17.8%). Desired outcomes expressed by participants included: (1) getting well and symptom resolution (72.0%), (2) obtaining a diagnosis (25.7%), and (3) functional independence (19.5%). At day 90 follow-up, concerns remained similar to the initial ED visit, and the majority of participants (66.2%) achieved their desired outcome. Frailty (adjusted odds ratio = 0.56, 95% CI: 0.38-0.83, P < 0.01) was associated with older adults not meeting their desired outcomes. CONCLUSIONS: Older adults identified a variety of concerns during emergency care, and two-thirds reported that desired outcomes were met at longitudinal day 90 follow-up

Emergency department · Medical emergency · MEDLINE · Political science · Emergency and Acute Care Studies · Frailty in Older Adults · Geriatric Care and Nursing Homes · Law · Medicine · Nursing