Elderly Medical Patients' Experience of an Acute Readmission to the Emergency Department-An Interpretative Phenomenological Analysis.

AIMS AND

objectivesTo explore the experiences of elderly medical patients shortly after an unplanned emergency department readmission and the perceived value of health care encounters.

backgroundElderly medical patients are often frail, have multiple health issues and are at risk for (re)admissions, loss of function, morbidity, and mortality. Elderly people are frequently admitted for a shorter time.

designThis study employed a qualitative design and was conducted at a 700-bed university hospital in Copenhagen, Denmark.

methodsA purposeful sampling included 10 readmitted medical patients over 65 years, admitted for less than 72 h. In-depth qualitative study within the phenomenological-hermeneutical research tradition, drawing analytical inspiration from Interpretative Phenomenological Analysis.

resultsThe analysis identified three main themes. Patients experience powerlessness and system-dependence in their attempt to navigate the healthcare system and are in need of clarification in relation to the acute readmissions. Patients described being in a life circumstance where they constantly had to balance acute and chronic disease(s).

conclusionsElderly readmitted patients are highly dependent on the randomness of support related to acute healthcare encounters and a supportive network. Lack of health clarification can provoke a negative spiral of disempowerment and lower the threshold for acute health care seeking. RELEVANCE TO CLINICAL PRACTICE: Identifying and understanding the perceived value of a readmission is essential to prevent unplanned readmission and guide healthcare professionals in enhancing the quality of care. REPORTING

methodCOREQ checklist. PATIENTS OR PUBLIC CONTRIBUTING: Elderly readmitted patients were involved in the study as participants providing the research data. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: This study illustrates how the organisation and flow culture in the emergency departments are inadequate to meet the multiple health issues of elderly medical patients, where the separation of acute and chronic illness may be blurred. This study describes the experienced consequences of missed care and how patients are having deep trouble connecting value of the acute hospitalisation to their overall health situation, leaving them in a debilitating dilemma in need of clarification. Elderly medical patients exposed to a varying degree of belonging to a personal network may be vulnerable to disempowerment and dependent on a system that does not accommodate their expectations or needs.

trial registrationThe study was approved by the Danish ethical committee protocol number: 17006481 and the regional governance AHH no. 2017028-is-suite no. 05367.