Understanding why older adults choose to seek non-urgent care in the emergency department: the patient's perspective

Abstract

Objectives: Older adults make up a significant proportion of patients seeking care in the ED, with about 25% of these visits classified as "non-urgent." This study explored older adults' understandings, expectations of and self-reported reasons for seeking care and treatment provided in the ED.

Methods: This qualitative study involved semi-structured interviews with CTAS 4-5 patients conducted at randomly selected times and days during ED visits at three Saskatoon facilities in 2016. Thematic analysis was used to analyze interview data.

Results: 115 patients over age 65 years (mean age 79.1 years) were interviewed. While the majority had independently or with family made the decision to attend the ED, almost one-third of patients (31.6%) reported that they had been referred to the ED by general practitioners or specialists. Few respondents indicated the visit was the result of their general practitioner not being available. Most participants cited comprehensiveness and convenience of diagnostic and treatment services in a single location as the primary motivation for seeking treatment in the ED, which was especially important to those in poor health, without family supports, or with functional limitations, personal mobility and/or transportation challenges. Other common motivations were availability of after-hours care and perceived higher quality care compared to primary care.

Conclusions: Accessibility to comprehensive care, availability, quality of care and positive past experiences were key considerations for older adults seeking treatment of non-urgent concerns. Older adults will likely continue to use EDs for non-urgent medical care until trusted, "one-stop" settings that better addresses the needs of this population are more widely available.

Keywords: Emergency Department; Older adults; accessibility; non-urgent care.