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There is a need for emergency departments to be more ‘frailty friendly’, according to new research published in the Emergency Medicine Journal.
A small qualitative study has found that emergency departments across England are often not set up to meet the basic care needs of frail older patients.
Patients did not always have access to the most basic care needs
The findings are based on in-depth interviews with 24 older people (75+) living with frailty and 16 of their carers with current or recent experience of emergency care in three separate hospital emergency departments in England between January and June 2019.
Around two-thirds (68%) of the sample were women, and the majority (57%) were aged over 85. Frailty scores varied from 5 (mild) to 7 (severe).
Analysis of the interviews revealed that overall, patients felt they did not always have access to the most basic care needs, such as being helped to eat or drink and assistance with toileting.
A quarter of the interviewees also reported waiting 12 or more hours in emergency departments, often on hard trolleys, will they waited to be admitted.
Need for better communication
Most said communication and involvement in decision-making could be improved, including involving next of kin, who were viewed as critical to supporting vulnerable older people during sometimes very protracted waits.
Many also reported that it was unclear who they needed to speak to if they had queries and who was in charge of their care.
While staff attitudes were, on the whole, seen as very caring and reassuring, some reported that they didn’t always take time to speak slowly and clearly to ensure that information was received and understood either.
Participants said wards were often noisy and busy, which proved particularly challenging for them, and said a calm and quiet environment was preferable where possible.
“Older people are not asking for special treatment or something that is unrealistic or undeliverable”
As the study only used a small sample of people across three hospitals, the authors highlight that experiences may be different at other sites in the country.
Nevertheless, they say the research suggests that “frailty can result in a particular vulnerability in [emergency departments] if physical (environment, personal comfort, waiting) and emotional (sense of dignity, communication, involvement, family support) needs are not met.”
The say that while the hospital environment may be hard to change, there are certain steps healthcare professionals can take to improve patients’ experiences.
“Healthcare professionals can help older people living with frailty by being mindful of their comfort, physical needs, the flow of information and the importance of patient/carer involvement. Indeed, in an environment where waiting times may be extending, the importance of a person-centred environment becomes even greater.
“More broadly and given the challenges of more fundamental changes to the fabric of the [emergency department] and the pressures on this part of the healthcare system, policy makers and practitioners need to consider service development changes when responding to the needs of older people living with frailty requiring urgent and emergency care,” they conclude.
In a linked editorial, Mary Dawood, of Imperial College NHS Trust, London, and Rosa McNamara, of St Vincent’s University Hospital, Dublin, Ireland, wrote: “Older people are not asking for special treatment or something that is unrealistic or undeliverable, they simply want to matter and that is what all our patients expect and hope for in our [emergency departments].”
