214 GEDI WISE: Geriatric Emergency Department Patients’ Priorities for Health-Related Quality of Life - A Qualitative Study

Study ObjectivesHealth-related quality of life (HRQoL), encompassing social, emotional, and physical well-being of patients is widely recognized as an important clinical outcome of medical care, especially among geriatric patients. However, assessments of HRQoL are rare in the ED, and it is unclear which aspects of HRQoL are most important to geriatric patients in the ED. The objective was to identify which domains of HRQoL are most valued by geriatric patients in the ED and what expectations patients have for addressing or improving their HRQoL during an ED visit.MethodsThis was a cross-sectional qualitative focus group study of geriatric ED patients from an urban, academic ED with >88,000 total annual visits (16,000 geriatric). Patients were eligible if they were age ≥65 and discharged from the ED within 45 days of recruitment. Semi-structured pilot interviews were performed to finalize the question guide. Focus group participants were asked to describe their experience in the ED and reflect on how that experience affected their physical, emotional and social aspects of health. Three coders experienced in qualitative methods used content and constant comparative methods to analyze focus group transcripts for emergent themes.ResultsThree individuals participated in pilot interviews and 30 participated in six focus groups. Median age was 70 years; 70% were women. Five main themes related to HRQoL emerged. (1) Patients expressed concerns about recovering to their baseline physical functioning and (2) placed emphasis on the anxiety and stress that uncertainty (in both diagnosis and regarding recovery) evokes. Specifically, they feared the loss of independence. (3) Patients noted that physical illness had a significant impact on their interpersonal relationships and (4) on their emotional and social quality of life. Finally, (5) patients questioned if the ED was the right place to attempt to address HRQoL.ConclusionsThe geriatric patients in this study discussed how their illness or injury not only caused physical symptoms, but also impacted relationships and emotional health. Although patients questioned if the ED was the proper venue to address HRQoL, they desired reassurance in the ED about the impact illness would have on their current quality of life. Evaluation of ED-based interventions for geriatric patients should incorporate measures of HRQoL that align with patient priorities. Study ObjectivesHealth-related quality of life (HRQoL), encompassing social, emotional, and physical well-being of patients is widely recognized as an important clinical outcome of medical care, especially among geriatric patients. However, assessments of HRQoL are rare in the ED, and it is unclear which aspects of HRQoL are most important to geriatric patients in the ED. The objective was to identify which domains of HRQoL are most valued by geriatric patients in the ED and what expectations patients have for addressing or improving their HRQoL during an ED visit. Health-related quality of life (HRQoL), encompassing social, emotional, and physical well-being of patients is widely recognized as an important clinical outcome of medical care, especially among geriatric patients. However, assessments of HRQoL are rare in the ED, and it is unclear which aspects of HRQoL are most important to geriatric patients in the ED. The objective was to identify which domains of HRQoL are most valued by geriatric patients in the ED and what expectations patients have for addressing or improving their HRQoL during an ED visit. MethodsThis was a cross-sectional qualitative focus group study of geriatric ED patients from an urban, academic ED with >88,000 total annual visits (16,000 geriatric). Patients were eligible if they were age ≥65 and discharged from the ED within 45 days of recruitment. Semi-structured pilot interviews were performed to finalize the question guide. Focus group participants were asked to describe their experience in the ED and reflect on how that experience affected their physical, emotional and social aspects of health. Three coders experienced in qualitative methods used content and constant comparative methods to analyze focus group transcripts for emergent themes. This was a cross-sectional qualitative focus group study of geriatric ED patients from an urban, academic ED with >88,000 total annual visits (16,000 geriatric). Patients were eligible if they were age ≥65 and discharged from the ED within 45 days of recruitment. Semi-structured pilot interviews were performed to finalize the question guide. Focus group participants were asked to describe their experience in the ED and reflect on how that experience affected their physical, emotional and social aspects of health. Three coders experienced in qualitative methods used content and constant comparative methods to analyze focus group transcripts for emergent themes. ResultsThree individuals participated in pilot interviews and 30 participated in six focus groups. Median age was 70 years; 70% were women. Five main themes related to HRQoL emerged. (1) Patients expressed concerns about recovering to their baseline physical functioning and (2) placed emphasis on the anxiety and stress that uncertainty (in both diagnosis and regarding recovery) evokes. Specifically, they feared the loss of independence. (3) Patients noted that physical illness had a significant impact on their interpersonal relationships and (4) on their emotional and social quality of life. Finally, (5) patients questioned if the ED was the right place to attempt to address HRQoL. Three individuals participated in pilot interviews and 30 participated in six focus groups. Median age was 70 years; 70% were women. Five main themes related to HRQoL emerged. (1) Patients expressed concerns about recovering to their baseline physical functioning and (2) placed emphasis on the anxiety and stress that uncertainty (in both diagnosis and regarding recovery) evokes. Specifically, they feared the loss of independence. (3) Patients noted that physical illness had a significant impact on their interpersonal relationships and (4) on their emotional and social quality of life. Finally, (5) patients questioned if the ED was the right place to attempt to address HRQoL. ConclusionsThe geriatric patients in this study discussed how their illness or injury not only caused physical symptoms, but also impacted relationships and emotional health. Although patients questioned if the ED was the proper venue to address HRQoL, they desired reassurance in the ED about the impact illness would have on their current quality of life. Evaluation of ED-based interventions for geriatric patients should incorporate measures of HRQoL that align with patient priorities. The geriatric patients in this study discussed how their illness or injury not only caused physical symptoms, but also impacted relationships and emotional health. Although patients questioned if the ED was the proper venue to address HRQoL, they desired reassurance in the ED about the impact illness would have on their current quality of life. Evaluation of ED-based interventions for geriatric patients should incorporate measures of HRQoL that align with patient priorities.