Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Division of Emergency Medicine Campus Mitte and Virchow, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
BMC Geriatr. 2024 Oct 29;24(1):890. doi: 10.1186/s12877-024-05429-9.
In aging societies, emergency departments (ED) face an increasing number of older, geriatric patients. Research shows that older emergency patients have a greater burden of comorbidities and a higher risk of adverse events. It has been questioned whether contemporary ED structures can meet the specific needs and characteristics of older patients. Little is known about how professional health care providers perceive and experience ED care for older patients. This study aimed to get insight into the perspective of healthcare providers working with older ED patients and to explore the challenges they experience in their daily work.
The study used a qualitative research design with a social-constructivist perspective and a Grounded Theory based methodology. Data were collected through qualitative interviews with N = 25 healthcare providers from different urban EDs in Berlin, Germany, and adjacent healthcare institutions. Following the Ground Theory approach, categories and central themes were identified, analyzed, and interpreted to gain a comprehensive understanding of the healthcare provider perspective.
The interviews revealed a significant and increasing relevance of geriatric ED patients for healthcare providers. However, there was no shared definition of 'the geriatric patient'. Most interviewees found ED structures to be inadequate for older patients. They described specific challenges, such as information gathering and safety risks in the ED, as well as an increased use of resources (both time and personnel) when caring for older patients. In addition, specific problems in the collaboration with other professions and institutions were addressed, namely nursing homes, hospital wards, consultations, and the hospital social service.
Healthcare providers experience a structural mismatch between contemporary EDs and the specific needs of geriatric patients. They are aware of the vulnerabilities of geriatric patients and try to compensate for inherent structural shortcomings. Such structures and limited resources often cause practical, organizational, and ethical problems. There is a great need to develop, implement, and evaluate systematic approaches and care concepts that address the specifics of ED care for geriatric patients.
在老龄化社会中，急诊科（ED）面临着越来越多的老年、老年患者。研究表明，老年急诊患者合并症负担更大，不良事件风险更高。人们质疑当代 ED 结构是否能满足老年患者的特殊需求和特点。对于医疗保健提供者如何感知和体验老年 ED 患者的护理，知之甚少。本研究旨在深入了解与老年 ED 患者合作的医疗保健提供者的观点，并探讨他们在日常工作中所面临的挑战。
本研究采用定性研究设计，具有社会建构主义观点和基于扎根理论的方法。数据通过对来自德国柏林不同城市 ED 和附近医疗机构的 25 名医疗保健提供者的定性访谈收集。根据扎根理论方法，确定了类别和核心主题，对其进行了分析和解释，以全面了解医疗保健提供者的观点。
访谈揭示了老年 ED 患者对医疗保健提供者的重要性和相关性日益增加。然而，对于“老年患者”并没有共同的定义。大多数受访者认为 ED 结构不适合老年患者。他们描述了 ED 中的一些具体挑战，例如信息收集和安全风险，以及在照顾老年患者时增加的资源（时间和人员）使用。此外，还涉及与其他专业和机构的合作中存在的具体问题，如疗养院、医院病房、会诊和医院社会服务。
医疗保健提供者认为当代 ED 与老年患者的特殊需求之间存在结构不匹配。他们意识到老年患者的脆弱性，并试图弥补内在的结构缺陷。这种结构和有限的资源往往会导致实际、组织和伦理问题。非常需要制定、实施和评估系统的方法和护理概念，以解决老年患者 ED 护理的特殊性。
