The Impact of Emergency Care on Health-Related Quality of Life for Older Adults in the Emergency Department: A Qualitative Study

Emergency departments are often faced with addressing older adults’ complex physical, mental, and social health-related needs without optimal resources or protocols. This study aimed to characterize older adults’ understanding of how emergency care can support the three major dimensions of Health-Related Quality of Life (HRQoL): physical health, mental health, and social health, as a key step to for EDs to develop effective practices and policies.

We conducted a qualitative study of adults aged ≥65 who presented to a large urban ED with a Geriatric Emergency Department (GED) program. Open ended survey questions asking about the impact of emergency care on physical, mental, and social health. Responses were obtained via telephone or online survey 7-12 days after an ED visit. Telephone responses were transcribed verbatim. Data were analyzed using inductive thematic analysis with iterative coding and theme development, supported by Dedoose software.

A total of 249 participants completed the survey. Mean age was 75.6 years (SD 7.2); 61% were female. Participants were 44% non-Hispanic white, 43% were Black, and 6% Hispanic. Most participants (68%) were hospitalized following the ED visit. Three thematic domains shaped participants’ perceptions. (1) Medical care as the central purpose of the ED: Participants emphasized diagnosis, treatment, and clinical decision-making as primary contributors to physical wellbeing. (2) The ED as a waypoint facilitating ongoing care: Patients viewed the ED as a bridge to hospitalization or safe discharge, highlighting the importance of referrals, monitoring, and transition planning. (3) Emotional support during the ED visit was strong, while broader social needs were less addressed and generally not expected: Participants described staff as reassuring and effective in reducing acute anxiety, whereas ongoing emotional or relational needs were viewed as outside the ED’s role.

In addition to high quality medical care, older adults identified key aspects of transitions of care and emotional support as important ways emergency care can improve their HRQoL. These themes can inform GED practices and policies which aligned with priorities of older adult patients.