The perceptions of frail older adults on contributing factors causing the onset of crises leading to hospital admissions; a qualitative study

Abstract Background Frail older adults living alone are frequently admitted to the emergency department (ED) with a chronic disease exacerbation and are at high risk for adverse outcomes like morbidity and mortality. The aim of this study was to explore the perceptions of frail patients who lived alone, on possible contributing factors causing a health crisis as perceived in the approximately nine months leading up to an ED-visit, and to create a combined patient journey map. Method An exploratory-descriptive qualitative study was conducted, using purposive sampling to recruit frail older patients of an urban academic ED. Semi-structured interviews were performed and analysed by thematic analysis. Patient journey mapping was used to identify, combine, and depict chronological similarities. Results Fifteen interviews contained five themes: ‘continuity of healthcare’, ‘self-perception on frailty’, ‘self-management’, ‘impact of support system within an urban environment’, and ‘acute event prior to ED-visit’. The patient journey map identified uncoordinated care by healthcare providers, deterioration from at least six months before the ED-visit, and an unexpected event that leads to an acute health problem four weeks prior to the ED-visit. Conclusion While patients were aware of the health event leading to the acute hospitalization, they were less aware of the impact of contributing cascading events in the months before. The journey map suggest strategies can be applied to inform older adults, be more patient-oriented, and provide an anticipated plan towards advance care, healthy ageing, and admission avoidance.