Perceptions of Frail Older Adults on Contributing Factors Causing the Onset of Crises Leading to Hospital Admissions: A Qualitative Study

AimTo explore frail older people's perceptions of factors contributing to a health crisis, describe similarities and depict these in a chronological, aggregated patient journey map.DesignAn exploratory-descriptive qualitative study.MethodsFrail older patients visiting the emergency department of a metropolitan academic hospital in the Netherlands during the first 6 months of 2021 were recruited by purposive sampling. Semi-structured interviews were conducted and analysed thematically. Patient journey mapping was used to identify, combine and depict chronological similarities in perceptions.ResultsFifteen interviews contained five themes: continuity of healthcare, self-perception on frailty, self-management, impact of support system within an urban environment and acute event before the emergency department visit. The patient journey map identified uncoordinated care by healthcare providers, deterioration from at least 6 months before the emergency department visit and a time demarcation at 4 weeks before the emergency department visit with an unexpected event leading to an acute health problem.ConclusionWhile patients were aware of the health event leading to the acute hospitalisation, they were less aware of the impact of contributing cascading events in the months before. The journey map suggests that 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.ImpactFindings showed contributing factors to a health crisis were not interpreted accordingly, creating a cascade of problems, difficult to counter when someone is already frail. By generating knowledge, standardising frequent assessments of daily life and intervening at an earlier stage by making use of the patient journey map, the risk of a potential crisis and hospitalisation could be reduced or even avoided.Reporting MethodCOREQ (COnsolidated criteria for REporting Qualitative research).Patient or Public ContributionNo patient or public contribution.