Hallways Feel Like Homelessness: The Geriatric Boarder Experience.

Background: Boarding in the Emergency Department (ED) is associated with increased delirium, morbidity, and mortality. Geriatric patients are especially vulnerable to these harms and are more likely to board for a prolonged time. Although multiple studies have investigated clinical outcomes for older adults, we present the first study examining the subjective experience of geriatric boarders through qualitative methods.

Methods: We conducted semi-structured interviews between June 2024 and July 2024 at a large urban academic hospital. We recruited patients over the age of 65 boarding in the ED for over four hours after an inpatient bed request. Patients were located in hallway care spaces, ED rooms, or in a dedicated unit for ED boarding patients. Interviews were transcribed, coded, and discussed for themes using grounded theory. We halted interviews when we reached thematic saturation.

Results: We recruited 26 participants (mean age 77). Four themes emerged: (1) Care space location matters, and border units are far preferable to hallways, (2) patients were able to compartmentalize the kindness of the hospital staff and quality of medical care from their environment, (3) boarding elicits feelings of powerlessness, and (4) older adults felt acuity of condition and dementia or frailty, rather than age, should determine who should be prioritized for an inpatient room.

Conclusion: Our sample of older adults felt stressed and powerless while boarding. They especially struggled in hallway care spaces and preferred dedicated units for boarding. They felt comorbidities and acuity of condition should determine prioritization for inpatient beds rather than age. These insights can help guide health systems how to improve the boarding experience for geriatric patients. More research is needed to understand the older adult's experience boarding in the ED and how to improve it.