Community dwelling older adults' decision to, and experience of attending the Emergency Department during COVID-19: a qualitative study.

Background: The COVID-19 pandemic resulted in a decrease in emergency department (ED) visits, particularly among older adults. The objective of this study is to explore the experiences of older adults attending the ED during COVID-19.

Methods: The study utilised a qualitative descriptive approach as part of a larger mixed-methods study. Data were collected at five different ED's in Ireland, which represented both urban and rural populations. The participants were all aged over 65 years. Semi-structured phone interviews were conducted up to 10 days after attending the ED and the interviews were audio-recorded. The interviews were transcribed and imported to NVivo software, and the data was analysed using reflexive thematic analysis.

Results: 16 interviews were conducted with older adults over 65 years. Three themes were generated following thematic analysis: Complexity of decision making regarding the ED attendance (theme 1), Quality and timeliness of care in the ED (theme 2), Communication with and empathy towards healthcare staff in the ED (theme 3). The COVID-19 pandemic had a significant impact on the decision-making process and pathway for older adults seeking emergency medical care. Despite the challenges, older adults reported a positive experience in the ED. This was attributed to improved conditions, including shorter triage waiting times and the implementation of COVID-19 protocols. Participants demonstrated resilience and expressed gratitude for the care they received. However, for some participants it was noted there was a reluctance to express any dissatisfaction or complain about the care they received while in the ED. The study also highlighted concerns regarding discharge information and follow-up care for the older adult.

Conclusion: The findings demonstrate that ED healthcare providers provided quality and timely care to older adults in the ED during COVID-19. However, the need for clear communication and information sharing from healthcare providers on ED discharge and across transitions of care was highlighted as an area needing improvement.