Older People´s Perceptions of Quality of Care in the Emergency Department

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Arvo building, Jarmo Visakorpi auditorium, address: Arvo Ylpön katu 34.


Doctoral defence of Lic.Med. Elina Mylläri

Päivystyshoidon laatu iäkkäiden potilaiden kokemana (Older People´s Perceptions of Quality of Care in the Emergency Department)

The field of science of the dissertation is Geriatrics.

The opponent is professor Eija Lönnroos (University of Eastern Finland). Professor Jaakko Valvanne acts as the custos.

The language of the dissertation defence is Finnish.

Variation in Perceived Quality of Geriatric Emergency Care

At best, older adults visiting emergency department (ED) get good quality care and exactly the help they needs. At worst, they suffer from feelings of being left alone, lack of information, anxiety, uncomfortable circumstances and inadequate symptom relief. The quality of emergency care experienced by older patients varies greatly from patient to another and from ED visit to another.

Aim of the study was to explore how older adults perceive an ED visit and how well their personal experiences coincide with their perceptions of good quality care. According to the study’s findings, good quality care consists of five major factors: accessibility of care; care that proceeds in a meaningful way and results in a desirable outcome; patient´s well-being during the ED visit; positive interaction between patient and staff; and that ED users’ different needs are taken equally into account. Whether or not these criteria were fulfilled varied considerably, and was determined by ED overcrowding, other patients´ need for staff´s attention, the staff’s procedures, and happenstance.

In the study, 21 older (aged 74–94) adults, who had visited an urban ED in Tampere, Finland, were interviewed. Qualitative semi-structured interviews along with qualitative content analysis and membership categorization analysis were utilized.

According to the study’s findings, older adults came to the ED because they felt an imperative need for help. The decision was either supported or held back by perceptions regarding presence or absence of alternatives, as well as trust or distrust in receiving adequate help in the ED. Opinions of the interviewees’ next of kin and healthcare professionals often had considerable significance.

During a typical ED visit, a larger proportion of time was spent by waiting than by being examined and receiving treatment. The interviewees had varying experiences of symptom relief and whether or not they felt safe. Many of the patients suffered from thirst and hunger. The interviewees appreciated access to information and other forms of participation, but the level of participation was usually not determined by the patient’s capabilities and desires, but by the staff and by the current situation in the ED.

The interviewees had a lot of confidence in the staff’s competence. They had both positive and negative experiences regarding interaction with members of staff. For instance, compassion, kindness, and taking the patient’s concerns seriously were considered manifestations of positive interaction, whereas negative interaction was manifested, for example, as lack of interest, rudeness, and a conveyor belt-like action. Other patients in the ED also had a significant effect on the interviewees’ experiences of the ED visit. According to the interviewees’ perceptions, the staff resources in the ED were insufficient, the order in which patients were seen was somewhat difficult to understand, and the most vulnerable patients’ special needs weren’t taken adequately into account. Nevertheless, most of the interviewees felt that as a result of the ED visit they had received the help they had originally been seeking.  

The study’s findings can be utilized when improving the quality of emergency care for older patients.


The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2296, Tampere University Press, Tampere 2017. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1799, Tampere University Press 2017.

The dissertation can be ordered at: Juvenes e-bookstore or by e-mail: verkkokauppa@juvenesprint.fi.

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