Hallways Feel Like Homelessness: The Geriatric Boarder Experience.

Area of Science:

• Geriatric Medicine
• Health Services Research
• Qualitative Research

Background:

• Emergency Department (ED) boarding is linked to adverse outcomes, particularly for vulnerable older adults.
• Geriatric patients face prolonged ED boarding and are disproportionately affected by its harms.
• This study uniquely explores the subjective experiences of geriatric patients during ED boarding using qualitative methods.

Purpose of the Study:

• To investigate the lived experiences of geriatric patients experiencing prolonged stays in the Emergency Department.
• To identify key themes and challenges faced by older adults during ED boarding.
• To inform strategies for improving the care environment and patient experience for this population.

Main Methods:

• Semi-structured interviews were conducted with 26 patients aged 65+ boarding in the ED for over four hours.
• Participants were located in various ED care spaces, including hallways and dedicated boarding units.
• Grounded theory was used for thematic analysis of transcribed interviews until saturation.

Main Results:

• Four major themes emerged: the importance of care space location (dedicated units preferred over hallways), the ability to separate care quality from environment, feelings of powerlessness, and a desire for prioritization based on medical acuity rather than age.
• Patients reported feeling stressed and powerless, particularly when cared for in hallway spaces.
• A strong preference for dedicated boarding units over hallway care was evident.

Conclusions:

• Older adults experience significant stress and powerlessness during ED boarding, with care space location being a critical factor.
• Prioritization for inpatient beds should consider patient acuity, frailty, and comorbidities over chronological age.
• Findings offer insights for health systems to enhance the ED boarding experience for geriatric patients, highlighting the need for further research.