Older Adults' Experiences and Expectations of Doctor–Patient Interactions During Early Hospital Care

Abstract

Background: ‘People-centered care’ is one of the World Health Organization's six defining features of quality care and recognizes the importance of tailoring healthcare to individual needs. This is particularly important for older patients who are more vulnerable to complications during their hospitalization. The initial medical assessment in hospital is a vital part of any admission, however, the older patient's experience of this is not well understood. Objective: The aim of this study was to investigate the perspectives of older patients, exploring their experience and expectations during these critical encounters. Methods: This was a qualitative study. Semi-structured interviews were conducted at a major teaching hospital in Sydney, Australia with adult inpatients who were > 75 years old, admitted from the Emergency Department, and had multimorbidity, polypharmacy or frailty. Interviews were transcribed and data were thematically analyzed. Results: The 20 study participants had a median (range) age of 85 (75–95) years and 13 (65%) were frail. Six themes were identified: (1) addressing the presenting complaint, (2) implicit trust, (3) being understood as an individual, (4) kindness and respect, (5) well-informed and sometimes shared decision-making and (6) willingness for challenging conversations. Conclusions: Our findings highlight that older patients expect holistic and individualized care, extending beyond clinical expertise to encompass key professional and interpersonal characteristics such as effective communication, respect and kindness. The next steps are developing ways to upskill doctors in these aspects and involve older people in the development of training and standards to support the delivery of medical care that aligns with their experiences, expectations and preferences. Patient or Public Contribution: The study design and interview guide were shaped by feedback from a patient and public involvement (PPI) workshop, which informed the interview process. Study findings were also shared with a PPI panel, whose insights were incorporated into this manuscript. As part of a larger research program, these findings will contribute to the co-design of educational interventions aimed at improving health professionals' assessment and management of older hospital patients.