Unmet Needs and Barriers in Providing Hospital Care for Older Adults: A Qualitative Study Using the Age-Friendly Health System Framework

Abstract

Youngseok Yi,1 Yura Lee,2 Selin Kang,3 Young Hye Kwon,4 Yeon Mi Seo,4 Ji Yeon Baek,1 Il-Young Jang,1 Eunju Lee,1 Younsuck Koh,5 Hee-Won Jung,1,* Chan Mi Park6,* 1Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; 2Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; 3Department of Economics, The Graduate School, Yonsei University, Seoul, South Korea; 4Department of Nursing, Asan Medical Center, Seoul, South Korea; 5Department of Pulmonary and Critical Care Medicine, Health Screening and Promotion Center, Asan Medical Center, Seoul, South Korea; 6Marcus Institute for Aging Research, Hebrew Senior Life, Harvard Medical School, Boston, MA, USA*These authors contributed equally to this workCorrespondence: Chan Mi Park, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, 1200 Centre Street, Boston, MA, 02131, USA, Tel [phone], Email [email protected] Hee-Won Jung, Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea, Tel [phone], Email [email protected]: This study aims to identify unmet needs and barriers for improving inpatient care for older adults at an academic hospital in Korea by using a qualitative focus group design and the Age-Friendly Health Systems (AFHS) framework.Patients and Methods: A total of 14 healthcare providers and employees participated in focus group interviews. Participants included medical doctors, registered nurses, a receptionist, a patient transporter, a pharmacist, a physical therapist, and a social worker. The data were analyzed qualitatively, as per the Consolidated Criteria for Reporting Qualitative Research guidelines. The analysis method encompassed a thematic framework analysis via the AFHS 4Ms framework, consisting of the four domains “What Matters”, “Medication”, “Mentation”, and “Mobility”.Results: Multiple barriers and unmet needs were identified using the AFHS 4Ms framework in the provision of inpatient care for older adults at the hospital. The main barriers identified in the “What matters” domain are a lack of shared decision-making and individualized care plans, as well as economic and safety-conscious preferences among some older patients. In the “Medications” domain, the main barriers to providing adequate and safe pharmacotherapy include patient and caregiver-related factors, increased complexity of medication use, and lack of institutional support systems. In the “Mentation” domain, the main issues identified are communication barriers related to patients, caregiver factors, and insufficient delirium management due to a lack of adequate processes/environments such as delirium identification. In the “Mobility” domain, the main challenges include reduced mobility and geriatric complications, unnecessary mobility restrictions, and the increased risk of falls due to lack of resources and environmental factors.Conclusion: The study highlighted the need for improvements in inpatient care for older adults at an academic hospital in Korea. Identified unmet needs and barriers can be used to guide a more patient-centered approaches for an age-friendly inpatient environment.Keywords: geriatrics, age-friendly health systems, 4M framework, patient-centered care, geriatric adverse outcomes

Keywords

• geriatrics
• age-friendly health systems
• 4m framework
• patient-centered care
• geriatric adverse outcomes