A study of attendance trends and care experiences of older people with mental health needs in Emergency Medical Services settings

Background: Older people with mental health needs are at risk of not having their needs met in acute care settings. An ageing society with rising numbers of older people will present challenges to care provision in the Emergency Medical Services to this vulnerable group of people particularly when staff are trying to provide person-centred care. Aim: The aim of the study was to describe and analyse attendance trends and explore the care experience of older people with mental health needs in pre-hospital and in-hospital Emergency Medical Services settings. Method: This study has used a sequential mixed methods design. Stage one was a quantitative retrospective exploration of National Health Service data on emergency department attendances in Northern Ireland. This online chart data was analysed using descriptive, correlational and inferential statistics. Stage two utilised an interpretive qualitative approach incorporating in-depth, individual interviews to gather information on the experience of the EMS staff, the older person with mental health needs and carers/partners. Data were analysed using Braun and Clarke's (2006) thematic analysis. Results: 74,766 attendances were examined in stage one and significant differences were found in the experiences of the total sample of all older people and the sub-sample of older people with mental health needs. Interviews were completed with Emergency Medical Services staff (n=21), older people with mental health needs (n=10) and with carers/partners (n=5). Themes surrounding support, time, the environment, prioritisation of care needs, perceptions and experiences of older people with mental health needs and planning for the future were illuminated. Conclusions: The results suggest that older people with mental health needs experience an inequality of care provision in the Emergency Medical Services setting. They wait longer than the older person without mental health needs, rely heavily on the ambulance service and experience loneliness and isolation. Stigma still exists for the older person and they remain reluctant to discuss or disclose their diagnosis in the Emergency Medical Services setting. Health and social care systems and services need to undergo transformations to ensure that all people who access services are treated fairly and effectively.