• Mary Lou Kelley, Belinda Parke, Nancy Jokinen, Michael Stones, and Donna Renaud.
• Centre for Education and Research on Aging and Health, Lakehead University, Ontario, Canada. mlkelley@lakehead.ca
• J Health Serv Res Policy. 2011 Jan 1;16(1):6-12.

Objectivesto assess the environment of an emergency department (ED) and its impact on care of adults aged 75 and over, using a 'senior-friendly' conceptual framework that included the physical environment, social climate, hospital policies and procedures, and wider health care system.Methodsin this focused ethnography, we collected and analysed data from the ED of a regional acute care hospital located in Ontario, Canada from October 2007 to January 2008. Data collection included interviews with seniors or their proxy decision-makers, staff and key community informants; on-site observations; a staff survey; and hospital administrative data. Data sets were individually analysed and a synthesis of findings developed to formulate recommendations for policy, practice and education.Resultsstaff expressed their vision of providing senior-friendly care. However, the ED was fast-paced, overcrowded, chaotic and lacked orientation and wayfinding cues, as well as appropriate equipment and furniture, all of which created barriers to providing appropriate care. Seniors' expectations often went unmet and staff expressed moral angst at recognizing unmet needs. Some hospital policies and procedures compounded these difficulties, including hallway practice, lack of off-hour access to multidisciplinary health care professionals, and the inability of patients to access food and drink. Better communication and coordination between the ED and other components of the health care system are needed.Conclusionsthe ED is an important part of seniors' health care. Changes to policy and practices, and enhanced education must occur to better meet the complex health care needs of seniors. This assessment provides a method that can be replicated elsewhere to generate site-specific recommendations and initiate capacity development processes to enhance senior-friendly care.The Royal Society of Medicine Press Ltd 2011.

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