Title : Complicated versus complexity: When elderly Esther and her daughter meet the health Care System
Background: Detecting infection in frail elderly is a challenge due to lack of specific signs and symptoms. We highlight the complex situation when an elderly woman (Esther) with urinary tract infection (UTI) and her daughter (Maria) meet the highly qualified health care system.
Aim: To describe and analyze the process when an elderly individual with an acute infection meet the medical system.
Method: A descriptive, retrospective Single Case Study design with a qualitative content analysis approach was used. Data from interviews with Esther and Maria, medical record-data and different regulatory documents were gathered and analysed with a qualitative content analysis. In a second step, the results were interpreted with concepts from the complexity theory.
Result: For Maria the situation causes a life crisis and a threat to her entire existence. Esther herself does not take part in what is happening, though after returning to home she is trying to understand her behaviour and what has happened. The health care tries different diagnoses and treatment according to standardized care plans without success. When urinary tract infection is finally diagnosed and treated successfully, Esther recovers quickly.
Conclusion: When patients and their next of kin seek health- care they expect a holistic approach in the encounter. Though, the system tries to reduce the complex situation by handling the patient at a complicated level. This is what we found with Esther. In the medical record she is reduced to a physical body, measurable with biochemical markers, ending up as a “green”, i. e not prioritized patient at the emergency apartment. Guidelines on priority setting should provide a guarantee for patients with the greatest need to be first in line to receive care. Shortcomings are that elderly with multiple disorders and very old individuals are difficult to evaluate and triage “correctly” for later placement in the appropriate continuum of care.