title: The older patient's experience of encountering professional carers and close relatives during an acute confusional state: an interview study.
abstract: BACKGROUND
  Acute confusional state (ACS) is a common and difficult condition among older patients with a variety of opinions about how to act when encountering patients with ACS. Few studies to our knowledge have been found exploring the encounter from the perspective of older patients and their experiences.
  
  
  OBJECTIVE
  The aim of this study was to understand the experiences of older patients with ACS when encountering professional carers and close relatives.
  
  
  METHODS
  In order to understand older patients' experiences of encounters during their ACS a latent qualitative content analysis was used.
  
  
  METHODS
  The data collection took place at two geriatric wards in an emergency hospital in a metropolitan area.
  
  
  METHODS
  The inclusion criteria included being aged 65 years or older and having suffered from ACS, according to the DSM-IV criteria, and having regained lucidity. Participants were being cared for at one of two geriatric wards. Patients diagnosed with dementia were excluded. About 150 patients were screened, 67 patients fulfilled the inclusion criteria and seven patients were included in the study, four females and three males, aged between 78 and 98 years.
  
  
  METHODS
  Data were collected by interviews.
  
  
  RESULTS
  Three themes were found, namely; 'Feeling lonely within the perceived reality of ACS', with three sub-themes: the unequal encounter, keeping a distance and being an outsider; 'striving towards understanding' with two sub-themes: searching for answers and it takes time to understand; and 'feelings of participation in the encounter' with two sub-themes: a mutual understanding and feeling safe and supported.
  
  
  CONCLUSIONS
  Within the encounter the older patients with ACS are searching for answers to what is happening and why. The patients feel dependent on the persons they encounter and their willingness to understand and communicate. The patients also feel lonely, unnecessarily questioned and untrustworthy; but they can also feel safe, trusted and understood.
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden. ewa.stenwall@mdh.se
authors.forename: Ewa
authors.initials: E
authors.lastname: Stenwall
authors.forename: Maria Eriksdotter
authors.initials: ME
authors.lastname: Jönhagen
authors.forename: Jonas
authors.initials: J
authors.lastname: Sandberg
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Fagerberg
mesh_terms: D000208:Acute Disease; D000223:Adaptation, Psychological; D000368:Aged / Q000523:psychology*; D000369:Aged, 80 and over; D001294:Attitude to Health; D003142:Communication; D032882:Comprehension; D003221:Confusion / Q000451:nursing / Q000517:prevention & control / Q000523:psychology*; D005190:Family / Q000523:psychology*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D007398:Interpersonal Relations; D008132:Loneliness / Q000523:psychology; D008297:Male; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000523:psychology*; D036301:Qualitative Research; D012449:Safety; D012944:Social Support; D011795:Surveys and Questionnaires; D013548:Sweden; D035502:Trust