Healthcare access and care experiences among adults aged 80 years and older: a qualitative study

Abstract

Background

Population aging is increasing worldwide, and adults aged 80 years and older represent a growing group with complex healthcare needs. Although healthcare access among older adults has been widely discussed, qualitative evidence focusing specifically on the experiences of adults aged 80 years and older remains relatively limited. This study aimed to explore healthcare access and care experiences among adults aged 80 years and older attending a Healthy Aging Center within a university-affiliated tertiary care hospital in Türkiye.

Methods

This qualitative study included adults aged 80 years and older. Participants were recruited using purposive sampling to seek variation in age, sex, educational background, and living arrangement. Data were collected through face-to-face, audio-recorded semi-structured interviews and analyzed using thematic analysis. Recruitment was discontinued when the dataset was considered sufficiently coherent and well supported to address the study aim and additional interviews were unlikely to materially alter the developing thematic structure.

Results

Seven main themes were identified: access through appointment and digital systems, physical and transportation burden in reaching care, family support as an enabler of access, communication as a source of trust and feeling valued, hospital processes as a source of physical and organizational burden, expectations for priority, guidance, and age-sensitive care, and positive system appraisals alongside persistent barriers. Participants described healthcare access and care experiences as conditional and multidimensional. Difficulties in obtaining timely appointments, limited ability to use telephone-based or digital appointment systems, physical fatigue, transportation burden, and reliance on family or informal caregiver support shaped access to care. Doctor–patient communication, including being listened to, receiving clear explanations, and being examined, was central to trust and perceived quality of care. Crowding, waiting, and navigation difficulties made hospital use physically demanding, while participants also expressed expectations for priority access, guidance, and age-sensitive service arrangements. Positive evaluations of the healthcare system coexisted with reported barriers and were interpreted cautiously rather than as evidence that unmet needs were absent.

Conclusions

Healthcare access among adults aged 80 years and older is shaped by interacting digital, physical, relational, communicative, organizational, and age-related factors. Access was generally not perceived as completely impossible, but as dependent on timely appointments, digital or telephone support, physical capacity, family assistance, and the ability to navigate healthcare processes. These findings highlight the need for age-sensitive healthcare pathways, including simplified appointment systems, support for digital access, physically manageable hospital environments, clear guidance, and respectful communication.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12877-026-08251-7.

Introduction

Population aging is accelerating worldwide and has become a major public health challenge. The World Health Organization estimates that by 2050 the global population aged 60 years and older will double to 2.1 billion, while the number of persons aged 80 years and older is expected to triple between 2020 and 2050, reaching 426 million [1]. Adults aged 80 years and older represent a particularly important subgroup because advancing age is often accompanied by multimorbidity, geriatric syndromes such as frailty, functional decline, and increasing need for coordinated healthcare services [2, 3]. Ensuring equitable and age-sensitive access to healthcare for this population has therefore become an important public health priority.

Access to healthcare is a multidimensional process shaped by the interface between individuals, households, communities, healthcare organizations, providers, and the broader health system [4]. In this study, healthcare access was understood not only as service availability, but also as older adults’ practical ability to seek, reach, enter, navigate, engage with, and complete care. Within this framework, communication with healthcare professionals, the hospital environment, and perceptions of care were considered relevant because they shape whether healthcare is usable, acceptable, and practically manageable for adults aged 80 years and older. In older adults, this process is frequently constrained by reduced mobility and transportation-related limitations, which are important determinants of autonomy and service use in later life [5]. Recent qualitative evidence from primary care and health services research further shows that older adults’ ability to navigate healthcare is influenced by physical mobility, literacy and technological literacy, social support, family facilitation, communication with health professionals, fragmentation of services, and the availability of elderly-friendly care [6, 7]. These challenges may become more pronounced with advancing age, particularly among individuals with multimorbidity, frailty, sensory limitations, reduced mobility, or increasing dependence on others.

Digitalization has become an increasingly important strategy for improving healthcare delivery and access, including through online appointment systems, patient portals, and other digital health platforms [8]. However, for older adults, these systems may also create new access barriers when digital health services are difficult to use or when users have limited digital literacy, physical or cognitive limitations, low confidence, insufficient social support, or concerns about trust and privacy [9, 10]. Recent evidence further suggests that the digital divide should be considered a determinant of health among older adults, while digital health and social services need to be designed in ways that reflect older adults’ needs, preferences, and practical capacities [11, 12]. In this context, the digital divide may affect not only access to health information, but also the ability of older adults to initiate, organize, and manage healthcare use independently.

Family support is another important relational determinant of healthcare access in advanced age. Recent qualitative evidence shows that adult children, other family members, and informal caregivers may act as a bridge between older adults and the healthcare system by helping with appointments, digital or telephone communication, access to information, accompaniment, and navigation of services [6]. Informal caregivers have also been described as system navigators and advocates who facilitate more seamless and timely access to community and healthcare services for older adults [13, 14]. However, family-mediated access has a dual character: it can make care easier, faster, and emotionally safer, while also making healthcare use contingent on family members’ or informal caregivers’ availability and potentially reducing older adults’ perceived autonomy or increasing concerns about being a burden [6, 13, 15]. This issue is particularly relevant for adults aged 80 years and older, among whom reliance on family caregivers for hospital visits and daily support remains common [16].

Doctor–patient communication also plays a central role in healthcare experiences. Effective clinician–patient communication may influence health outcomes through improved understanding, shared decision-making, therapeutic alliance, patient agency, trust, and emotional support [17]. In older adults, high-quality communication is particularly important because age-related sensory, cognitive, functional, and psychosocial changes may affect how patients understand information, express concerns, and participate in care [18]. Being listened to, receiving clear and understandable explanations, feeling respected, and being involved in decisions are therefore key components of person-centered care for older adults, especially those with chronic conditions or functional limitations [19, 20]. For adults aged 80 years and older, communication may be closely linked not only to understanding medical information, but also to trust, dignity, and emotional safety during healthcare encounters.

Although a growing body of research has examined healthcare access barriers among older adults, much of this literature addresses older populations as a broad age group, commonly defined as adults aged 60 or 65 years and above [21]. Existing studies have identified important barriers such as reduced mobility, lack of information, fragmented care processes, communication difficulties, limited guidance, and insufficient age-friendly services [7, 22] However, qualitative studies focusing specifically on adults aged 80 years and older remain relatively limited, and existing research in this age group has more often examined help-seeking behavior, hospital care quality, or post-discharge experiences rather than healthcare access as an integrated process [23, 24]. Moreover, the combined effects of appointment systems, digital access, physical mobility, family-mediated support, hospital navigation, doctor–patient communication, and age-related expectations have been less often explored together in this age group.

In this context, the present study aimed to explore healthcare access and care experiences among adults aged 80 years and older attending the Healthy Aging Center of a university-affiliated tertiary care hospital in Türkiye. By focusing on adults aged 80 years and older and examining access as embedded within the wider care process, this study provides a comprehensive qualitative account of how this age group enters, navigates, experiences, and evaluates healthcare services. The sample included 4 participants aged 80–84 years and 13 participants aged 85 years and older, allowing the study to capture experiences across the defined 80 + study population while also reflecting the predominance of more advanced ages within the sample.

Materials and methods

Research design

This study was designed as a qualitative study using thematic analysis within an interpretivist paradigm. The aim was to explore in depth the healthcare access and care experiences of individuals aged 80 years and older in their real-life healthcare context. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist [25].

Study setting

The study was conducted at the Healthy Aging Center of a university-affiliated tertiary care hospital in Türkiye. In this context, tertiary care refers to specialist hospital-based care provided within a higher-level healthcare setting, rather than primary or community-based care. The center provides comprehensive geriatric assessment, preventive care, chronic disease follow-up, and multidisciplinary support for community-dwelling older adults and represents an appropriate setting to explore healthcare access and care experiences among individuals in advanced age.

Participants and sampling

Participants were selected from individuals aged 80 years and older who were registered at the Healthy Aging Center. Purposive sampling was used to seek variation in participants’ age, sex, living arrangement, and educational level.

Eligibility criteria were being aged 80 years or older and being able to participate meaningfully in a face-to-face interview. Individuals who were unable to participate meaningfully in the interview because of evident cognitive or communication difficulties were excluded. Interview capacity was assessed by the researcher during the face-to-face screening encounter based on communication ability, orientation, understanding of the study information, and ability to provide coherent responses. No formal cognitive screening instrument was used for this purpose.

Thirty individuals aged 80 years or older were initially approached and screened for eligibility at the Healthy Aging Center. Thirteen individuals did not meet the eligibility criteria because of difficulties in communication or meaningful interview participation. Seventeen individuals met the eligibility criteria and were subsequently invited to participate; all agreed to take part. No eligible invited individual refused participation. Written informed consent was obtained after eligibility had been confirmed and before the interviews, and was not treated as an eligibility criterion.

Sampling and data collection were conducted concurrently; the stopping decision was based on a pragmatic assessment of data adequacy, as described in the Data analysis section.

Data collection

Data were collected between 15 March 2026 and 30 April 2026 through face-to-face, semi-structured interviews. All interviews were conducted by the same researcher (M.V.). A semi-structured format was chosen to ensure consistency across participants while allowing flexibility to explore individual experiences in depth.

The semi-structured interview guide was developed by the research team based on the study aim, the patient-centered conceptualization of healthcare access described by Levesque et al. [4], relevant qualitative literature on healthcare navigation and access experiences among older adults [6, 7], and clinical experience in family medicine and healthy aging services. The guide included open-ended questions and probing prompts covering broad sensitizing domains related to access to healthcare services, transportation and physical accessibility, appointment systems and digital access, family or informal caregiver support and dependency, access to physicians and consultation, doctor–patient communication, hospital environment and service experience, age-related expectations, financial barriers, home healthcare services, positive and negative healthcare experiences, overall perceptions of the healthcare system, and suggestions for improvement. Before the main data collection, the interview guide was piloted with two older adults who were not included in the final analysis. Based on these pilot interviews and subsequent discussion within the research team, the wording and order of the questions and probing prompts were reviewed and finalized. The full interview guide is provided in Supplementary Table S2.

Interviews were conducted in a quiet and comfortable environment at the center, lasted approximately 30–45 min, and were audio-recorded with participants’ consent. All interviews were conducted one-to-one, and no relatives or accompanying persons were present during the interviews. Field notes were also taken during and immediately after interviews to capture contextual observations. Participants were encouraged to describe both current and previous healthcare experiences in their own words.

Data analysis

Data were analyzed using a hybrid deductive–inductive, primarily semantic thematic analysis approach informed by Braun and Clarke’s six-phase framework [26]. The broad domains of the semi-structured interview guide served as initial sensitizing concepts and therefore provided a limited deductive orientation to the analysis. However, coding was not restricted to these predefined domains. Initial codes were also developed inductively through repeated engagement with the interview transcripts, allowing patterns not explicitly represented in the interview guide to be identified. Theme development therefore involved both consideration of the study’s predefined areas of interest and iterative refinement of patterns emerging from participants’ accounts. The analysis remained primarily semantic, focusing on the explicit meanings expressed by participants rather than developing predominantly latent interpretations.

Data adequacy was assessed pragmatically during concurrent sampling and analysis. Recruitment was discontinued when additional interviews no longer generated substantially new codes or patterns relevant to the study aim and the developing thematic structure was considered sufficiently coherent and well supported by the dataset. This decision was not interpreted as indicating that all possible meanings had been exhausted, but rather as a pragmatic assessment that further interviews were unlikely to materially alter the main patterns identified in relation to the study aim.

All interviews were transcribed verbatim and analyzed in Turkish. Initial codes were generated by M.V. from the transcripts and compared across participants to identify recurring patterns. NVivo version 12 (QSR International) was used to support data organization and coding. Related codes were grouped into candidate themes, which were then reviewed against the original transcripts and refined through discussion with the research team. During this process, conceptually overlapping codes and categories were refined, and categories that initially reflected broad interview topics were revised to better capture shared patterns of meaning across participants’ accounts.

The final themes therefore did not represent a direct reproduction of the interview guide, but reflected analytically refined patterns concerning how participants sought, reached, navigated, experienced, and evaluated healthcare services. Representative quotations were selected to support each theme and subtheme after theme development. The analysis was conducted on the original Turkish transcripts, and only selected quotations were translated into English for reporting purposes. The initial translation was performed by M.V. and then reviewed by the research team to ensure that the linguistic meaning, cultural context, and tone of participants’ accounts were preserved as closely as possible.

Researcher reflexivity

The interviews were conducted by M.V., a male family physician with experience in the care of older adults. Participants had no established professional or personal relationship with the interviewer before recruitment. However, the interviewer’s physician role may have influenced how participants described healthcare professionals, hospital services, or the health system. In particular, expressions of satisfaction, gratitude, or reluctance to criticize services may partly reflect courtesy, respect for physicians, social desirability, or the interview context.

To address this possibility, the interview guide included open-ended questions and probing prompts, and participants were encouraged to describe both positive and negative healthcare experiences in their own words. During analysis, positive appraisals of care were interpreted cautiously and considered alongside reported barriers, unmet needs, and possible interviewer influence. Analytical discussions also included consideration of how the researchers’ professional perspectives and assumptions could shape theme development and interpretation.

Trustworthiness

Several strategies were used to enhance the trustworthiness of the study. Credibility was supported through face-to-face interviews, the use of open-ended questions and probing prompts, verbatim quotations, and iterative comparison between codes, candidate themes, and the original transcripts. Dependability was supported by using a semi-structured interview guide, conducting all interviews by the same researcher, applying a systematic and iterative analytical process, and reviewing coding decisions and theme development within the research team. Confirmability was supported through reflexive consideration of the researchers’ professional perspectives and assumptions, team discussions of interpretive decisions, and cautious interpretation of positive appraisals alongside reported barriers and possible interviewer influence. Transferability was supported by purposive sampling with variation in participants’ age, sex, living arrangement, and educational level, as well as detailed descriptions of the study setting, participant characteristics, sampling and screening procedures, and data collection process. The COREQ checklist guided reporting and enhanced methodological transparency.

Ethical considerations

Ethical approval was obtained from the Trabzon University Faculty of Medicine Non-Interventional Scientific Research Ethics Committee (approval date: 02 March 2026; reference number: 10496660-2026-26013). All participants were informed about the purpose and procedures of the study, and written informed consent was obtained before the interviews. Participation was voluntary, and confidentiality was maintained throughout the study. Identifying information was removed from transcripts and quotations. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Results

The final sample consisted of 17 participants aged 82–95 years. Nine participants were female and eight were male; 13 lived with family and 4 lived alone. Four participants were aged 80–84 years, and 13 participants were aged 85 years and older (Table 1).

Table 1.

Demographic characteristics of participants (n = 17)

Participant	Age	Sex	Living Situation	Education Level
P1	85	Female	With family	Illiterate
P2	90	Female	With family	Illiterate
P3	87	Male	With family	Literate
P4	87	Female	With family	Literate
P5	95	Female	With family	Illiterate
P6	86	Female	With family	Literate
P7	83	Male	Alone	High school
P8	84	Male	With family	Primary school
P9	84	Male	Alone	Primary school
P10	90	Male	Alone	Primary school
P11	92	Female	With family	Illiterate
P12	89	Female	With family	Literate
P13	87	Female	With family	Illiterate
P14	85	Female	With family	Illiterate
P15	95	Male	With family	Literate
P16	89	Male	With family	Literate
P17	82	Male	Alone	Associate degree

The thematic analysis identified seven main themes. These themes reflected not only areas of discussion but also recurring patterns in how participants described seeking, reaching, navigating, experiencing, and evaluating healthcare services in advanced age. Detailed themes, subthemes, and key findings are summarized in Table 2, and representative verbatim quotations supporting each theme are provided in Supplementary Table S1.

Table 2.

Themes, subthemes and key findings

Themes	Subthemes	Key Findings
Access Through Appointment and Digital Systems	Appointment-related access difficulties; Digital dependency and reduced autonomy	Access often began with the appointment process and the ability to use telephone-based or digital systems. Difficulties obtaining timely appointments, appointment cancellations, and limited digital literacy made access dependent on family or other support.
Physical and Transportation Burden in Reaching Care	Physical fatigue and mobility limitations; Transportation-related access burden	Transportation was experienced as physically demanding when walking difficulties, pain, fatigue, fear of falling, long distances, or public transportation problems limited independent access.
Family Support as an Enabler of Access	Practical family support in accessing care; Family presence as reassurance and guidance	Family members enabled appointment-making, transportation, hospital accompaniment, and navigation. Their presence made access easier and more reassuring, but also made healthcare use dependent on family members’ or informal caregivers’ availability.
Communication as a Source of Trust and Feeling Valued	Being listened to and valued; Clear explanations and trust-building clinical behaviors	Being listened to, receiving clear explanations, respectful communication, and physical examination increased trust and made participants feel valued, whereas insufficient explanations or unanswered questions caused uncertainty and feelings of being undervalued.
Hospital Processes as a Source of Physical and Organizational Burden	Crowding and waiting burden; Navigation and service-process difficulties	Crowding, waiting, insufficient seating, prolonged standing, fragmented service processes, and navigation difficulties made hospital use physically and organizationally demanding for older adults.
Expectations for Priority,Guidance,and Age-Sensitive Care	Priority access for older adults; Guidance and accompaniment needs; Age-specific healthcare arrangements	Participants expected priority access, shorter waiting times, guidance, accompaniment, and age-specific arrangements as ways to reduce confusion, physical strain, dependency, and feelings of being overlooked.
Positive System Appraisals Alongside Persistent Barriers	Positive evaluations of healthcare services; Positive appraisals shaped by past comparisons	Positive appraisals reflected perceived adequacy of healthcare services and comparisons with past experiences, but coexisted with appointment-related, digital, transportation, waiting, and navigation barriers. These accounts were interpreted cautiously rather than as evidence that access problems or unmet needs were absent.

Theme 1: access through appointment and digital systems

Participants described access to healthcare services as closely linked to the appointment process and their ability to use telephone-based or digital appointment systems. Access was not generally experienced as completely impossible; rather, it was described as delayed, inconsistent, and dependent on participants’ capacity to manage appointment-related procedures independently.

Difficulties in obtaining timely appointments were frequently reported. Some participants stated that appointments were given for later dates or that they sometimes had difficulty finding available appointments. In a few cases, appointment cancellations were also described as an additional source of difficulty. These findings suggest that access barriers were not limited to reaching the hospital physically but also began at the stage of entering the healthcare system through appointment mechanisms.

Example quotes

P3 “Sometimes we have difficulty getting an appointment; appointments are given for much later dates.”

P10 “I sometimes have difficulty finding an appointment, but there is usually no problem during the examination itself.”

P16 “Getting an appointment through MHRS and having scheduled appointments cancelled are what make access most difficult for me. I tell my grandson, and he calls 182 or uses e-Nabız to make the appointment. I cannot go to the hospital whenever I want; sometimes I cannot find an appointment.”

Limited digital literacy and difficulty using phones or appointment systems independently further shaped participants’ access experiences. Several participants stated that they could not use phones, online appointment systems, or digital health applications by themselves. This reduced their autonomy in managing healthcare access and made appointment-related processes more difficult, especially for those with limited literacy or unfamiliarity with technology.

Example quotes

P13 “I cannot make appointments like that. I am not literate; I cannot read or write. My son or daughter always makes the appointment. I do not feel difficulty because they handle it, but I trust only my daughter and want to go with her wherever I need to go.”

P12 “I cannot use the phone. The most difficult thing for me is not being able to use it.”

Theme 2: physical and transportation burden in reaching care

Participants described transportation and physical capacity as important determinants of healthcare access. Although most participants were able to reach healthcare facilities, access was often experienced as physically demanding rather than straightforward. Walking difficulties, pain, fatigue, fear of falling, and prolonged standing reduced participants’ ability to access services independently.

Example quotes

P14 “I could not go on foot; I need help. I have difficulty even getting from the house into the car; I have pain and become tired.”

P9 “Because of my herniated disc, long walking or standing for a long time makes it difficult for me.”

Transportation-related difficulties were also reported, particularly among participants who did not have access to a private car or who had to use public transportation. Getting on and off public transport, waiting for buses or minibuses, long distances, and delays during travel made access more tiring and less predictable for older adults. In contrast, coming by private car or having a shorter travel route was described as making healthcare access easier.

Example quotes

P2 “We do not have a private car; public transportation is very difficult, both getting on and off and because the distance is long. I usually go by taxi because it is easier. I cannot go to the hospital whenever I want; we sometimes postpone it according to my children’s work. I cannot go alone; even with help, it is very tiring.”

P10 “Sometimes I come by bus and sometimes by private car. If the bus is late, it becomes difficult.”

P16 “I can walk on my own, but sometimes I get tired from walking or waiting for the minibus or bus.”

Theme 3: family support as an enabler of access

Family members played a central role in enabling participants to access healthcare services. Participants commonly described receiving support from children, grandchildren, in-laws, or other family members when arranging appointments, travelling to healthcare facilities, communicating with the system, and completing hospital-related procedures. In this sense, healthcare access was often not experienced as an entirely individual process, but as a family-mediated process.

Example quotes

P11 “My son and daughter-in-law usually help me; we go together.”

P12 “My daughter and son-in-law take me there.”

P13 “If my son and daughter were not there, it would be very difficult. I could not manage by myself; I am glad they are there.”

Beyond practical help, the presence of family members also provided emotional reassurance and a sense of safety. For some participants, being accompanied by family members made the healthcare process easier, faster, and less confusing. Family presence was particularly important when participants felt uncertain about where to go, how to proceed, or how to manage hospital procedures alone.

Example quotes

P8 “It is easier with my daughter; that is why I come with them. They help me with everything.”

P17 “When my son is with me, the hospital doors open for me. He is a great blessing; when he is with me, things that would take three or four weeks can be solved in one or two days. When I am alone, I sometimes get confused about where to go, and we need a healthcare worker to guide us.”

Theme 4: communication as a source of trust and feeling valued

Participants described doctor–patient communication as a central element shaping their healthcare experience. Being listened to without interruption, receiving clear explanations, and being treated with patience and respect made participants feel valued and reassured. For older adults, communication was not only a matter of information transfer, but also a source of emotional comfort, trust, and dignity within the healthcare encounter.

Example quotes

P16 “When the doctor listens to me, I feel valued and happy.”

P17 “Speaking calmly, looking me in the eye, and not rushing.”

P14 “The behavior that gives the most confidence is being friendly.”

Participants also emphasized that clinical behaviors such as physical examination contributed strongly to trust. Some participants associated being examined with being taken seriously and cared for. In contrast, brief consultations, unanswered questions, insufficient explanations, or perceived lack of attention led to uncertainty, dissatisfaction, and feelings of being undervalued.

Example quotes

P15 “When the doctor listens to us, we feel satisfied and the patient’s psychology improves. Doctors usually give information and explanations. The most confidence-building behavior is examining the patient; many physicians do not touch the patient and send them for blood tests or imaging. When the doctor examines us, we feel trust.”

P10 “Some doctors do not answer my questions. When that happens, I feel undervalued. Once, a doctor prescribed medication without even getting up to examine me properly and then said that my condition was psychological. I was very upset. What hurt me most was feeling judged and not taken seriously.”

Theme 5: hospital processes as a source of physical and organizational burden

Participants described the hospital environment as an important component of their healthcare experience. Crowded outpatient areas, long waiting times, insufficient seating, and prolonged standing increased physical discomfort and fatigue among older adults. Even when healthcare services were considered adequate, the hospital environment could become tiring when it was crowded or when patients had to wait for long periods.

Example quotes

P11 “We complain about the crowding in this hospital. The service is adequate, but it is very crowded. Waiting makes us tired.”

P13 “I waited a lot at the faculty hospital. My back was freezing; I sat on something I found. When I cannot get an appointment, I wait for a long time. I tell my daughter not to bring me there again. This place was good; they did not keep me waiting, and there were enough seats.”

P1 “When it is crowded, I get tired; standing is difficult for me. If there were a special outpatient clinic for people at my age, it would be very good and we would be more comfortable. It would also be good to have someone to guide us, so that we would not get confused.”

Some participants also described service processes within the hospital as fragmented or physically demanding. Moving between tests, medications, control visits, and different units could be tiring, particularly for older adults with reduced mobility. Environmental barriers such as narrow outpatient clinics or difficulties with wheelchair access further shaped participants’ experiences of care.

Example quotes

P7 “Some days, going back and forth between tests, medications, and control visits becomes very tiring.”

P5 “Outpatient clinics are narrow and difficult for older adults. Wheelchair entry and exit are difficult.”

Theme 6: expectations for priority, guidance, and age-sensitive care

Participants expressed expectations that healthcare services should be more responsive to the needs of older adults. These expectations were not limited to receiving faster care; they were also closely related to being respected, valued, protected from unnecessary physical strain, and guided through complex healthcare processes. Priority access was therefore perceived not simply as convenience, but as a form of age-sensitive care.

Example quotes

P2 “They should not make older people wait. There should be a staff member to help them.”

P4 “It would be good if older people were given priority. When we are old, we want to be respected and valued.”

Participants also emphasized the need for guidance and accompaniment within the hospital. For older adults, especially those with hearing difficulties, mobility limitations, or uncertainty about where to go, the presence of a staff member who could guide them through examinations and hospital procedures was perceived as a source of safety and reassurance.

Example quotes

P16 “When we come to the hospital, if there were a staff member to guide us and accompany us during examinations, I would feel much safer and finish my tasks more quickly. Sometimes when I am alone, I forget some things; with a staff member accompanying me, I would not leave anything incomplete. I would also like clinic days dedicated only to us.”

P17 “When we are alone, we need a healthcare worker to guide us.”

Some participants also suggested age-specific healthcare arrangements, such as outpatient clinic days dedicated to older adults or simplified access without the usual appointment burden. These expectations reflected a desire for healthcare services to be organized around the vulnerabilities and practical needs of advanced age.

Example quote

P15 “If there were outpatient clinic days specifically for us, of course we would want that; it would be very good.”

Theme 7: positive system appraisals alongside persistent barriers

Positive evaluations of the healthcare system coexisted with the barriers described in the preceding themes. Several participants described healthcare services as generally adequate, accessible, or improved compared with the past, even when they had also reported appointment difficulties, crowding, waiting, transportation problems, or dependency on family members. These positive appraisals were therefore interpreted cautiously and were not treated as evidence that access problems or unmet needs were absent.

Example quotes

P7 “I generally find it adequate. I have not had any major problem.”

P12 “I do not see any problem; everything is very good.”

P8 “I had no difficulty reaching the hospital, not even in the emergency department. May God be pleased with the state; I am satisfied. I usually come with my daughter, and my granddaughter takes us there and brings us back.”

For some participants, positive evaluations appeared to be shaped by comparisons with previous healthcare experiences, particularly perceived improvements in cleanliness, hospital conditions, and service organization. However, satisfaction and gratitude may also reflect courtesy, low expectations, generational norms, or the influence of being interviewed by a physician. The data do not allow these explanations to be separated definitively. These accounts were therefore interpreted as positive system appraisals that coexisted with persistent barriers, rather than as evidence that access difficulties or unmet needs were absent.

Example quotes

P4 “It is better compared with the past. It used to be dirty; now it is better.”

P6 “Compared with the past, everywhere is very clean and nice.”

Financial barriers and home healthcare services were included in the interview guide and were explored during the interviews. However, these domains did not form sufficiently coherent or analytically distinct patterns of meaning to warrant presentation as standalone themes. They were therefore not presented as separate themes in the final thematic structure.

Discussion

This qualitative study explored healthcare access and care experiences among adults aged 80 years and older attending a Healthy Aging Center in a university-affiliated tertiary care hospital in Türkiye. The principal finding was that healthcare access in advanced age was not experienced as a single event or simply as a matter of service availability. Instead, access depended on a sequence of linked tasks: obtaining an appointment, using or obtaining help with digital and telephone systems, travelling to the hospital, moving through service units, communicating with clinicians, and completing care.

The main interpretive contribution of this study is that healthcare access and care experiences among adults aged 80 years and older should be understood as a cumulative and relational care pathway. In this pathway, digital systems, physical mobility, transportation, family support, hospital navigation, and clinician communication interacted to determine whether care was practically usable and emotionally acceptable. Positive evaluations of services did not negate these barriers; rather, satisfaction and gratitude often coexisted with dependency, fatigue, uncertainty, and the need for guidance.

This interpretation extends previous access frameworks by showing how different stages of access and care may accumulate and interact among adults aged 80 years and older. In the Turkish healthcare context, appointment and digital infrastructures such as MHRS and e-Nabız shaped the first steps of accessing care. For adults aged 80 years and older, these systems may facilitate the organization of care, but they may also create dependence on family members or informal caregivers when digital literacy, telephone use, mobility, or confidence is limited [8, 9]. Access should therefore be understood not only as the availability of services, but also as older adults’ practical capacity to enter, navigate, experience, and complete the care process [4, 6].

The difficulty of obtaining timely appointments and using digital or telephone-based systems was one of the clearest access-related barriers in this study. Participants who were unable to use appointment systems independently often had to rely on others to enter the healthcare system. This finding is consistent with the growing literature on digital health inequalities, which shows that older adults may benefit from digital health services only when these systems are accessible, understandable, and usable for them [9, 12]. Among adults aged 80 years and older, digital exclusion is not merely a technical problem; it may also reduce autonomy, increase dependence on others, and delay access to care [11].

Physical and transportation-related barriers further complicated access. Even when participants were able to obtain appointments, reaching the healthcare facility could be tiring because of pain, walking difficulties, fatigue, fear of falling, waiting for public transportation, or long travel routes [5, 27]. These findings suggest that access should be understood as a full pathway extending from appointment scheduling to physical arrival, movement within the hospital, and completion of care [4]. For adults aged 80 years and older, each step of this pathway may create a cumulative burden [5].

Family support emerged as a major facilitator of healthcare access. Family members helped participants make appointments, arrange transportation, accompany them to hospital, and navigate hospital procedures [6, 13]. This support made healthcare access easier, faster, and emotionally safer [13]. However, the findings also show a delicate balance: while family involvement enabled access, it also meant that healthcare use could become dependent on family members’ or informal caregivers’ availability [6, 13]. Therefore, health systems serving adults aged 80 years and older should not assume that family or informal caregiver support is always available, sufficient, or sustainable.

Doctor–patient communication was another central component of healthcare experience in this study. Participants did not describe communication merely as the transfer of medical information; rather, they associated it with being listened to, respected, reassured, and taken seriously [17, 18]. Calm speech, eye contact, clear explanations, not being rushed, and being physically examined were perceived as behaviors that strengthened trust [17, 18]. These findings suggest that, for adults aged 80 years and older, communication is closely linked to dignity and emotional safety within the clinical encounter [18].

This finding is particularly important in advanced age, where patients may have multiple chronic conditions, sensory limitations, reduced confidence, or fear of not being understood [18, 20]. In such circumstances, insufficient explanations, unanswered questions, or brief consultations may create not only informational uncertainty but also feelings of being undervalued [18]. Therefore, communication quality should be considered a core component of age-sensitive healthcare, rather than a secondary interpersonal issue [18, 20].

The emphasis placed on physical examination is also noteworthy. Some participants interpreted being examined as evidence that the physician cared, paid attention, and took their problem seriously. This suggests that clinical and relational behaviors are closely intertwined in older patients’ experiences of care [17, 18]. For adults aged 80 years and older, a respectful clinical encounter requires not only technical competence, but also visible attentiveness, patience, and embodied forms of care such as careful examination and supportive explanation [18, 20].

The hospital environment also shaped participants’ healthcare experiences after access had been achieved [24]. Crowding, waiting, insufficient seating, prolonged standing, and moving between different units were described as physically tiring and emotionally discouraging [7, 24]. For adults aged 80 years and older, the hospital environment was therefore not a neutral background to care, but an active component of the care experience [24].

These findings suggest that hospital-based care may create cumulative strain for adults aged 80 years and older, particularly when services are crowded, fragmented, or difficult to navigate [7, 24]. Even when participants were satisfied with medical care, the process of waiting, walking through hospital corridors, locating units, and completing sequential procedures could make healthcare use burdensome [24]. This distinction is important because improving clinical care alone may not be sufficient if the physical and organizational environment remains difficult for older patients to manage [4, 7].

The findings also highlight the importance of designing hospital processes around the functional realities of advanced age [28, 29]. Clear signage, adequate seating, shorter walking distances, wheelchair-accessible spaces, simplified patient flow, and staff support for navigation may reduce avoidable burden [29]. In this sense, an age-sensitive hospital environment should aim not only to provide treatment, but also to make the care pathway physically manageable, understandable, and less exhausting for older adults [28, 29].

Participants’ age-related expectations showed that healthcare access in advanced age requires more than standard service provision [29]. Participants did not simply ask for faster care; they expected healthcare services to be organized in a way that recognized the physical, cognitive, sensory, and emotional vulnerabilities associated with advanced age [20, 29]. Priority access, shorter waiting times, guidance within the hospital, accompaniment during procedures, and age-specific outpatient arrangements were perceived as ways to make healthcare use safer, easier, and more respectful [29].

These expectations should not be interpreted as a request for privilege, but rather as a need for proportional support. For adults aged 80 years and older, waiting for long periods, walking between units, understanding procedures, or managing appointments may require considerably more effort than for younger adults [20, 29]. Therefore, age-sensitive arrangements may help reduce avoidable strain and support older adults’ ability to use healthcare services with dignity and confidence [20, 29].

Participants’ positive evaluations of the healthcare system should be interpreted cautiously. Although participants reported several difficulties related to appointments, digital access, transportation, waiting, and hospital navigation, many still described healthcare services as generally adequate, improved, or acceptable. These appraisals may reflect genuine satisfaction, but they may also be influenced by courtesy, low expectations, generational norms, comparisons with previous healthcare experiences, or social desirability in an interview conducted by a physician.

Therefore, positive evaluations should not be interpreted as evidence that unmet needs are absent. Older adults may express gratitude while still experiencing significant access barriers and service-related burdens. The coexistence of positive appraisals and reported barriers suggests that age-sensitive service planning should consider expressed satisfaction together with practical difficulties experienced during access and care [20, 29].

Implications for practice

The findings of this study have several implications for healthcare services caring for adults aged 80 years and older. First, access pathways should be designed with the functional, digital, and social realities of adults aged 80 years and older in mind. Appointment systems should not rely solely on digital platforms or individual technological ability. Telephone-based support, face-to-face assistance, simplified appointment procedures, and proactive guidance may help reduce access barriers for older adults who cannot use digital systems independently [8, 9, 11].

Second, healthcare facilities should consider the physical burden created by transportation, waiting, walking within the hospital, and navigating complex service processes. Age-sensitive arrangements such as adequate seating, clear directions, shorter walking distances, accessible outpatient areas, wheelchair-friendly spaces, and staff who can guide older adults through hospital procedures may reduce unnecessary fatigue and improve the care experience [7, 24, 29]. These arrangements are particularly important in tertiary hospital settings, where services are often fragmented across multiple units.

Third, family support should be recognized as an important facilitator of healthcare access, but it should not be assumed to be always available or sufficient. Health systems should provide supportive mechanisms for older adults who attend appointments alone or whose family members or informal caregivers cannot accompany them [6, 13]. In addition, communication with older patients should be prioritized as a core component of care. Listening carefully, explaining clearly, speaking calmly, allowing time for questions, and performing attentive clinical examinations may strengthen trust, preserve dignity, and improve the perceived quality of care [17, 18, 20].

Finally, Healthy Aging Centers and similar services may provide useful points of contact for identifying access difficulties and care-experience needs among adults aged 80 years and older. In this study, the findings most directly support practical service adjustments such as assistance with appointment processes, non-digital or supported digital access routes, clear guidance within hospital settings, physically manageable service environments, and respectful, age-sensitive communication [29]. Broader coordination between Healthy Aging Centers, primary care, home healthcare, and hospital outpatient services may be important, but this was not directly evaluated in the present study and should be examined in future research and service-development work.

Strengths and limitations

This study has several strengths. First, it focused specifically on adults aged 80 years and older, a group whose healthcare access experiences are often insufficiently represented in studies of older populations. Second, the inclusion of 17 participants with variation in age, sex, educational background, and living arrangement provided diverse accounts of healthcare access and care experiences in advanced age. Third, face-to-face interviews allowed participants to describe their current and previous healthcare experiences, expectations, and difficulties in their own words. The use of verbatim quotations strengthened the transparency and credibility of the findings. In addition, the data were analyzed systematically using thematic analysis, and the reporting was guided by qualitative research standards.

Some limitations should also be acknowledged. This was a single-center qualitative study conducted in a specialized Healthy Aging Center within a university-affiliated tertiary care hospital; therefore, transferability to primary care, community-based services, and non-tertiary hospital settings may be limited. More importantly, all participants had already reached and engaged with this center, meaning that they had crossed an important threshold of access. The recruitment and screening procedures may therefore have resulted in a sample of relatively autonomous, communicative, and healthcare-engaged older adults. In addition, because only individuals who met the eligibility criteria and were subsequently invited to participate were counted as eligible invitees, the absence of recorded refusals should be interpreted within this recruitment process.

These recruitment and screening procedures have implications for the transferability of the findings. The findings may underrepresent the experiences of older adults who are housebound, socially isolated, less engaged with healthcare services, unable to attend tertiary care, or face the most severe barriers to initiating contact with healthcare services. In addition, individuals who were unable to participate meaningfully in interviews because of cognitive or communication difficulties were excluded. Therefore, the findings may not fully represent the perspectives of the most cognitively or communicatively vulnerable older adults, who may experience different or greater barriers to healthcare access.

The interviewer’s professional role as a physician may have influenced participants’ accounts, particularly positive comments about clinicians, hospital services, or the health system. Although participants were encouraged to describe both positive and negative experiences, social desirability and courtesy bias cannot be excluded.

Finally, this study explored healthcare access and care experiences exclusively from the perspective of older adults and did not include the views of family caregivers, healthcare professionals, or administrative staff. Future studies incorporating multiple stakeholder perspectives and different healthcare settings would provide a more comprehensive understanding of healthcare access and care experiences in advanced age.

Conclusion

This qualitative study provides an in-depth account of healthcare access and care experiences among adults aged 80 years and older attending a Healthy Aging Center in a university-affiliated tertiary care hospital. The principal finding is that access in this age group was not experienced as a single act of service use, but as a cumulative process shaped by appointment systems, digital or telephone-based support, transportation and physical capacity, family or informal caregiver support, hospital navigation, and clinician communication.

The study contributes to understanding healthcare access in advanced age by showing that positive evaluations of services can coexist with dependency, fatigue, uncertainty, and persistent practical barriers. These findings highlight the need to view access not only as service availability, but as the practical and relational capacity of older adults to enter, navigate, experience, and complete care.

Abbreviations

COREQ

Consolidated Criteria for Reporting Qualitative Research

MHRS

Central Physician Appointment System

NVivo

qualitative data analysis software

Authors’ contributions

MV conceived and designed the study, conducted the recruitment and face-to-face interviews, transcribed the interviews, performed the initial coding and thematic analysis, translated the selected quotations, interpreted the findings, and drafted the manuscript. CY, VA, and BAY contributed to the study design, interpretation of the findings, refinement of the thematic structure, review of the translated quotations, and critical revision of the manuscript. All authors reviewed and approved the final manuscript.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability

The datasets generated and/or analysed during the current study are not publicly available because they contain potentially identifiable qualitative interview data. De-identified data may be available from the corresponding author on reasonable request and with permission from the relevant ethics committee.

Declarations

Ethics approval and consent to participate

Ethical approval for this study was obtained from the Trabzon University Faculty of Medicine Non-Interventional Scientific Research Ethics Committee (approval date: 02 March 2026; reference number: 10496660-2026-26013). The study was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants before the interviews.

Consent for publication

The manuscript contains only anonymized participant quotations, and no identifiable individual data are presented. Written informed consent was obtained from all participants for participation in the study. Therefore, separate consent for publication of identifiable individual data was not applicable.

Competing interests

The authors declare no competing interests.