الفهرس 
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Abstract
With aging populations, the growing needs of older patients became critical in later years. Their satisfaction with the health service care provided may be related to their expectations. Understanding and meeting these patients‟ expectations are one of the major objectives of nursing profession for achieving efficient care for the patients. However, most patients are aware of their expectations from the nurses; yet it is necessary to assess their expectations separately from their satisfaction since patients may report a high level of satisfaction despite unmet expectations. This study is an attempt to fill a gap of knowledge regarding elderly patients‟ expectations of services and their related satisfaction.
The aim of this study was to identify the relationship between aged patients‟ expectations and their satisfaction with health service quality in outpatient clinics. The study was conducted in the outpatient departments of the Health Insurance Hospitals in Beni-Suef and Al-Fayoum Governorates using a cross-sectional analytic study design. The sample consisted of 195 elderly patients attending these settings. An interview questionnaire form was used in data collection. It comprised sections for demographic data and medical history, and the modified validated SERVQUAL instrument to assess their expectations of and satisfaction with the services provided. The fieldwork lasted from February to July 2020.
The main study findings were as following.
The age of elderly patients was mostly <65 years (83.1%), with 56.4% females, 51.8% with no formal education and no work, 58.5% having sufficient income, and 75.9% currently married.
45.1% reported having chronic diseases, mostly hypertension (52.3%) and diabetes (46.6%).
The highest care expectation was related to assurance (55.9%), whereas the lowest was related to reliability (47.7%).
In total, 55.9% of the elderly patients were having low total expectations from the services provided.
Elderly patients‟ satisfaction with care ranged between 31.8% for reliability and empathy, and 39.0% for being tangible.
Overall, 28.2% of the elderly patients were having high total satisfaction with care.
Elderly patients‟ satisfaction exceeded their expectations mostly regarding responsiveness (53.3%), and least regarding empathy (41.0%).
The median score of the gap between elderly patients‟ expectations and related satisfaction was 0.0 only in the domains of responsiveness and assurance.
Overall, 41.0% of the elderly patients were having their satisfaction exceeding their expectations.
The satisfaction-expectations difference tended to decrease with increasing duration of illness.
A significant weak negative correlation was found between elderly patients‟ scores of total expectations and total gap between their satisfaction and expectation.
Age had a significant weak negative correlation with satisfaction and expectation scores.
The duration of illness had a significant moderate negative correlation with satisfaction score (r=-0.459).
In multivariate analysis:
o The independent positive predictors of elderly patients‟ expectation score were urban far residence and being married, while the duration of illness was a negative predictor.
o The independent positive predictors of elderly patients‟ satisfaction score were being married and living in urban far residence, whereas the duration of illness was a negative predictor.
o The independent positive predictor of the difference between the scores of satisfaction and expectations was being retired/unemployed, while getting service in location B was a negative predictor.
In conclusion, the elderly patients in the study settings have low expectations and even lower satisfaction with the care provided. Their personal and health characteristics have significant influences on their expectations and satisfaction.
The study recommends corrective actions to improve elderly patients‟ expectations, particularly regarding the service reliability and responsiveness through timely provision of services, improving documentation, and reducing waiting time, and prompt response to patients‟ needs. Corrective actions to improve patients‟ satisfaction related to empathy involve dealing with patient with respect and dignity and putting patient‟s wellbeing as the priority of the healthcare services. Training for all healthcare providers in gerontology and in communication with elderly people is needed. Further research is proposed to pinpoint the service-related factors influencing elderly patients‟ expectations and satisfaction, with intervention studies investigating the effectiveness of corrective actions.