Background <p>Offering palliative care to older adults with serious illnesses can be challenging in the emergency department. Understanding the factors that affect access to palliative care in this context is crucial for improving the quality of life for older adults and reducing the cost of aggressive treatments in the emergency department. The factors identified from the perspective of older adults, family caregivers and healthcare providers are unknown in context of Thailand and should be considered to improve access. This study aimed to describe the factors that influence access to palliative care in the emergency department for older adults with serious life- limiting illnesses from various perspectives.</p> Methods <p>A descriptive qualitative study was conducted in a community with five older adults, and five family caregivers and a hospital with ten healthcare providers were purposively recruited and participated in semi-structured interviews. Thematic analysis was used to analyze the data.</p> Results <p>Five themes described the factors affecting the access to palliative care in the emergency department that is, organizational support, training, cultural competence, attitude towards palliative care, and the traditional nature of the emergency department’s mission.</p> Conclusion <p>Healthcare providers should be trained in palliative care to improve their skills in providing effective palliative care for older adults with life-limiting illnesses and FG in the emergency department.</p>