Patient centred care and vulnerability in old age:
An overview of qualitative empirical research
undertaken as part of a PhD
Presentation for BGS Nurse Consultant SIG - September 2010
Clare Abley
Nurse Consultant for Vulnerable Older Adults – Newcastle
Clare.abley@newcastle-pct.nhs.uk
Overview of thesis
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Background and policy context: patient centred care and vulnerability
Methods
What can we learn from older people about patient centred care:
– Getting back to normal, improved function, feeling good about oneself, not knowing that
you are getting old.
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Barriers to providing patient centred care (3 levels)
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Uncertainty as to what constitutes patient centred care
Dilemmas: balancing the needs of older person with needs of others
When older people have mental health problems
When older people have alcohol problems
Overcoming the barriers:
– Build on good practice – involvement, creativity, flexibility
– Patient centred care with selective focus on others
Overview……….
• Introducing vulnerability in old age:
• Older people - being in a particular situation ‘at the mercy’ of others
• Volunteers – social isolation, dependence on others for care, occurrence of
a critical event, whole systems failure
• Professionals – mentally and physically frail and lives alone, no significant
other, crime victim, at risk or having a number of risk factors, unable to
manage own risks, in abusive or potentially abusive situation, imbalance in
care needed and care provided which is detrimental to person
• Vulnerability: What can we conclude from its social construction?
• Vulnerability comprises at least 2 concepts: insider and outsider
vulnerability - this equates to feeling and being vulnerable
Overview…….
• Patient centred care for vulnerable older people: key findings
– Those who consider their care to be patient centred do not see
themselves as vulnerable
– Those who see themselves as vulnerable do not consider themselves
to be in receipt of patient centred care
• Conclusions: A matrix taxonomy of patient centred care and
vulnerability in old age
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Recommendations
Recommendations
Policy
Research
Practice
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Professionals to focus more on insider vulnerability
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Use of indicators to determine if practice is patient centred
(handout)
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Ask older patients: Do you ever feel vulnerable? If so, when
and in what situations?
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Use of patient centred interactions to reduce older people’s feelings of vulnerability
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Teams to acknowledge uncertainties (about PCC), but still agree a way forward
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Explicit discussion of dilemmas – aim for patient centred care with selective focus on others
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Improved communication between staff from different organisations
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Proactive development work to eradicate negative stereotypes of old age
Any questions?