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

Overview of thesis 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. Barriers to providing patient centred care (3 levels) –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

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……….

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 Recommendations

Practice Policy Research

Professionals to focus more on insider vulnerability Use of indicators to determine if practice is patient centred (handout) Ask older patients: Do you ever feel vulnerable? If so, when and in what situations? Use of patient centred interactions to reduce older people’s feelings of vulnerability Teams to acknowledge uncertainties (about PCC), but still agree a way forward Explicit discussion of dilemmas – aim for patient centred care with selective focus on others Improved communication between staff from different organisations Proactive development work to eradicate negative stereotypes of old age

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