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‘I often worry about the older person being in that system’: exploring the key influences on the provision of dignified care for older people in acute hospitals

Published online by Cambridge University Press:  27 February 2012

M. CALNAN ,
W. TADD ,
S. CALNAN ,
A. HILLMAN ,
S. READ  and
A. BAYER
M. CALNAN*
Affiliation:
School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK.
W. TADD
Affiliation:
Cesagen, School of Social Sciences, Cardiff University, UK.
S. CALNAN
Affiliation:
School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK.
A. HILLMAN
Affiliation:
Cesagen, School of Social Sciences, Cardiff University, UK.
S. READ
Affiliation:
Cesagen, School of Social Sciences, Cardiff University, UK.
A. BAYER
Affiliation:
School of Medicine, Cardiff University, UK.
*
Address for correspondence: M. Calnan, School of Social Policy, Sociology and Social Research, University of Kent, Cornwallis North East, Canterbury CT2 7NF, UK. E-mail: m.w.calnan@kent.ac.uk
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Abstract

Older age is one stage of the lifecourse where dignity maybe threatened due to the vulnerability created by increased incapacity, frailty and cognitive decline in combination with a lack of social and economic resources. Evidence suggests that it is in contact with health and welfare services where dignity is most threatened. This study explored the experiences of older people in acute National Health Service (NHS) Trusts in relation to dignified care and the organisational, occupational and cultural factors that affect it. These objectives were examined through an ethnography of four acute hospital Trusts in England and Wales, which involved interviews with older people (65+) recently discharged from hospital, their relatives/carers, and Trust managers, practitioners and other staff, complemented by evidence from non-participant observation. The picture which emerged was of a lack of consistency in the provision of dignified care which appears to be explained by the dominance of priorities of the system and organisation tied together with the interests of ward staff and clinicians. The emphasis on clinical specialism meant that staff often lacked the knowledge and skills to care for older patients whose acute illness is often compounded by physical and mental co-morbidities. The physical environment of acute wards was often poorly designed, confusing and inaccessible, and might be seen as ‘not fit for purpose’ to treat their main users, those over 65 years, with dignity. Informants generally recognised this but concluded that it was the older person who was in the ‘wrong place’, and assumed that there must be a better place for ‘them’. Thus, the present system in acute hospitals points to an inbuilt discrimination against the provision of high-quality care for older people. There needs to be a change in the culture of acute medicine so that it is inclusive of older people who have chronic co-morbidities and confusion as well as acute clinical needs.

Keywords

ageingacute hospital caredignified care
Type
Articles
Information
Ageing & Society , Volume 33 , Issue 3 , April 2013 , pp. 465 - 485
Copyright
Copyright © Cambridge University Press 2012

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