Qualitative Research in Age and Ageing

This themed collection of Age and Ageing articles includes a selection of papers published over the last 10 years which highlights the value of qualitative methodologies in health services research, particularly in understanding patient experience of health and illness and decision making about treatment and preventive care. We hope this issue will raise awareness of the scope for further contributions and encourage authors to submit papers reporting qualitative studies to the journal.

Summary of topics and themes:

In an editorial in Age and Ageing ⁽⁵⁾, we drew attention to the way in which the application of qualitative research methods within the social science disciplines of sociology, anthropology and social psychology can enrich understanding of ageing and illness: for example, through eliciting the meaning and process of ageing, health and illness from the perspective of older people; the practice of service delivery and what shapes it; and the beliefs, values and ‘taken for granted ‘knowledge that professionals may apply in their work with older people.

Seen the doctor on the Tele? Patient centred care needs to arrive for all, and none more urgent than for our older patients

Chris Subbe is a Consultant in Acute, Respiratory & Critical Care Medicine. He is a Service Improvement Fellow with the Health Foundation. He does research on patient safety at Bangor University. He tweets @csubbe

Unsurprisingly many of us have more medical needs as we get older. While some people manage to stay remarkably fit, for others it is getting more difficult to get around town or worse across country. The hike around an overflowing car park of an inner-city hospital does surprisingly little for mobility, and most people get little value from sitting in an outpatient waiting area to wait while their medical team is struggling with the application of queuing theory to healthcare.

A few years ago, when granddad was sent a follow-up appointment for his cardiac surgery several months after the operation, I was suspicious. I rang the secretary of the colleague who had done an amazing job on his heart to ask for the reason for the review. “An important part of quality assurance: we like to make sure that everything has gone well”. I explained that granddad had been in hospital, survived prolonged rehabilitation, and had already been followed up by an excellent local geriatrician and one of our brilliant cardiologists. He felt well. I suggested cancelling the appointment.

Measuring up with ICHOM

Asan Akpan is a community geriatrician in Merseyside and research fellow for the Older Persons Working Group at the International Consortium for Health Outcomes Measurement. In this blog, he introduces ICHOM’s work and calls for your involvement. 

There’s a growing consensus around how to provide optimal care for people with multiple conditions: this involves comprehensive, continuous care and oversight. Structures and processes should focus on the person receiving care, allowing them to determine their own preferred outcomes.

Anywhere you look, a common theme is variation in care outcomes within and between healthcare organisations. Traditionally, outcome measures tend to be designed for episodic care, are focused on processes rather than people, and usually aren’t standardised. When different parts of the same healthcare organisation (or different organisations) want to compare their performance, interpretation of the outcomes is unreliable. This often impedes the important work of improving care across departments and organisations.

A taste of your own medicine

Dipti Samani is a Speciality Registrar (ST6) in Geriatric medicine working in the East Midlands South Deanery, and tweets at @HmniDipti. In this blog she looks at an inventive approach to NHS Change Day.

“Treat others as you would wish to be treated” is something I have heard time and time again growing up. I wonder if this is only true in personal relationships and dealings. Can we, and should we, extend this out into our professional lives, both in terms of our colleagues and also to the patients that we treat?

After my 2014 NHS Change Day pledge to walk in my patients’ shoes for a day by wearing a continence pad: ‘Continence: My Conscience is Clear’; I decided this year to go back to the roots of NHS Change Day and Damien Roland’s idea to taste the medicines that we give to our patients.

The aim of doing this was not just to know how (awful) some medicines taste, but to give myself and others an appreciation and awareness of what our patients go through. I wanted to highlight some of the alternative medications where available and to increase our compassion towards patients.

I took some of the common medications prescribed to older people to a lunchtime meeting in our department. The medications included: laxatives (Lactulose, Laxido), food thickeners, Sando-K, various nutritional supplements, Calogen and Hypostop – I’m sure you can think of more, but these were the most benign, unpleasant ones I could think of. The experiment was completely voluntary and I was impressed that all grades of doctor from medical student (who seemed to think it was some kind of initiation) to consultant took part. Of course I couldn’t have done this without the support of our departmental pharmacist who sought permission to support us with samples.

Feedback given from the tasters included recognition of the difficulties experienced by patients, increased care when thinking about prescribing, and empathy with patients’ experiences. It shows that it is sometimes easy to forget about the person behind the patient, and by putting ourselves in their place, it is possible to re-awaken our compassion for them:

I would love to go one step further to see if we could all be more compassionate and kinder towards each other in the work place. Patients are here to get better and we could acknowledge that they may be having a rough time; meanwhile, each of us comes to work only to do our best and to help people, and a lack of compassion with unkind words or actions towards each other just serve to depress this aim.

I would wish that by giving ourselves a taste of our own medicine this NHS Change Day, we will hopefully be able to get closer to treating others how we would like to be treated ourselves.

Photo credit: Ian Lamont via flickr

New patient experience measure could give older people a greater say in their care

A new Patient-Reported Experience Measure (PREM) published as a research paper in Age and Ageing, the journal of the British Geriatrics Society, has allowed healthcare professionals to explore patients’ experience of intermediate care in ways which previously weren’t possible.

Recording data on patient care in these very vulnerable patient groups has historically been difficult, but researchers from the University of Leeds have successfully piloted a new questionnaire, making it possible to take these patients’ perspective into account.

The 12 Days of Christmas – a hospital doctor’s lament

David Oliver is the current President of the BGS, a visiting Fellow at the Kings Fund, and a consultant in geriatrics and acute general medicine at the Royal Berkshire NHS Foundation Trust.

This time last year, I wrote the “Geriatrics Profanisaurus” – all about words and phrases which should be banned when discussing older people. It triggered plenty of  responses “below the line”, adding to the list of ageist and ignorant language regarding healthcare for older people and went a bit “viral” online. Indeed, the BGS is now being followed by Roger Melly’s Profanisaurus on Twitter, as is occasionally “sweary geriatrician” Dr Wyrko.

As I started the precedent of a festive Presidential blog, I couldn’t resist my own re-write of the old favourite “The 12 Days of Christmas”. I say this as a frontline doctor who frequently disappears into an uber-busy acute medical unit, or emergency department and has inpatients who are increasingly frail and complex and often requiring step down health and social care services which are themselves over-stretched. It’s a very challenging environment both for staff, patients and families and one that I know colleagues right across the four nations face, especially in the winter months. Its important in letting off steam on this site – mainly read by clinicians, that we are all deadly serious about trying to provide the highest quality care for patients. So no fun is intended to be at anyone’s expense.

But here goes anyway: do join in, especially with a hearty “Five Interims”.

On the twelfth day of Christmas,
My true love sent to me:
Twelve “vacant” locums,
Eleven “bed meetings”,
Ten “points of access”,
Nine winter pilots,
Eight re-admissions,
Seven day working,
Six delayed transfers,
Five Interims,
Four hour breaches,
Three Iberian Nurses,
Two Norovirus,
and  an over-crowded ED…

I also sometimes find other songs going through my head that seem strangely appropriate to the jobs we all do. Here are one or two:

“Back in Black” …”I want my bed base back”  – with thanks to Los Bravos.

Or indeed “Back to Black” by Amy Winehouse. “Black Alert” that is – when we have as many beds as Bethlehem had room at the Inn. At such times, though I am a Man City Fan, “Simply Red” would be a welcome sight for once.

Talking of Amy, if I had a quid for every patient whom I have wanted to send to intermediate care for ongoing rehab, but has preferred either to stay in hospital or to go home with no rehabilitation and support, surely “They tried to make me go to rehab, I say No, No, No” fits the bill.

Allied to this is the Beatles “Hard Day’s Night” – not only applicable to overstretched on call teams and nurses but also when patients who don’t want to stay another hour in hospital say to me “Doctor, when I’m home…” and I do feel like replying “I know…everything seems to be right”.

Sadly it’s hard for many patients to understand that hospital consultants can’t click their fingers and magic up social care or community rehab places; I can see these patients singing Gwen Stefani’s “What you waitin’, what you waitin’ for?”

When it comes to falls resulting from postural instability, then we have to acknowledge the sage words of Miss Meghan Trainor: “It’s all about that Base”

Now over to the readers of this blog, for your suggestions! Nothing disrespectful or inappropriate, please or our Digital Media Editor will be in like Flynn and remove the post,  but if you can think of any more songs for the thread or any more lyrics for those twelve days, we’d like to hear from you!

Finally, let me wish you all a very Happy Christmas. And remember, winter pressures or not, the health service is an immensely rewarding place to work: our colleagues are troupers and caring for people at their neediest is a privileged occupation, however demanding it may be. But perhaps a bit of dark humour can help through the worst two clinical weeks of the year.

Avoiding Serial Projectitis – Making Health and Care Systems fit for an Ageing Population

David Oliver is a Consultant Geriatrician in Berkshire and a visiting Professor in Medicine of Older People at City University, London. He is President Elect of the British Geriatrics Society. He writes on the King’s Fund blog about their paper, launched today.

By 2030, one in 5 people in England will be over 65 and at that age, men will on average live till 88 and women till 91. This population ageing shouldn’t constantly be catastrophised with language like “burden” “timebomb” or “tsunami”. In fact, it represents a victory for improved societal conditions and for modern healthcare – preventative and curative. Indeed, well into older age, most people report high levels of happiness, health and wellbeing and even over 80, only half say they live with life limiting long-term conditions.

However, despite the “upside” of population ageing, we need to be realistic about its inevitable implications for health and care services.

Quality Mark for Elder Friendly Hospital Wards

Ensuring that we are delivering a high quality service is, or should be, the preoccupation of geriatricians and specialists in health care for older people. But how do we know if we are? As we consider the ongoing implications of the Francis Report, the BGS will be seeking to develop tools and services which help in this quest. There is much more to do but the BGS has assisted with the development of a Quality Mark for Elder Friendly hospital wards in collaboration with the Royal College of Psychiatrists and others. Dr Chris Dyer, the BGS representative on this project (with Peter Crome) shares more details.

At a single ward level, the Quality Mark for Elder Friendly Hospital Wards is a method that hospitals can use to raise standards of care for its most vulnerable group of patients. Indeed, as part of its response to the Francis Report the Royal College of Physicians has recommended use of the Quality Mark.

Named clinicians for vulnerable older people – how will it work in practice?

Prof David Oliver is a Consultant Geriatrician in Berkshire and a visiting Professor in Medicine of Older People at City University, London. He is President Elect of the British Geriatrics Society.

David writes in the King’s Fund blog on the how assigning named clinicians for vulnerable older people might work in practice:

Older people and their families have repeatedly expressed concerns about discharge from hospital being rushed, poorly planned or with insufficient involvement, notice or information. 

Streamlining admissions

Dr Sean Ninan is a Specialist Registrar in General (Internal) Medicine and Geriatric Medicine working in the Yorkshire deanery, UK.

When I was 20 I travelled round India, a wonderful beguiling country with some of the worst administration I have ever encountered, much of it unchanged from systems introduced during the Empire.

I have fond memories of the trip but there were many frustrating experiences too. Taking out money from the bank, for example, was particularly painful.

You enter, make your way to reception and explain that you would like to take out some money. They ask you to take a ticket, and you wait in the queue. After some time, patiently waiting you reach the front of the queue.

“Saving, deposit or withdrawal?”