“If she recommends it, I would have it”. A qualitative study of nonagenarians’ perspectives of their health status and healthcare

Main Article Content

Ross Edward Grant Upshur
Cecile Bensimon
James Westcott
Stephanie Bell
C. Shawn Tracy

Abstract

In the developed world, the population is rapidly aging. Primary care physicians will be called upon to deliver person-centred care to this population. However, current models of care are poorly adapted to the needs of the very old and an adequate evidence base does not exist. We conducted a qualitative study to elicit and explore the perceptions of nonagenarians who attend a primary care clinic in Ontario, Canada. Saturation was achieved after 13 interviews. The key themes identified were, positive self-perception of health status trust in the primary care physician, fear of ageism in the healthcare system, and limits to care. The trust in the competency of the primary care physician may be misplaced given the paucity of available evidence on appropriate outcome measures in this population. Ageism should be countered by creating systems of person-centered care that focus specifically on the needs of the very old in primary care.

Article Details

Section
Regular Articles

References

Tinetti, M.E., Fried T.R.& Boyd C.M. (2012). Designing health care for the most common chronic condition -multimorbidity. Journal of the American Medical Association 307 (23) 2493-2494.

Mutasingwa DR, Ge, H. & Upshur, R.E. (2011). How applicable are clinical practice guidelines to elderly patients with co-morbidities? Canadian Family Physician 57 (7) e253-e262.

Boyd, C.M., Darer, J., Boult, C., Fried, L.P., Boult, L. & Wu, A.W. (2005). Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. Journal of the American Medical Association 294 (6) 716-724.

Fried, T., Tinetti, M. & Iannone, L. (2011). Primary Care clinicians’ experiences with treatment decision making for older adults with multiple conditions. Archives of Internal Medicine 171, 75-80.

Denzin, N.K. & Lincoln, Y.S. (Eds.). (1994). Handbook of Qualitative Research. Thousand Oaks: Sage Publications.

Fereday. J. & Muir-Cochrane, E. (2006). Demonstrating rigor using thematic analysis: A hybrid approach of inductive and deductive coding and theme development. International Journal of Qualitative Methods 5

http://www.ualberta.ca/~iiqm/backissues/5_1/HTML/fereday.htm (Accessed June 23, 2012)

Strauss, A. & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks, CA: Sage Publications.

Carcary M. (2009). The research audit trail-enhancing trustworthiness in qualitative inquiry. The Electronic Journal of Business Research Methods 7, 11-24.

Ekdahl, A.W., Hellström, I., Andersson, L. & Friedrichsen, M. (2012). Too complex and time-consuming to fit in! Physicians' experiences of elderly patients and their participation in medical decision making: a grounded theory study. British Medical Journal Open 2 (3) e001063.

Robine, J.M., Michel, J.P. & Herrmann, F.R. (2007). Who will care for the oldest people in our ageing society? British Medical Journal 334 (7593) 570-571.

Tracy, C.S., Bell, S., Nickell, L., Charles, J. & Upshur R.E.G. (2013). The IMPACT Clinic: An innovative model of interprofessional primary care for elderly patients with complex healthcare needs. Canadian Family Physician In press.

Upshur, R.E. & Tracy, S. (2008). Chronicity and complexity: is what's good for the diseases always good for the patients? Canadian Family Physician 54 (12) 1655-1658.