34 Stories from the fourth age

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Most older care home residents will die in the care home environment. The majority of older people would like the opportunity to discuss end-of-life care, though this rarely happens. The current model of palliative care does not cater well for care home residents.


This study explores the narratives shared by older people living in care homes.


1. What are the issues facing elderly people in the last years of life?


2. What are the key events that shape this phase and how do their interactions and relationships with carers, healthcare professionals, family and friends affect this?


Five participants were recruited from two care homes in the South West of England. Each participant was interviewed at least three times over ten months. A structural narrative analysis was performed and a typology generated to present the different narratives that might constrain and/or empower the participants in relation to their ageing process.


Participants’ narratives are presented in three different contexts: Becoming a care home resident, living in a care home and death and dying. A variety of narrative types emerged, but the concept of “imposed dependency” was a key thread. In addition to presenting the findings in the traditional academic format, 5 illustrations have been commissioned to bring some of the relevant themes to life.


The narratives constructed suggest that there is still much to be done in order to improve transition into a care home and to promote autonomy and choice, particularly at the end of life.

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