Elders and patient participation revisited – a discourse analytic approach to older persons’ reflections on patient participation

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Aim and objective.This study focuses on how older persons’ accounts of participation might be framed and constructed based on their social and historical situatedness.Background.The picture emerging from contemporary research tends to portray older people as a group who prefer to leave decisions to the professionals during a hospital stay. Through an approach that sought to contextualise the respondents’ accounts of participation, different features of patient participation became visible.Design.The study is based on a postmodern framework using a discursive approach, informed by the works of Foucault and on works that have been developed in line with his main ideas.Method.Eighteen individual in-depth interviews with older people (age 80+) were conducted between one to two weeks after discharge from hospital.Results.Findings indicate that older people actively position themselves in relation to various discourses at play in the hospital, and display a wide variety of strategies aimed at gaining influence. To the older persons in this study, participation was practised in a subtle and discreet way, as a matter of choosing a good strategy to interact with the personnel. Participation was also seen as a matter of balancing their own needs against the needs of others and as a behaviour that required self-confidence.Conclusion.The accounts of patient participation given by the older persons differed from the dominant and taken-for-granted discourse of patient participation as a right.Relevance to clinical practice.As the older persons’ understanding and practice of patient participation do not ‘fit’ the contemporary idea of participation, it is in danger of being ignored or overlooked by care-givers as well as by researchers. To identify older patients’ wish to participate, one must actively search for it.

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