Older people and their families are recognised and respected
Participants articulated that older patients need to be recognised as a group with particular and often complex care needs requiring specific knowledge and skills, and as legitimate and deserving recipients of acute care. There was a perception that many staff viewed older patients negatively, due to ageism, false expectations set during training, complex care that disrupts and delays hospital processes, and nihilism about outcomes.
“I think there is still a very strong…belief of ‘older people aren’t my real patients. They’re the exception. They’re the difficult ones”’ P4, geriatrician, clinician “We need to generate more positive attitudes to ageing. People say they’re not working with older people, they’re acute care therapists, but that’s who they’ll end up working with” P11, AHP, academic
Older people needed to be recognised as individuals, with variation in their care needs, expectations, and life experience. Ageist stereotypes contributed to homogenisation of older people, reducing their individual value.
“I think [it’s often said that] ‘older people like this, older people like that’. Older people are actually more individual than you or me. Because over the lifespan, if you think about it, we just keep differentiating, don’t we?” P4, geriatrician, clinician
Some respondents noted that older people may be unable to advocate for their needs, due to generational characteristics or cognitive impairment. Family and carers of older people were recognised as important sources of information, providing advocacy and supporting individualised care. However, many participants reported a transactional approach to engagement e.g. information exchange rather than genuine partnership in decision making and care.
“We certainly had conversations and they were very respectful and polite and all that but it wasn’t shared decision making really.” P12, AHP, clinician (reflecting on consumer experience) “The carers are often so involved and really good advocates for those people but that’s not what you want when you’re trying to look after a patient…You probably don’t want someone telling you how that person likes their cup of tea or likes to eat their breakfast or take their shower.” P9, nurse, academic
In contrast, some respondents had poignant reflections about their personal experience as care-givers, recognising that family are often invisible and require confidence and health literacy to initiate engagement.
“It changed once they knew I was a nurse and it made me think ‘What happens to people who don’t have medical knowledge and can’t ask the questions?’….Up until then they’d walk into the room and ignore me.” P15, nurse, academic (reflecting on consumer experience)