Developing approaches to person-centred outcome measures for older people in rehabilitation settings

Abstract

The rationale for this study was the need to bring a social science perspective to developing approaches for person-centred outcome measures in rehabilitation settings for older people. To date this field has largely been dominated by clinicians and the biomedical model of impairment, disability and handicap. Qualitative methods (findings from focus group discussions informed later focus interviews with individuals) were used to establish and explore the views of older people about a range of issues linked to conceptualising outcome, including participating in decisions regarding their health, to examine how older people made judgements, what they valued and prioritised, what their expectations were, how care was experienced and how changes are sustained over time. Symbolic interactionism and grounded theory provided the overall theoretical approach to the methods used. A distinction is made between older people's 'public' and 'private views'. This analytical distindon provides the framework within which the accounts are explored and presented in the thesis. The public accounts focus on the social and moral obligations associated with the experience of being an older citizen. The thesis explores the role of reciprocity, justice and conscience in these accounts. The private accounts reveal the wide range and diversity of opinion and experiences that exist. Three groups of people were identified: empowered,, reluctant collaborators; and dominated. It is argued that future best practice for outcome evaluation in health and social care professionals will need to explore the private views of older people in greater depth. Institutionalised ageism and structured dependency are major barriers to empowering older people to participate in identifying outcomes. Until these issues are recognised and resolved, more meaningful participation in the identification and method of assessment of outcomes is unlikely. The findings should be of relevance to researchers, to users of health services and to clinicians working in rehabilitation settings for older people.