Experts & Expertise

Elderly people (75+) in the hospital. A study into patient participation from a care ethical perspective. PhD project 2010-2014

More than one third of people admitted to the hospital are people from 65 year and older (ref.). Hospital admission has a huge impact on the condition of elderly people. A great part leave the hospital in a worse shape than before they enter the hospital. Part of the reason for the decline is that older people tend to have serious and debilitating disorders when they enter the hospital. The other part is that just being in a hospital is so shocking that many older people have difficulty bouncing back psychologically and physically from this experience. This may count for all patients, regardless of age. However, older people are likely to have more difficulties dealing with this, and the consequences are to be more serious.

A large amount of research on elderly patients focuses on functional decline related to hospital admission and is dominated by the concept of frailty. Frailty refers to the physiological body, and involves as such an abstraction from immediate experiencing. There is lack of studies from the perspective of the older people themselves which examine what hospital admission means to them. The aim of my project is to understand what elderly patients go through in the hospital. Besides, I intend to (further) develop a care ethical framework on patient expertise and patient participation.

I am conducting the empirical study from a reflective lifeworld approach. This is an empirical application of the thoughts of the phenomenological and hermeneutic philosophers Edmund Husserl, Martin Heidegger, Maurice Merleau-Ponty and Hans-George Gadamer (Dahlberg et al., 2008). The aim of reflective lifeworld research is to discover the essence of a certain phenomenon (here the hospitalization of elderly patients). I use the method of shadowing. Shadowing is an observational method in which the researcher (shadower) observes an individual (shadowee) during a relatively long time. The central aspects of shadowing are the focus on meanings expressed by the entire body and the extended stay of the researcher in the phenomenal event itself (less an instant recording). The method of shadowing can give a voice to vulnerable people whose voices are excluded from a great part of phenomenological healthcare studies since a good verbal intelligence is implicitly required to become included in interview studies.

The increasing importance of patient participation in healthcare policy makes it specifically crucial to gain a clear insight into the actual experiences of more vulnerable groups that are less often heard in regular patient participation activities. Elderly who are admitted to a hospital are such a patient group. On the basis of the results of the empirical study, a method of shadowing (as patient participation method) will be developed that enables a better use of the experiences of elderly in health care.

Vulnerability and autonomy are central concepts in my project. By reinterpreting the empirical data departing from the framework of care ethics, a critical perspective on elderly patients (and on patient participation) will be developed.