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

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.