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A new political anatomy of the older body? An examination of approaches to illness in old age in primary care

Published online by Cambridge University Press:  25 May 2012

SUSAN PICKARD*
Affiliation:
Department of Sociology, Social Policy and Criminology, University of Liverpool, UK.
*
Address for correspondence: Susan Pickard, Department of Sociology, Social Policy and Criminology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool L69 7ZA, UK E-mail: [email protected]

Abstract

This paper examines the new approaches to older bodies found within primary care, with the purpose of determining whether they represent a significant disjunction from established approaches in geriatric medicine. A genealogical review of clinical approaches to certain conditions commonly found in old age is undertaken utilising (a) key texts of pioneering British geriatricians and (b) three editions of a key textbook of general practice, published between 1989 and 2009. The discourses and practices established by the Quality and Outcome Frameworks in England are then examined, focusing on evidence-based guidance for these same conditions. Following this excavation of written texts, empirical data are analysed, namely the accounts of general practitioners and practice nurses regarding application of the technologies associated with chronic disease management to older patients. Continuities and changes identified by these practitioners are explored in terms of three specific consequences, namely conceptualising and treatment of older bodies and interaction with patients. The paper's conclusion considers whether these changes are significant enough to warrant describing them as representative of an epistemic rupture or break in the way older bodies are perceived, both in medicine and also in society more generally, and thus of constituting a new political anatomy of the older body.

Type
Articles
Copyright
Copyright © Cambridge University Press 2012 

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References

Alder, J., Mayhew, L., Moody, S., Morris, R. and Shah, R. 2005. The Chronic Disease Burden. City University, London.Google Scholar
Armstrong, A. 1981. Pathological Life and Death: medical spatialisation and geriatrics. Social Science and Medicine, 15A, 253–7.Google Scholar
Armstrong, D. 1983. The Political Anatomy of the Body. Cambridge University Press, Cambridge.Google Scholar
Armstrong, D. 1995. The rise of surveillance medicine. Sociology of Health and Illness, 17, 3, 393404.Google Scholar
Ashworth, M. and Kordowicz, M. 2010. Quality and outcomes framework: time to take stock. British Journal of General Practice, 60, 578, 637–8.Google Scholar
Berg, M. 1998. Medical work and the computer-based patient record: a sociological perspective. Methods of Information in Medicine, 37, 3, 294301.Google Scholar
British Medical Association (BMA) 2011. Chronic Kidney Disease: Frequently Asked Questions. BMA, London.Google Scholar
Checkland, K., Harrison, S., McDonald, R., Grant, S., Campbell, S. and Guthrie, B. 2008. Biomedicine, holism and general medical practice: responses to the 2004 GP contract. Sociology of Health and Illness, 30, 5, 788803.Google Scholar
Crome, P. 2010. Geriatrics in Europe. In Fillit, H. M., Rockwood, K. and Woodhouse, K. (eds), Brocklehurst's Textbook of Geriatric Medicine and Gerontology. Seventh Edition, Elsevier/Saunders, Philadelphia, Pennsylvania, 971004.Google Scholar
Department of Health 2004. Better Health in Old Age. Department of Health, London.Google Scholar
Department of Health 2006. A New Ambition for Old Age: Next Steps in Implementing the National Service Framework for Older People. HMSO, London.Google Scholar
Fillit, H. M., Rockwood, K. and Woodhouse, K. (eds) 2010. Brocklehurst's Textbook of Geriatric Medicine and Gerontology. Seventh Edition, Elsevier/Saunders, Philadelphia, Pennsylvania.Google Scholar
Fortin, M., Hudon, C., Haggerty, J., Akker, M. and Almirall, J. 2010. Prevalence estimates of multi-morbidity. BMC Health Services Research, 10, 111. http://www.biomedcentral.com/1472-6963/10/111.Google Scholar
Foucault, M. 1979. Discipline and Punish. Vintage Books, New York.Google Scholar
Fox, N. 1993. Postmodernism, Sociology and Health. Open University Press, Buckingham, UK.Google Scholar
Fox, N. 1995. Beyond Health: Postmodernism and Embodiment. Free Association Books, New York.Google Scholar
Freer, C. B. 1985. Geriatric screening: a reappraisal of preventive strategies in the care of the elderly. Journal of the Royal College of General Practitioners, 35, 275, 288–90.Google Scholar
Gilleard, C. and Higgs, P. 2000. Cultures of Ageing. Prentice Hall, Harlow, UK.Google Scholar
Haber, C. 1986. Geriatrics: a specialty in search of specialists. In van Tassel, D. and Stearns, P. N. (eds), Old Age in a Bureaucratic Society. Greenwood Press, New York, 6684.Google Scholar
Hadler, N. M. 2008. Worried Sick. University of North Carolina Press, Chapel Hill, North Carolina.Google Scholar
Hadler, N. M. 2011. Rethinking Aging. University of North Carolina Press, Chapel Hill, North Carolina.Google Scholar
Harrison, S. and McDonald, R. 2008. The Politics of Healthcare in Britain. Sage, London.CrossRefGoogle Scholar
Heath, I. 1995. The Mystery of General Practice. Nuffield Provincial Hospitals Trust, London.Google Scholar
Heath, I. 2008. Multiple health problems in elderly people: never had it so good? British Medical Journal, 336, 7650, 950–1.Google Scholar
Howell, T. H. 1944. Old Age: Some Practical Points in Geriatrics. H. K. Lewis, London.Google Scholar
Hogan, D. B. 2010. Geriatrics in North America. In Fillit, H. M., Rockwood, K. and Woodhouse, K. (eds), Brocklehurst's Textbook of Geriatric Medicine and Gerontology. Seventh Edition, Elsevier/Saunders, Philadelphia, Pennsylvania, 1005–9.CrossRefGoogle Scholar
Isaacs, B. (ed.) 1982. Recent Advances in Geriatric Medicine. Churchill Livingstone, London.Google Scholar
Lapin, A. 2010. Laboratory medicine in geriatrics. In Fillit, H. M., Rockwood, K. and Woodhouse, K. (eds), Brocklehurst's Textbook of Geriatric Medicine and Gerontology. Seventh Edition, Elsevier/Saunders, Philadelphia, Pennsylvania, 218–22.Google Scholar
Last, J. M. 1963. The iceberg: ‘completing the clinical picture’ in general practice. The Lancet, II, 2831.Google Scholar
Lawrence, C. and Weisz, G. 1998. Medical holism: the context. In Lawrence, C. and Weisz, G. (eds), Greater than the Parts: Holism in Biomedicine 1920–1950. Oxford University Press, Oxford, 122.Google Scholar
Mangin, D., Sweeney, K. and Heath, I. 2007. Preventive health care in elderly people needs rethinking. British Medical Journal, 335, 7614, 285–87.Google Scholar
Merleau-Ponty, M. 1945/1962. Phenomenology of Perception. Routledge and Kegan Paul, London.Google Scholar
McDonald, R., Checkland, K. and Harrison, S. 2009. The new GP contract in English primary health care: an ethnographic study. International Journal of Public Sector Management, 22, 1, 2134.Google Scholar
McWhinney, I. R. 1989. A Textbook of Family Medicine. Oxford University Press, Oxford.Google Scholar
McWhinney, I. R. 1997. A Textbook of Family Medicine. Second edition, Oxford University Press, Oxford.Google Scholar
McWhinney, I. R. and Freeman, T. 2009. A Textbook of Family Medicine. Third edition, Oxford University Press, Oxford.Google Scholar
Oliver, D. 2008. QOF and public health priorities don't improve care in ageing. British Medical Journal, 337, a1403.Google Scholar
Pickard, S. 2010. The role of governmentality in the establishment, maintenance and demise of professional jurisdictions: the case of geriatric medicine. Sociology of Health and Illness, 32, 7, 115.Google Scholar
Pickard, S. 2011. Health, illness and normality: the case of old age. Biosocieties, 6, 323–41.Google Scholar
Pickard, S. and Rogers, A. 2012. Knowing as practice: self-care in the case of chronic multi-morbidities. Social Theory and Health, 10, 2, 101–20.Google Scholar
Potter, J. F. 2003. Hypertension. In Tallis, R. C. and Fillit, H. M. (eds), Brocklehurst's Textbook of Geriatric Medicine and Gerontology. Sixth edition, Churchill Livingstone, London, 393406.Google Scholar
Potter, J. F. 2010. Hypertension. In Fillit, H. M., Rockwood, K. and Woodhouse, K. (eds), Brocklehurst's Textbook of Geriatric Medicine and Gerontology. Seventh edition, Elsevier/Saunders, Philadelphia, Pennsylvania, 300–11.Google Scholar
Prout, A. 2000. Childhood bodies: social construction and translation. In Williams, S. J., Gabe, J. and Calnan, M. (eds), Health, Medicine and Society. Routledge, London, 109–22.Google Scholar
Reeve, J. 2010. Interpretive Medicine. Royal College of General Practitioners, London.Google ScholarPubMed
Rosen, S., Kortez, B. and Reuben, D. B. 2010. Presentation of diseases in old age. In Fillit, H. M., Rockwood, K. and Woodhouse, K. (eds), Brocklehurst's Textbook of Geriatric Medicine and Gerontology. Seventh edition, Elsevier/Saunders, Philadelphia, Pennsylvania, 205–10.Google Scholar
Royal College of General Practitioners 1981. Health Prevention in Primary Care. Report No. 18, Royal College of General Practitioners, London.Google Scholar
Sanders, T., Harrison, S. and Checkland, K. 2010. Personalizing protocol-driven care: the case of specialist heart failure nurses. Journal of Advanced Nursing, 66, 9, 1937–45.Google Scholar
Tallis, R. C. and Fillit, H. M. (eds) 2003. Brocklehurst's Textbook of Geriatric Medicine and Gerontology. Sixth edition, Churchill Livingstone, London.Google Scholar
Tudor Hart, J. 1982. Hypertension – does it exist and should it be treated? In Isaacs, B. (ed.), Recent Advances in Geriatric Medicine. Churchill Livingstone, London, 7190.Google Scholar
Williams, E. I. 1986. The evolution of anticipatory care for elderly patients in general practice. Family Practice, 3, 1, 4953.Google Scholar
Williamson, J., Stokoe, I. H., Gray, S., Fisher, M., Smith, A., McGhee, A. and Stephenson, E. 1964. Old people at home: their unreported needs. The Lancet, 1, 7343, 1117–20.Google Scholar