Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-23T11:46:44.104Z Has data issue: false hasContentIssue false
  • English
  • Français

Negotiating Vulnerabilities: How Older Adults with Multiple Chronic Conditions Interact with Physicians*

Published online by Cambridge University Press:  04 November 2013

Laura Hurd Clarke ,
Erica V. Bennett  and
Alexandra Korotchenko
Laura Hurd Clarke*
Affiliation:
University of British Columbia
Erica V. Bennett
Affiliation:
University of British Columbia
Alexandra Korotchenko
Affiliation:
University of British Columbia
*
†Correspondence and requests for reprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Laura Hurd Clarke, Ph.D. School of Kinesiology The University of British Columbia 156-1924 West Mall Vancouver, BC V6T 1Z2 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

The literature on patient-physician interactions has largely ignored the perspectives of older adults with multiple morbidities. Featuring in-depth interview data from 16 men and 19 women with an average of six chronic conditions, this study focused on how participants perceived and experienced the care provided by their primary care physicians. Participants suggested that physicians caring for patients with multiple chronic conditions should be thorough, amenable to gate keeping, trustworthy, and open to different decision-making styles. However, many study participants perceived that they received inadequate care due to the personal failings of their physicians, constraints of medical consultations, and societal ageism. Consequently, many of the participants, especially the women, employed various strategies to maximize the care they received and manage their physicians’ impressions of them as worthy patients. Our findings suggest that elderly patients with multiple morbidities perceive that their health needs are not being adequately met.

Résumé

La littérature concernant les interactions entre les patients et les médecins a largement ignoré les points de vue des personnes âgées souffrant de comorbidités multiples. Cette étude, avec des données recueillies à partir d’entretiens approfondis avec 16 hommes et 19 femmes qui ont eu une moyenne de six affections chroniques, a porté sur la façon dont les participants ont perçus et vécus les soins fournis par leurs médecins de soins primaires. Les participants ont suggéré que les médecins qui soignent les patients atteints de maladies chroniques multiples devraient être minutieux, prête à “gate-keeping,” fiables et ouvert à différents styles de prise de décision. Cependant, nombreux participants à l’étude ont perçu qu’ils recevaient des soins inadéquats en raison de faiblesses personnelles de leurs médecins, les contraintes de consultations médicales, et l’âgisme sociétal. Par conséquent, beaucoup de participants, surtout les femmes, ont utilisé des diverses stratégies pour maximiser les soins reçus et pour gérer les impressions des médecins à leur egard comme dignes patients. Nos résultats suggèrent que les patients âgés atteints de morbidités multiples perçoivent que leur besoins de santé ne sont pas suffisamment satisfaits.

Keywords

agingageismmedical caremultiple chronic conditionsolder adultsphysiciansvieillissmentâgismesoins médicauxaffections (maladies) chroniques multiplesadultes (personnes) âgésmédecins
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 33 , Issue 1 , March 2014 , pp. 26 - 37
Copyright
Copyright © Canadian Association on Gerontology 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

We thank all of the individuals who took part in the study and shared with us their time, personal stories, and important insights. We also thank Lauren Courtice and Chris Liu for their invaluable assistance with data management. This research was supported by a SSHRC Standard Research Grant titled “Body Image and Identity: The Experience of Multiple Chronic Conditions” (Council Grant no. 410-2008-0081), which was awarded to Laura Hurd Clarke.

References

Adams, W. L., Mcllvain, N. L., Lacy, N. L., Magsi, H., Crabtree, B. F., Yenny, S. K., et al. (2002). Primary care for elderly people: Why do doctors find it so hard? The Gerontologist, 42(6), 835–482.CrossRefGoogle ScholarPubMed
Adelman, R., Greene, M. G., & Charon, R. (1987). The physician-elderly patient-companion triad in the medical encounter: The development of a conceptual framework and research agenda. The Gerontologist, 27(6), 729–734.Google Scholar
Adelman, R. D., Greene, M. G., & Charon, R. (1991). Issues in the physician-elderly patient interaction. Ageing and Society, 11(2), 127–148.Google Scholar
Adelman, R. D., Greene, M. G., & Ory, M. G. (2000). Communication between older patients and their physicians. Clinics in Geriatric Medicine, 16(1), 1–24.CrossRefGoogle ScholarPubMed
Album, D., & Westin, S. (2008). Do diseases have a prestige hierarchy? A survey among physicians and medical students. Social Science & Medicine, 66(1), 182–188.Google Scholar
Arber, S., & Ginn, J. (1991). Gender and later life: A sociological analysis of resources and constraints. London, UK: Sage.Google Scholar
Arora, N. K., & McHorney, C. A. (2000). Patient preferences for medical decision making: Who really wants to participate? Medical Care, 38(3), 335–341.Google Scholar
Asbring, P., & Narvanen, A. L. (2002). Women’s experiences of stigma in relation to chronic fatigue syndrome and fibromyalgia. Qualitative Health Research, 12(2), 148–160.Google Scholar
Bastiaens, H., Royen, P., Pavlic, D. R., Raposo, V., & Baker, R. (2007). Older people’s preferences for involvement in their own care: A qualitative study in primary health care in 11 European countries. Patient Education and Counseling, 68(1), 33–42.Google Scholar
Beisecker, A. E. (1988). Aging and the desire for information and input in medical decisions: Patient consumerism in medical encounters. The Gerontologist, 28(3), 330–335.Google Scholar
Belgrave, L. L. (1994). Discrimination against older women in health care. Journal of Women & Aging, 5(3–4), 181–199.CrossRefGoogle Scholar
Burroughs, H., Lovell, K., Morley, M., Baldwin, R., Burns, A., & Chew-Graham, C. (2006). ‘Justifiable depression’: How primary care professionals and patients view late-life depression? A qualitative study. Family Practice, 23(3), 369–377.Google Scholar
Butler, R. N. (1969). Age-ism: Another form of bigotry. The Gerontologist, 9(4), 243–246.Google Scholar
Butler, R. (1975). Why survive? Being old in America. New York, NY: Harper and Row.Google Scholar
Butler, R. N. (1980). Ageism: A foreword. Journal of Social Issues, 36(2), 8–11.Google Scholar
Bytheway, B. (1995). Ageism. Bristol, PA: Open University Press.Google Scholar
Calasanti, T. M. (2003). Theorizing age relations. In Biggs, S. & Lowenstein, A. (Eds.), The need for theory: Critical approaches to social gerontology for the 21st century (pp. 199−218). Amityville, NY: Baywood.Google Scholar
Calasanti, T. M., & Slevin, K. F. (2006). Age matters: Realigning feminist thinking. New York, NY: Routledge.Google Scholar
Campbell, C., & McGauley, G. (2005). Doctor-patient relationships in chronic illness: Insights from forensic psychiatry. British Medical Journal, 330(7492), 667–670.Google Scholar
Coles, R., Watkins, F., Swami, V., Jones, S., Woolf, S., & Stanistreet, D. (2010). What men really want: A qualitative investigation of men’s health needs from the Halton and St Helens Primary Care Trust men’s health promotion project. British Journal of Health Psychology, 15(4), 921–933.Google Scholar
Damiano, P., Momany, E., Willard, K., & Jogerst, G. (1997). Factors affecting primary care physician participation in Medicare. Medical Care, 35(10), 1008–1019.Google Scholar
Edwards, C., Staniszweska, S., & Crichton, N. (2004). Investigation of the ways in which patients’ reports of their satisfaction with healthcare are constructed. Sociology of Health and Illness, 26(2), 159–183.Google Scholar
Ekdahl, A. W., Andersson, L., & Friedrichsen, M. (2010). “They do what they think is best for me.” Frail elderly patients’ preferences for participation in their care during hospitalization. Patient Education and Counselling, 80(2), 233–240.Google Scholar
Ekdahl, A. W., Hellstrom, I., Andersson, L., & Friedrichsen, M. (2012). Too complex and time-consuming to fit in! Physicians’ experiences of elderly patients and their participation in medical decision making: A grounded theory study. British Medical Journal (Open Access), 2(3), 1–7.Google Scholar
Elkin, E. B., Kim, S. H. M., Casper, E. S., Kissane, D. W., & Schrag, D. (2007). Desire for information and involvement in treatment decisions: Elderly cancer patients’ preferences and their physicians’ perceptions. Journal of Clinical Oncology, 25(33), 5275–5280.Google Scholar
Evans, K., & Robertson, S. (2009). “Dr. Right”: Elderly women in pursuit of negotiated health care and mutual decision making. The Qualitative Report, 14(3), 409–432.Google Scholar
Gott, M., Hinchliff, S., & Galena, E. (2004). General practitioner attitudes to discussing sexual health issues with older people. Social Science and Medicine, 58(11), 2093–2103.Google Scholar
Greene, M. G., Adelman, R., Charon, R., & Hoffman, S. (1986). Ageism in the medical encounter: An exploratory study of the doctor-elderly patient relationship. Language and Communication, 6(1–2), 113–124.CrossRefGoogle ScholarPubMed
Greene, M. G., Adelman, R. D., Friedmann, E., & Charon, R. (1994). Older patient satisfaction with communication during an initial medical encounter. Social Science and Medicine, 38(9), 1279–1288.Google Scholar
Greenfield, S., Blanco, D. M., Elashoff, R. M., & Ganz, P. A. (1987). Patterns of care related to age of breast cancer patients. The Journal of the American Medical Association, 257(20), 2766–2770.Google Scholar
Haug, M. (1979). Doctor patient relationships and the older patient. Journal of Gerontology, 34(6), 852–860.Google Scholar
Helton, M. R., & Pathman, D. E. (2008). Caring for older patients: Current attitudes and future plans of family medicine residents. Family Medicine, 40(10), 707–714.Google Scholar
Henderson, J. W. (1997). Issues in the medical treatment of elderly women. Journal of Women and Aging, 9(1–2), 107–115.Google Scholar
Ishikawa, H., Takayama, T., Yamazaki, Y., Seki, Y., & Katsumata, N. (2002). Physician-patient communication and patient satisfaction in Japanese cancer consultations. Social Science and Medicine, 55(2), 301–311.Google Scholar
Kaplan, S. H., Gandek, B., Greenfield, S., Rogers, W., & Ware, J. E. (1995). Patient and visit characteristics related to physicians’ participatory decision-making style: Results from the Medical Outcomes Study. Medical Care, 33(2), 1176–1187.Google Scholar
Keville, T. (1993). The invisible woman: Gender bias in medical research. Women’s Rights Law Reporter, 15(2–3), 123–142.Google Scholar
Kong, M. C., Camacho, F. T., Feldman, S. R., Anderson, R. T., & Balkrishnan, R. (2007). Correlates of patient satisfaction with physician visit: Differences between elderly and non-elderly survey respondents. Health and Quality of Life Outcomes, 62(5), 1–6.Google Scholar
Lee, Y., & Kasper, J. D. (1998). Assessment of medical care by elderly people: General satisfaction and physician quality. Health Services Research, 32(6), 741–758.Google Scholar
Maly, R. C., Leake, B., & Silliman, R. A. (2004). Breast cancer treatment in older women: Impact of the patient-physician interaction. Journal of the American Geriatrics Society, 52(7), 1138–1145.Google Scholar
Marshall, C., & Rossman, G. B. (2006). Designing qualitative research. Thousand Oaks, CA: Sage.Google Scholar
McCandless, J. N., & Conner, F. P. (1999). Older women and the health care system: A time for change. Journal of Women and Aging, 11(2–3), 13–27.Google Scholar
Mutran, E., & Ferraro, K. F. (1988). Medical need and use of services among older men and women. Journal of Gerontology, 43(5), S162–S171.Google Scholar
Nelson, T. D. (2002). Ageism: Stereotyping and prejudice against older persons. Cambridge, MA: MIT Press.Google Scholar
Nussbaum, J. F., Pitts, M. J., Huber, F. N., Krieger, Raup, , J. L., & Ohs, J. E. (2005). Ageism and ageist language across the life span: Intimate relationships and non-intimate interaction. Journal of Social Issues, 61(2), 287–305.Google Scholar
Ogden, J., Bavalia, K., Bull, M., Frankum, S., Goldie, C., Gosslau, M., et al. (2004). “I want more time with my doctor:” A quantitative study of time and the consultation. Family Practice, 21(5), 479–483.Google Scholar
Palmore, E. B. (1999). Ageism: Negative and positive. New York: Springer.Google Scholar
Patton, M. (2002). Qualitative research and evaluation methods. Thousand Oaks, CA: Sage.Google Scholar
Peck, B. M. (2011). Age-related differences in doctor-patient interaction and patient satisfaction. Current Gerontology and Geriatrics Research, 28(3), 1–10.Google Scholar
Pereles, L., & Russell, M. (1996). Needs for CME in geriatrics. Part 2: Physician priorities and perceptions of community representatives. Canadian Family Physician, 42(4), 632–640.Google Scholar
Quadagno, J. S. (1999). Aging and the life course: An introduction to social gerontology. Boston, MA: McGraw-Hill.Google Scholar
Rice, E. L., Berekmyei, S., Kuby, A., Levinson, W., & Braddock, C. H. (2012). New elements for informed decision making: A qualitative study of older adult’s views. Patient Education and Counselling, 86(3), 335–341.Google Scholar
Robb, C., Chen, H., & Haley, W. E. (2002). Ageism in mental health and health care: A critical review. Journal of Clinical Geropsychology, 8(1), 1–12.Google Scholar
Rost, K., & Frankel, R. (1993). The introduction of the older patient’s problems in the medical visit. Journal of Aging and Health, 5(3), 387–401.CrossRefGoogle ScholarPubMed
Seale, C., & Charteris-Black, J. (2008). The interaction of age and gender in illness narratives. Ageing and Society, 28(7), 1025–1045.Google Scholar
Sharpe, P. A. (1995). Older women and health services: Moving from ageism toward empowerment. Women and Health, 22(3), 9–23.Google Scholar
Skuladottir, H., & Halldorsdottir, S. (2008). Women in chronic pain: Sense of control and encounters with health professionals. Qualitative Health Research, 18(7), 891–901.Google Scholar
Statistics Canada. (2006). Dependency, chronic conditions and pain in seniors. Catalogue 82-003. Retrieved 4 January 2013 from http://www.statcan.gc.ca/pub/82003s/2005000/pdf/9087-eng.pdf.Google Scholar
Tannenbaum, C. B., Nasmith, L., & Mayo, N. (2003). Understanding older women’s health care concerns: A qualitative study. Journal of Women and Aging, 15(1), 3–15.Google Scholar
Teh, C. F., Karp, J. F., Kleinman, A., Reynolds, C. F., Weiner, D., & Cleary, P. D. (2009). Older people’s experiences of patient-centered treatment for chronic pain: A qualitative study. Pain Medicine, 10(3), 521–530.Google Scholar
Vieder, J. N., Krafchick, M. A., Kovach, A. C., & Galluzzi, K. E. (2002). Physician-patient interaction: What do elders want? The Journal of American Osteopathic Association, 102(2), 73–78.Google Scholar
Weitzman, P. F., Ballah, K., & Levkoff, S. E. (2008). Native-born Chinese women’s experiences in medical encounters in the U.S. Ageing International, 32(2), 128–139.Google Scholar
Weitzman, P. F., Chang, G., & Reynoso, H. (2004). Middle-aged and older Latino American women in the patient-doctor interaction. Journal of Cross-Cultural Gerontology, 19(3), 221–239.Google Scholar
Werner, A., Isaksen, L. W., & Malterud, K. (2004). ‘I am not the kind of woman who complains of everything’: Illness stories on self and shame in women with chronic pain. Social Science and Medicine, 59(5), 1035–1045.Google Scholar
Werner, A., & Malterud, K. (2003). It is hard work behaving as a credible patient: Encounters between women in chronic pain and their doctors. Social Science and Medicine, 57(8), 1409–1419.Google Scholar
Wolff, J. L., & Roter, D. L. (2008). Hidden in plain sight: Medical visit companions as a resource for vulnerable older adults. Archives of Internal Medicine, 168(13), 1409–1415.Google Scholar