Primary Care for Elderly People Why Do Doctors Find It So Hard
TL;DR: Much of the difficulty participants experienced could be facilitated by changes in the health care delivery system and in medical education, and the voices of these physicians and the model resulting from the analysis can inform change.
Abstract: Purpose: Many primary care physicians find caring for elderly patients difficult. The goal of this study was to develop a detailed understanding of why physicians find primary care with elderly patients difficult. Design and Methods: We conducted in-depth interviews with 20 primary care physicians. Using an iterative approach based on grounded theory techniques, a multidisciplinary team analyzed the content of the interviews and developed a conceptual model of the difficulty. Results: Three major domains of difficulty emerged: (i) medical complexity and chronicity, (ii) personal and interpersonal challenges, and (iii) administrative burden. The greatest challenge occurred when difficulty in more than one area was present. Contextual conditions, such as the practice environment and the physician’s training and personal values, shaped the experience of providing care and how difficult it seemed. Implications: Much of the difficulty participants experienced could be facilitated by changes in the health care delivery system and in medical education. The voices of these physicians and the model resulting from our analysis can inform such change.
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01 Jan 2021
TL;DR: In this article, an analysis of intra-generational communication, or the ways in which old people communicate with each other, is presented, which poses specific challenges to both the old and the young.
Abstract: Language and communication starts with an analysis of intra-generational communication, or the ways in which old people communicate with each other. Intra-generational communication tends to differ from communicating with younger generations (inter-generational communication) which, in turn, poses specific challenges to both the old and the young. Communication is expressed through narratives that can unravel our priorities, concerns, emotions, beliefs, ways of processing life events and understanding of the relationships we establish with other people. The narratives of the elderly are to some extent a window into their mind. Such narratives can however remain more hidden in multicultural societies due to language barriers, in which case older people will require the services of bilingual family members or specifically trained interpreters and translators to communicate more effectively, especially in institutional and medical settings.
6 citations
Dissertation•
01 Jan 2017
6 citations
Cites methods from "Primary Care for Elderly People Why..."
...Individual interviews with key participants at each stage of the transition process was chosen as the method of data collection and aimed to obtain data that was rich and meaningful with increased depth and breadth (Adams et al., 2002; Polkinghorne, 2005)....
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TL;DR: Methods of empowerment, identification of barriers and methods of overcoming them, and tools for the health care provider in promoting positive health care interactions is the focus of this article.
6 citations
09 Mar 2020
TL;DR: In this paper, a qualitative case study was conducted to understand host and guest perceptions and experiences of the traditional Rush Mela Festival in the Sundarbans forest region, specifically at the sites of Dublar Char and Chila (on the periphery of the forest), in Bangladesh.
Abstract: Authentic experiences of intangible cultural heritage (ICH) are popular as tourist attractions, particularly in developing countries. However, how the authenticity of ICH is conceptualized in the context of tourism and how ICH relates to community empowerment is unexplored in recent literature. This study aims to investigate how hosts and guests (in this case domestic tourists) at a traditional cultural festival perceived the role of ICH in community empowerment. The study also sought to identify the factors influencing how hosts and guests perceive the authenticity of ICH, and how the effect of mutual (host-guest) authentication of ICH can build on community empowerment. A qualitative case study approach was utilised to understand host and guest perceptions and experiences of the traditional Rush Mela Festival (as an example of ICH) in the Sundarbans forest region, specifically at the sites of Dublar Char (inside the forest) and Chila (on the periphery of the forest), in Bangladesh.
The study was based on a conceptual model for understanding mutual (host-guest) authentication of ICH and its relationship to community empowerment. This model was developed based on prior literature. The study revealed that the major elements of the Rush Mela Festival comprised of religious rituals, cultural programmes, economic activities, tourism, and community institutions. The majority of hosts and guests perceived that these elements play an important role in four dimensions of community empowerment (psychological, economic, social and political). However, there was some variation in the perceptions depending on the locality of the festival (i.e., Dublar Char or Chila) and the tourism opportunities available. The study found that factors such as the hosts’ attitudes, motivations, economic benefits, emotional benefits, individual participation, and institutional involvement influenced their perceptions of authenticity (both objective and existential) of the Rush Mela Festival. Also, the study found that factors such as guests’ attitudes, motivations, authenticity of objects, and authentic experiences also play a significant role in building guests’ perceptions of authenticity of the Rush Mela Festival.
Despite some differences, most of the hosts and guests have perceived that some of the objects (e.g. the statues of the God and Goddess, the temple, the dried fish and local foods (sweets)) and experiences (e.g. worship ceremony, the holy bath, cultural programmes, and meeting family and friends) during the Rush Mela Festival were authentic, and these support the objective and existential authenticity of the festival. Mutual authentication of the festival has led to host support and guest loyalty towards Rush Mela tourism. Few hosts were concerned about excessive tourism and commodification of cultural practices, whereas some guests were not satisfied as they expected improved tourist facilities and more authentic local products.
Moreover, the research also suggests that the mutual authentication of the festival and support for tourism have ultimately influenced the community’s psychological empowerment (i.e. strengthens spiritual belief), economic empowerment (i.e. increasing economic benefits), social empowerment (i.e. increasing social cohesion and consensus for preserving cultural tradition and natural resources), and political empowerment (i.e. development of community institutions). Finally, the study suggests that empowerment of the community could influence host and guest factors for authenticating the Rush Mela Festival and increasing loyalty and support for tourism, which could contribute to the development of sustainable ICH tourism. Further research should be carried out to test and validate the conceptual mutual (host-guest) authentication model in various ICH-based tourism contexts. Also, further study could explore the potential for a community-based ICH tourism programme that can facilitate the preservation of authenticity of ICH and enhance community empowerment.
6 citations
TL;DR: This paper seeks to heighten the awareness of pastoral care professionals to common ageist themes found in health and mental care service delivery.
Abstract: Pastoral care professionals are cognizant of many forms of prejudice and discrimination in society and health care environments. Ageism is perhaps the least likely to be challenged as prejudice or ...
5 citations
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...Low reimbursement rates also discourage intervention (Adams et al., 2002)....
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References
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TL;DR: The Nature of Qualitative Inquiry Theoretical Orientations Particularly Appropriate Qualitative Applications as mentioned in this paper, and Qualitative Interviewing: Qualitative Analysis and Interpretation Enhancing the quality and credibility of qualitative analysis and interpretation.
Abstract: PART ONE: CONCEPTUAL ISSUES IN THE USE OF QUALITATIVE METHODS The Nature of Qualitative Inquiry Strategic Themes in Qualitative Methods Variety in Qualitative Inquiry Theoretical Orientations Particularly Appropriate Qualitative Applications PART TWO: QUALITATIVE DESIGNS AND DATA COLLECTION Designing Qualitative Studies Fieldwork Strategies and Observation Methods Qualitative Interviewing PART THREE: ANALYSIS, INTERPRETATION, AND REPORTING Qualitative Analysis and Interpretation Enhancing the Quality and Credibility of Qualitative Analysis
31,305 citations
TL;DR: In this article, the authors discuss the uses of literature and open coding techniques for enhancing theoretical sensitivity of theoretical studies, and give guidelines for judging a grounded theory study.
Abstract: Introduction Getting Started Theoretical Sensitivity The Uses of Literature Open Coding Techniques for Enhancing Theoretical Sensitivity Axial Coding Selective Coding Process The Conditional Matrix Theoretical Sampling Memos and Diagrams Writing Theses and Monographs, and Giving Talks about Your Research Criteria for Judging a Grounded Theory Study
28,999 citations
Journal Article•
TL;DR: The Nature of Qualitative Inquiry Theoretical Orientations Particularly Appropriate Qualitative Applications as mentioned in this paper, and Qualitative Interviewing: Qualitative Analysis and Interpretation Enhancing the quality and credibility of qualitative analysis and interpretation.
22,714 citations
21,313 citations
TL;DR: The challenge is to organize these components into an integrated system of chronic illness care, which can be done most efficiently and effectively in primary care practice rather than requiring specialized systems of care.
Abstract: Usual medical care often fails to meet the needs of chronically ill patients, even in managed, integrated delivery systems. The medical literature suggests strategies to improve outcomes in these patients. Effective interventions tend to fall into one of five areas: the use of evidence-based, planned care; reorganization of practice systems and provider roles; improved patient self-management support; increased access to expertise; and greater availability of clinical information. The challenge is to organize these components into an integrated system of chronic illness care. Whether this can be done most efficiently and effectively in primary care practice rather than requiring specialized systems of care remains unanswered.
2,805 citations
"Primary Care for Elderly People Why..." refers background in this paper
...In the area of practice organization, a number of interventions to facilitate primary care of chronically ill elders have been proposed and a few have been studied (Boult, Boult, Morishita, Smith, & Kane, 1998; Leveille et al., 1998; Schraeder, Shelton, & Sager, 2001; Netting & Williams, 2000; Wagner et al., 1996)....
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