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Title: The 'oldest old' and their use and experiences of out-of-hours services : a mixed methods study
Author: Lambert, Wendy
ISNI:       0000 0004 6421 9159
Awarding Body: Lancaster University
Current Institution: Lancaster University
Date of Award: 2016
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In order to remain living at home, older people (85 years and above) often need support, which includes engaging with mainstream healthcare services including out-of-hours services. The aim of the study was to increase understanding of the use and experiences of the 'oldest old' accessing out-of-hours services. A sequential mixed methods study design was undertaken. Phase 1 comprised of a medical records review of the use of out-of-hours services by older people accessing two out-of-hours services. Phase 2 sought to obtain the older person's (and their family's) perspective of their experiences of using the service through semi-structured interviews. Descriptive and multinomial statistical analyses of Phase 1 data were integrated with the thematic analysis of the interview data and then interpreted using Complex Adaptive Systems Theory. In Phase 1, data were collected on 398 older people who accessed out-of-hours organisations. In Phase 2, fourteen older people and seven family members who had recently accessed those services participated. This study identified several factors influencing the 'oldest old’ and their use and experiences of out-of-hours services and the outcome of their calls, including, i) the individual older person: their social situation; independence or dependence on others; degree of mobility and ability to physically make the call; ii) the structured system of out-of-hours healthcare; and iii) the 'interface' between the older person and the service: a 'zone of complexity' for older people living in their own home. The out-of-hours assessment process is not currently equipped to manage the complexity of older people's lives and health needs. A reductionist model of healthcare is adopted whereby decisions are based on limited information, rather than looking beyond the 'reason for call’. Attention to this complexity, at a time of self-identified need by older people could ensure more appropriate and timely interventions by healthcare professionals.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available