Smith, Fiona; (2003) The Doctor, the older patient and the unmet need: The effect of a patient centred approach on unmet needs in older adults. Doctoral thesis (D.Clin.Psy.), UCL (University College London).

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Abstract

Many older people in the UK have unmet health and social care needs, despite being the most frequent users of primary health care services. Older people may not seek help for reasons of withdrawal, resignation, and low expectations, but no study to date has investigated why many needs remain unmet even after people have seen a doctor. There is some evidence that the communication style and content of the consultations between doctors and older patients is different to that with younger patients, which may impede the identification and treatment of needs. The purpose of this study was to investigate the effect of a general practitioner's "patient centredness" (a widely advocated approach to consultation style) on unmet needs in older adults, and resultant reports of satisfaction. 78 participants over the age of 65 were recruited from two South London general practice surgeries to participate in this study, with 67 completing the follow up interview. The participants were interviewed before and after their meeting with the general practitioner. After the consultation they completed questionnaires of their perception of the doctor's patient centredness and their satisfaction with the consultation. The Camberwell Assessment of Need for the Elderly was administered by semi-structured interview. Patient centredness was significantly associated with satisfaction, but not unmet need. Half of the sample had at least one unmet need after they had seen a doctor, yet almost all of this group said that the consultation had met their needs. The most common unmet needs were for information, sensory difficulties, and help with benefits. These findings have implications for older people's apparent acceptance of unmet need, and the extent to which they can play an active role in their health care if they have an unmet need for information.

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