Background
Methods
Study population, sampling and data collection
Sampling and data collection of ‘hard to reach’ older people
Sampling and data collection of professionals
Data analysis
Results
Characteristics of participants
ID | Data | ‘Hard to reach’ group | Gender | Age in years |
---|---|---|---|---|
Int1 | Interview | Oldest old | Male | ≥85 |
Int2 | Interview | Oldest old, deprived area | Female | ≥85 |
Int3 | Interview | Oldest old, BME, deprived area | Female | ≥85 |
Int4 | Interview | Oldest old, BME, deprived area | Female | ≥85 |
Int5 | Interview | Oldest old, BME, deprived area | Female | ≥85 |
Int6 | Interview | BME | Female | 65–84 |
Foc1 | Focus group | BME, deprived area | Female | 65–84 |
Foc1 | Focus group | BME, deprived area | Female | 65–84 |
Foc1 | Focus group | BME, deprived area | Female | 65–84 |
Foc1 | Focus group | BME, deprived area | Female | 65–84 |
Int7 | Interview | BME, deprived area | Male | 65–84 |
Int8 | Interview | BME, deprived area | Male | 65–84 |
Int9 | Interview | BME, deprived area | Male | 65–84 |
Int10 | Interview | BME, deprived area | Female | 65–84 |
Int11 | Interview | Deprived area | Male | 65–84 |
Int12 | Interview | Deprived area | Male | 65–84 |
Int13 | Interview | Deprived area | Male | 65–84 |
Int14 | Interview | Deprived area | Male | 65–84 |
Int15 | Interview | Deprived area | Female | 65–84 |
ID | Job sector | Job role | ‘Hard to reach’ group of experience |
---|---|---|---|
Pro1–11 | Academic | 9 researcher/lecturer, 2 director | 7 oldest old, 6 BME, 4 deprived area |
Pro12–20 | Local authority | 2 practitioner, 5 manager/director, 1 commissioner, 1 city councillor | 2 oldest old, 6 BME, 7 deprived area |
Pro21 | Multiple sectors | 1 ‘health promoter’ | Deprived area |
Pro22–23 | NHS | 2 practitioner | 2 oldest old, 1 BME, 2 deprived area |
Pro24 | Social care | 1 manager | Oldest old |
Pro25–31 | Voluntary/third sector | 3 project officer/coordinator, 3 manager/director, 1 trustee | 6 oldest old, 3 BME, 5 deprived area |
Themes | Oldest old | BME | Deprived area |
---|---|---|---|
Context of older people’s lives and health | x | x | x |
Practicing activities to feel or stay well | x | x | x |
The role of others on health and wellbeing | x | x | x |
Practicing health promotion requires making an effort | x | ||
Behaviours to reach advanced age | x | ||
Withdrawal from health promotion activities | x | ||
Wish to remain independent | x | ||
Taking health advice | x | ||
Language barriers | x | ||
Scepticism about engaging in health promotion | x | ||
Apathy | x | ||
Opportunities for health promotion in the local area | x |
Themes across all ‘hard to reach’ groups
Context of older people’s lives and health
“Not being able to do what you want to do plays a great part in my life, it more or less makes me handicapped, like a handicapped person because I can’t do this, I can’t do that, I can’t … you know? It’s as if my life is not my own now. … . I can’t do anything hardly. I can’t hoover, I can’t make up my bed. Sometimes even to get my clothes on, I can’t do that. I can’t go in the bath on my own. So it’s hard and I cannot rush to do anything.” (Int10, female, BME, deprived area)
“General lack of physical ability gets in the way. There are things like loss of or difficulty in seeing, hearing. Some may have dementia.” (Pro27, voluntary/third sector, trustee)
Practicing activities to feel or stay well
“Well, in my young days, I didn’t exercise because I was working, but now I come down here for exercise classes, you know, they’re held in the morning.” (Int5, female, oldest old, BME, deprived area)
“I mean, you are aware of the benefits of it, of course you are, because otherwise you wouldn’t go, you wouldn’t even think about it. So you know the benefit is ongoing but actually going itself, getting up and going, that’s the main thing.” (Int1, male, oldest old)
“I read quite a lot and I struggle with the crossword and do the Sudoku and that sort of thing.” (Int11, male, deprived area)
The role of others on health and wellbeing
“Yeah, they [peers] have cars and they come and take me to church.” (Int3, female)
“They [patient transport services] take me where I have to go and pick me up and take me home as well.” (Int4, female)
“The other thing is that I can’t go out now on my own, unless I’m with my daughter with a stick and I hold her arm.” (Int2, female)
“I’ve spent a lot of time with my granddaughter, she’s eight now. And so she gives you a whole new outlook on life and she does gymnastics, so she has me down on the floor doing some of them with her!” (Int6, female)
“A friend introduced me to [the community centre], they were having something and she took me. And then I became a member.” (Int3, female)
“But they [peers from the same BME group and age] just stopped, they just stopped coming [to health class]; they didn’t say why they’re not coming and then in the end, there was just me alone.” (Int10, female)
“Now her husband is not well and that’s why she looks after her husband.” (Foc1, female x4)
“Sometimes it’s good to have somebody to talk to you, better than taking this rubbish medication.” (Int10, female)
“The community church and you go there and meet a friend from your country, you talk and it’s good.” (Int9, male)
“Well, you meet other people. You meet a lot of people who don’t just live in the block (of flats) in the area.” (Int11, male)
“I used to go to [adjacent area] to that day centre and they have the little minibus taking you there. I’ve tried to get a few of them involved to go, because they’re not doing anything. But they didn’t want to; I was the only one that the bus picked up from here.” (Int10, female)
“I don’t know a good many people. I don’t need to socialise a great deal … . If not at 40 [years of age] I wasn’t particularly worried about making friends with them, why should I do it 20 years later.” (Int14, male)
“Arrange transport for elders so that they can be picked up from their home” (Pro4, academic, researcher/lecturer)
“[To facilitate participation] engaging with this group in their own homes” (Pro31, voluntary/third sector, director)
“Attitudes of others. Can be linked to ageism but here expressly meant as concerns of family and careers in older relatives participating” (Pro3, academic, researcher/lecturer)
“A reluctance to engage with services, families preferring to take care 'of their own' - of course this is encouraged, but along with certain support mechanisms when appropriate would increase carer support and reduce risk e.g. by providing moving and handling equipment rather than a carer lifting a cared-for-person manually.” (Pro18, local authority, practitioner)
“The socialising and community aspects of older BME groups is important. For some communities I worked with, particularly Viet Laos Cambodian and African / African Caribbean it would be seen as quite rude to try to 'engage' without FIRST enjoying a meal together.” (Pro15, local authority, commissioner)
“[I] often come across residents who have no social contact with their neighbours, family or friends. Ill-health often lead to social isolation when close family decease. In some cases residents do not get out and sometimes becomes social isolated. The groups who are not involved with e.g. churches, clubs or other organisation, it can be very difficult to engage with these groups.” (Pro17, local authority, city councillor)
Oldest old
Practicing health promotion requires making an effort
“I just have to, you know, take my time, like going up the stairs and so on, I have rails to hold onto to go up. I take my time, one at a time, you know?” (Int3, female)
“But if I go out with a pusher (mobility aid), I can go out with that on my own, but I can’t put weight on it to go downstairs.” (Int2, female)
Behaviours to reach advanced age
“First of all it means being lucky for a start, not everybody is healthy. It’s something like a lottery, isn’t it? … Well, looking back, in hindsight looking back, all the things I could have done to improve my health but I didn’t do it. One was smoking, I smoked all my life, so that was a ‘no-no’, but there again, I grew up in a culture that encouraged you to smoke.” (Int1, male)
Withdrawal from health promotion activities
One participant reported hesitating going to a local charity event without their partner who was too ill to attend:“No, I don’t go out any more when it’s late like that [7 pm], unless my boys are here and they have a show or something and they take me out to it. But I wouldn’t like going out in the evening, late in the evening now.” (Int3, female)
“Well, I felt they couldn’t give me nothing at the moment. It was a place … it was, er, (location) and I found it hard to get there and also I didn’t really get to … because I used to go there with my partner, going there on my arm, I didn’t really know anybody, know what I mean? If I go with my partner, I was OK, but going on my own was a different matter altogether.” (Int1, male)
“Engagement with their wider social networks, which might include kinship but also community groups. Direct involvement of formal care workers and informal carers.” (Pro6, academic, researcher/lecturer)
Older people from BME groups
Wish to remain independent
“I suppose being independent; that’s the biggest thing to me, losing my independence.” (Int6, female)
“Well why should I go before the younger ones!?” (Int3, female)
“My family help with cooking, washing, everything the family can do, you know?” (Int9, male)
“Daughter-in-law stays at home, she’s not work, in that way she supports.” (Foc1, female x4)
Taking health advice
Taking health advice also included attending health check-ups at the GP practice:“I don’t take advice from anyone, only my doctor. He knows about all the problems that we have. I wouldn’t trust anyone else; I’d trust my GP because they’re trained for that, they’re qualified in that. So I’ll take their advice any time.” (Int8, male)
“You get the letter, you go there.” (Int9, male)
“I don’t know, it’s just old age, I don’t know. It’s long term problems.” (Int10, female)
“I don’t expect much when I go to the doctor; I know that they cannot do miracles. If you’re old, you are old.” (Int7, male)
“They [health professionals] tell us boiled vegetables and things, but we’re not eating them. What doctor advise us to boil food, that will not be tasty, that’s the reason not listen to doctor!” (Foc1, female x4)
“I found it can take time because you need to build trust and understanding of culturally appropriate ways of working.” (Pro15, local authority, commissioner)
Language barriers
“Like sometimes when the doctor is speaking, you don’t understand and it’s very important to have some interpreter.” (Int9, male)
“It is vital to have someone who can speak the languages, or very good translators.” (Pro2, academic, researcher/lecturer)
Older people living in deprived areas
Scepticism about engaging in health promotion
“I hate people telling me what to do, you know? A bit of advice, fine, but don’t try and force it down me, you know?” (Int13, male)
“They [peers of the same age] don’t like to go to the doctors, they don’t like doctors, let alone going to see them! And they hate hospitals. I think because their mothers and fathers and things from many years ago died in hospital, you know, because they didn’t have the facilities. … ‘If I go in there, I shall die; I won’t come out!’ That’s their favourite saying.” (Int13, male)
“Well, I’m reluctant to go [visiting GP], but I find I’ve had to accept it over this last year or so, that I have to go when it’s necessary. I don’t … I didn’t think that, er, it was necessary and, er, it’s not part of my life, it hasn’t been part of my life to go to the doctors’ surgery, up until now. So, you know, it was just something that was happening to other people that they have to go, maybe, and I didn’t.” (Int14, male)
When asked if he (Int7) would like to attend a group session to help improve his memory, he replied: “I’d be interested in, yeah, but I don’t believe that it can be done.”“I forget things; one hour or two, I put something here, and one hour or two, what did I put? The memory, in the last three years, the memory is not so good, and that’s all. So I manage with what I’ve got left (slight laugh) and it’s nothing the doctor can do, I know, with memory.” (Int7, male)
“Lack of trust of those who should be supporting.” (Pro21, multiple sectors, ‘health promoter')
“Reluctance to change.” (Pro18, local authority, practitioner)
Apathy
“I think it’s all the attitude of the mind with them … a lot of them [peers of the same age], I don’t know, they think they’re going to die tomorrow and they’ve got to really closet their self and don’t do anything, you know? Because a lot of them are younger than me” (Int13, male)
“A lot of people [peers of the same age] just let themselves go; they just can’t be bothered. It’s the way you think, right, you know, that I think that keeps you young. I know friends of mine, they just sit indoors and they puff and they blow when they go out. I find like a lot of people that I ask to an event and they say, ‘Oh, I don’t want to go to that!’” (Int15, female)
“Well, I think there seems to be a mind-set, I would think, of the older people. People when they reach about 50 or 55, or maybe even earlier, they think ‘I’m physically done now, it’s all downhill!’” (Int14, male)
“An awful lot of people here, I fear, sit at home all day in their flat. … So I think you’ve got to encourage those who are using these facilities to get other people to draw them in.” (Int11, male)
“Apathy, not empowered to think they can make a difference - lack of genuine engagement i.e. coming out to where they are.” (Pro22, NHS, practitioner)
“This group often say 'it's too late to change'.” (Pro18, local authority, practitioner)
“I found they often are aware of someone who doesn’t come out much or engage.” (Pro15, local authority, commissioner)
Opportunities for health promotion in the local area
“Well, the services, like I go to the swimming pool and it’s free for me, for over 65s it’s free swimming, which is a very good service.” (Int12, male)
“An acquaintance from the keep fit (class), and her husband is coming up to 90 [years of age]. These are very fit people and they get the local bus from the council to take them shopping once a week; so I mean more amenities like that for the elderly that help people to live independently.” (Int15, female)
“Putting on relevant events that are close to where they live. Preferably free and providing a lunch or other refreshments. Getting transport organised for those less able to use public transport.” (Pro27, voluntary/third sector, trustee)
“I mean, my exercise, I’ve got a lot of machines here to do my exercise; if I get some encouragement to start doing something, like go to the gym or something” (Int8, male)
“I’d go there one day and we’d be up there, and then next week we’d be over there, and the next week up there, and then they wouldn’t turn up that week. I just gave it up, you know, because I can’t be bothered with things like that.” (Int13, male)
“It wasn’t language, because he [older neighbour referred to as ‘an English guy’] couldn’t read and write … He knew he’d got a letter, so he would phone me up and say, ‘Could you come and read this letter for me?’ so I used to go over and read it for him. The thing is, with people who can’t read and write, they need advice, because he really needed someone to advise him on how he could get help and nobody visited him. ” (Int8, male)
“[Enable participation by] not too much written info (information) required to fill in before enrolment.” (Pro23, NHS practitioner)