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Finding a ‘new normal’ following acute illness: A qualitative study of influences on frail older people’s care preferences

Etkind, Simon Noah; Lovell, Natasha; Nicholson, Caroline Jane; Higginson, Irene J.; Murtagh, Fliss EM


Simon Noah Etkind

Natasha Lovell

Caroline Jane Nicholson

Irene J. Higginson


Background: The frail older population is growing, and many frail older people have episodes of acute illness. Patient preferences are
increasingly considered important in the delivery of person-centred care and may change following acute illness.
Aim: To explore influences on the care preferences of frail older people with recent acute illness.
Design: Qualitative in-depth individual interviews, with thematic analysis.
Setting/participants: Maximum variation sample of 18 patients and 7 nominated family carers from a prospective cohort study of
people aged over 65, scoring ⩾5 on the Clinical Frailty Scale, and with recent acute illness, who were not receiving specialist palliative
care. Median patient age was 84 (inter-quartile range 81–87), 53% female. Median frailty score 6 (inter-quartile range 5–7).
Results: Key influences on preferences were illness and care context, particularly hospital care; adaptation to changing health;
achieving normality and social context. Participants focused on the outcomes of their care; hence, whether care was likely to help
them ‘get back to normal’, or alternatively ‘find a new normal’ influenced preferences. For some, acute illness inhibited preference
formation. Participants’ social context and the people available to provide support influenced place of care preferences. We combined
these findings to model influences on preferences.
Conclusion: ‘Getting back to normal’ or ‘finding a new normal’ are key focuses for frail older people when considering their
preferences. Following acute illness, clinicians should discuss preferences and care planning in terms of an achievable normal, and
carefully consider the social context. Longitudinal research is needed to explore the influences on preferences over time.

Journal Article Type Article
Publication Date Mar 1, 2019
Journal Palliative Medicine
Print ISSN 0269-2163
Electronic ISSN 1477-030X
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 33
Issue 3
Pages 301-311
APA6 Citation Etkind, S. N., Lovell, N., Nicholson, C. J., Higginson, I. J., & Murtagh, F. E. (2019). Finding a ‘new normal’ following acute illness: A qualitative study of influences on frail older people’s care preferences. Palliative medicine, 33(3), 301-311.
Keywords Anesthesiology and Pain Medicine; General Medicine