Fears of disease and disability in elderly primary health care patients

Care recipients' perceptions of activity-related life space and life satisfaction during and after geriatric rehabilitation

The debate concerning older people's life spaces should be based on subjective priorities of the elderly themselves. The purpose of this study was therefore to improve the understanding of preferences of elderly care recipients regarding activity-related life space (ARLS) and life satisfaction. A mainly qualitative design was used. Fifteen persons aged 80-94 years, undergoing geriatric rehabilitation, were interviewed during hospital stay and on two follow-up occasions after discharge. Transcribed interviews were analyzed in line with the thematic framework approach. The results point to three approaches related to preferences of ARLS: hierarchical limitations, changing continuity, and boundary breaking. Adaptive approaches were employed when physical incapacity was considered a hindrance to activity, adaptations which as a rule resulted in limitations of ARLS preferences. Activity related to the area 'close to one's own body' emerged as one of three identified key activities with importance for life satisfaction, the others being socializing and going out of doors. Continuity of activity in a familiar life space was expressed as a common ideal. If the aim of geriatric rehabilitation is to improve care recipients' life satisfaction, attention needs to be paid to the subjective dimensions of the ARLS in the goal setting.

Making the invisible body visible. Bone scans, osteoporosis and women's bodily experiences

The imaging technology of bone scans allows visualization of the bone structure, and determination of a numerical value. Both these are subjected to professional interpretation according to medical (epidemiological) evidence to estimate the individual's risk of fractures. But when bodily experience is challenged by a visual diagnosis, what effect does this have on an individual? The aim of this study was to explore women's bodily experiences after a bone scan and to analyse how the scan affects women's self-awareness, sense of bodily identity and integrity. We interviewed 16 Danish women (aged 61-63) who had had a bone scan for osteoporosis. The analysis was based on Merleau-Ponty's perspective of perception as an embodied experience in which bodily experience is understood to be the existential ground of culture and self. Women appeared to take the scan literally and planned their lives accordingly. They appeared to believe that the 'pictures' revealed some truth in themselves. The information supplied by the scan fostered a new body image. The women interpreted the scan result (a mark on a curve) to mean bodily fragility which they incorporated into their bodily perception. The embodiment of this new body image produced new symptom interpretations and preventive actions, including caution. The result of the bone scan and its cultural interpretation triggered a reconstruction of the body self as weak with reduced capacity. Women's interpretation of the bone scan reorganized their lived space and time, and their relations with others and themselves. Technological information about osteoporosis appeared to leave most affected women more uncertain and restricted rather than empowered. The findings raise some fundamental questions concerning the use of medical technology for the prevention of asymptomatic disorders.

Older people as health service consumers 3: obstacles to access in the village

Faster access to hospital services, swift advice and treatment in GP surgeries and quicker access to information at home are among the improvements brought about as a result of recent Government policies in England. These developments have increased the infrastructure, such as walk-in clinics and extended surgery hours, but the responsibility lies with the patient to present themselves. Although older people use NHS services proportionately more than other age groups, they also tend to normalize disease symptoms, attributing them to ageing (Tod et al, 200a). This article, the third in a series which addresses older people's beliefs and behaviour in relation to health care, discusses the factors which influence the accessing of health services within an older, white village community in South England.

Serious, frightening and interesting conditions: differences in values and attitudes between first-year and final-year medical students

CONTEXT AND OBJECTIVE

During medical education and training, the values and attitudes of medical students are shaped both by knowledge and by role models. In this study, the aim was to compare the views of first- and final-year students concerning patients with different medical conditions.

PARTICIPANTS AND METHOD

In the spring of 1998 all first- and final-year medical students at Göteborg and Lund Universities, Sweden, were invited to answer a questionnaire. A total of 20 medical conditions were to be rated on visual analogue scales, according to three aspects: their perceived seriousness, the student's own fear of them and interest in working with these conditions in the future.

RESULTS

The overall response rate was 75%. Concerning seriousness, there was a high degree of concordance between the first- and final-year students. Concerning their own fear, the concordance was less pronounced. When the conditions were rated from the aspect of interest, for the final-year students, gastric or duodenal ulcer replaced infection with Ebola virus for the first-year students, among the five highest-ranked conditions. The correlations between seriousness and fear were lower among the final-year students, but this reached statistical significance only in a few cases.

DISCUSSION

A reasonable interpretation of the results is that the values and attitudes of the students were influenced by increased knowledge, as well as by role models encountered during the clinical parts of the training. Conditions less likely to be contracted become less feared, and conditions with effective treatment become more interesting; and the converse was true for each of these changes.