Age and Ageing Advance Access originally published online on March 10, 2008
Age and Ageing 2008 37(3):351; doi:10.1093/ageing/afn045
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Evaluating the impact of the National Service Framework for Older People; qualitative science or populist propaganda?
SIR—Harwood's editorial [1] challenges the readership to decide the worth of the qualitative research by Manthorpe et al. [2] regarding the impact of the National Service Framework for Older People (NSFOP).The authors acknowledge the use of purposive sampling, which led to over-representation of ethnic minorities but we are not given any data about other ‘hard-to reach’ groups that were involved. A lack of data regarding socio-economic, health or educational status makes results harder to interpret. Only the 120 participants interviewed were identified as having specific contact with health care services. A significant number of participants were aged 50–59, a group I would suggest who do not usually identify themselves as ‘older people.’
The authors make much of the fact that the majority of older people involved had not heard of the NSFOP or intermediate care. Yet they failed to build on this by questioning the research groups about their thoughts regarding a relaunch of the NSFOP or the need for policy change directed specifically at older people.
The themes identified are identity; losses and gains; expectations (specifically around inconsistencies in social care) and knowledge of the NSFOP. Although multi-disciplinary members were involved in analysing the data, it is not clear how themes were identified and there is no specific evidence of respondent validation. Many of the quotations used do not seem to complement the themes. For example, ‘They asked me a lot of questions and then assumed that I was confused because of my age’ is a poignant quote which reflects both age discrimination and the way that older people perceive that they are viewed by health care professionals. Yet it does not seem to fit into any of the themes. In a robust system with review of emerging themes this problem would have been addressed.
One quote from the article is ‘many felt that the actual goal [of rehabilitation] was to accelerate discharge.’ But how does this affect engagement with rehabilitation services? Are there differing views about hospital-based versus intermediate care versus home-based rehabilitation? Having this knowledge would be invaluable in improving rehabilitation services and is ideally investigated by qualitative research, but the opportunity was missed.
The research question was probably always unanswerable. Maybe it would have been better to have asked, ‘How do older people feel that health policy affects them? Do older people perceive a need for health policy to outlaw age discrimination?’ or even, ‘Do older people feel that the existence of a NSFOP actually marginalises them and excludes them from ‘mainstream’ medical management?’
Specialist Registrar in Geriatric Medicine, Royal Oldham Hospital, Rochdale Road, Oldham, UK
E-mail: s.powell{at}doctors.org.uk
References
- Harwood R. Evaluating the Impact of the National Service Framework for Older People; qualitative science or populist propaganda? Age Ageing (2007) 36:483–5.
[Free Full Text] - Manthorpe J, Clough R, Cornes M. Older People Researching Social Issues. Four years on: The impact of the National Service Framework for Older People on the experiences, expectations and views of older people. Age Ageing (2007) 36:501–7.
[Abstract/Free Full Text]
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