Transactions between older people and the hospital environment: A social ecological analysis

PurposeTo illuminate how problems arise between older adults and the hospital environment through examination of the transactions between the two rather than a focus on one or the other.Design and methodsA critical ethnographic study that used constant comparative analysis applied to three data sets: hospital observations, interviews with older adults, and hospital employees.FindingsTwo groups of older people are distinguished: those identified as appropriate older patients and those found to be different or less appropriate. Incongruent relationships emerge only when older people who are inappropriate for the hospital's cultural space confront four areas of poor fit: architectural features, bureaucratic conditions, chaotic atmosphere and hospital employee attitude. These environmental features act in independent and interactive ways to produce a disempowering synergy that erodes independence and confidence; produces stress, worry and anxiety; and enhances disabilities when functional impairments exist. Being different is key to a lack of fit in the hospital environment and the construction of problems. Problem construction with older people is less about age and more about the efficiency of a one-size fits all approach to acute care. Ageism emerges as a bi-product of the pressure on hospital employees to keep the system moving.