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Dignity in old age
165
26. Montgomery P, Dennis J. Bright light therapy for sleep prob-
lems in adults aged 60+ (Cochrane Review). In The Cochrane
Library, Issue 4. Oxford: Update Software, 2002.
27. Middelkoop HA, Lammers GJ, Van Hilten BJ, Ruwhof C,
Pijl H, Kamphuisen AC. Circadian distribution of motor
activity and immobility in narcolepsy: assessment with contin-
uous motor activity monitoring. Psychophysiol 1995; 32: 286–91.
28. Youngstedt SD, Kripke DF, Elliott JA. Circadian phase-
delaying effects of bright light alone and combined with exer-
cise in humans. Am J Physiol Regulatory Integrative Comp
Physiol 2001; 10: R259–66.
29. Lack L, Wright H. The effect of evening bright light in delaying
the circadian rhythms and lengthening the sleep of early morning
awakening insomniacs. Sleep 1993; 16: 436–43.
30. Chesson A, Hartse K, Anderson WM et al. Practice parameters
for the evaluation of chronic insomnia. American academy of
sleep medicine report. Standards of practice committee of the
American academy of sleep medicine. Sleep 2000; 23: 237–41.
31. Pollack CP, Tryon WW, Nagaraja H, Dzwonczyk R. How
accurately does wrist actigraphy identify the states of sleep and
wakefulness. Sleep 2001; 24: 957–65.
32. Klosch G, Gruber G, Anderer P, Saletu B. Activity monitor-
ing in sleep research, medicine and psychopharmacology.
Wien Klin Wochenschr 2001; 113: 288–95.
33. Lockley SW, Skene DJ, Arendt J. Comparison between subjec-
tive and actigraphic measurement of sleep and sleep rhythms.
J Sleep Res 1999; 8: 175.
34. King AC, Oman RF, Brassington GS, Bliwise DL, Haskell
WL. Moderate-intensity exercise and self-rated quality of sleep
in older adults. A randomised control trial. JAMA 1997; 277:
32–37.
35. Van Someren EJ, Lijzenga C, Mirmiran M, Swaab DF. Long-
term Wtness training improves the circadian rest-activity rhythm
in healthy elderly males. J Biol Rhythms 1997; 12: 146–56.
36. Singh NA, Clements KM, Fiatarone MA. A randomised con-
trolled trial of the effect of exercise on sleep. Sleep 1997; 20:
95–101.
37. Naylor E, Penev PD, Orbeta L et al. Daily social and physical
activity increases slow wave sleep and daytime neuro-
psychological performance in the elderly. Sleep 2000; 23: 87–95.
38. Jean-Louis G, Kripke DF, Ancoli-Israel S, Klauber MR,
Sepulveda R. Sleep duration, illumination, and activity pat-
terns in a population sample: effects of gender and ethnicity.
Biol Psychiatry 2000; 47: 921–7.
Received 25 February 2003; accepted in revised form 18 September
2003
Age and Ageing 2004; 33: 165–170 Age and Ageing Vol. 33 No. 2 British Geriatrics Society 2004; all rights reserved
DOI: 10.1093/ageing/afh045
Dignity in older age: what do older people
in the United Kingdom think?
GILLIAN WOOLHEAD
1
, MICHAEL CALNAN
2
, PAUL DIEPPE
2
, WIN TADD
3
1
Department of Social Medicine,
2
Medical Research Council Health Services Research Collaboration, Canynge Hall,
University of Bristol, Bristol BS8 2PR, UK
3
Academic Department of Geriatric Medicine, UWCM Academic Centre, Llandough Hospital, Penlan Road,
Cardiff CF64 2XX, UK
Address correspondence to: G. Woolhead. Fax: (+44) 117 928 7236. Email: gill.woolhead@bristol.ac.uk
Abstract
Background: dignity is a complex concept and there is little empirical research to show how older people view dignity. This
study, using qualitative methods, explored the concept of dignity from the older person’s perspective.
Methods: 15 focus groups and two individual interviews were conducted in 12 different settings, with a total of 72 partici-
pants. Participants were purposively sampled to ensure a mix of socio-economic status, ethnicity, gender, age (65+) and level
of Wtness. Focus groups were audio-taped and transcribed. The method of constant comparison was used to analyse the data.
Results: there was strong evidence to suggest that dignity was salient to the concerns of older people. Dignity was seen as
a multi-faceted concept: (i) dignity of identity (self-respect/esteem, integrity, trust); (ii) human rights (equality, choice); and
(iii) autonomy (independence, control). Examples of dignity being jeopardised rather than being enhanced were given. A loss
of self-esteem arose from being patronised, excluded from decision-making, and being treated as an ‘object’. Lack of integrity
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G. Woolhead et al.
166
in society meant that there was an inability to trust others and an increased vulnerability. Equality was an important issue but
many felt that government policies did not support their rights.
Conclusions: this work identiWes the different ways dignity is conceptualised by older people. The evidence showed that
person centred care for older people needs to be speciWcally related to communication, privacy, personal identity and feelings
of vulnerability. It provides evidence for policy makers and professionals to tailor policies and practices to the needs of the
older person.
Keywords: dignity, older age, qualitative research
Background
National and international policies for the health and social
care of older people increasingly emphasise the right to and
the need for dignity [1–3]. Despite these documents, there is
evidence of undigniWed treatment in health and social situa-
tions, especially in relation to older age groups [4–7]. Further-
more, the term dignity is rarely deWned and little empirical
research has been undertaken in relation to older people’s
experience of dignity.
There is evidence to suggest that treating someone with
dignity may impact positively upon treatment and social out-
comes [8]. Also, research has indicated that feeling valued and
appreciated is important to mental well-being [9]. UndigniWed
treatment may also have a detrimental economic effect due to
the increase in formal complaints [10]. This qualitative study
explored the meanings and experiences of dignity from the
perspectives of older people. The study forms part of an
international project comparing older people’s views from
different European countries [11].
Methods
Focus group discussions were used as the main method of
data collection. The groups were held in cities in South
West England and South Wales, between April and October
2002. Participants were chosen to represent a mix of socio-
economic status, ethnicity, gender, age (65+) and level of
Wtness. However, within the focus groups we attempted to
promote homogeneity of group members to avoid potential
hierarchical problems. Despite the recommended number
of participants per group being between 8 and 10 [12], after
conducting a number of focus groups with varying numbers
of participants, it was evident that the optimum number was
four to six. Groups with more than six participants lacked
cohesion, and those with less than four participants tended
to lapse into serial questioning. Fifteen focus groups and
two individual interviews were held in a variety of settings,
involving 72 out of 108 invited participants (see Table 1).
A semi-structured schedule was developed to explore the
participants’ perceptions of dignity. The facilitators were well
trained in conducting focus groups and attempted to include
everyone in the discussion.
Data collection and analysis continued concurrently
according to the constant comparison methods of grounded
theory [13]. Focus groups were tape recorded and fully
transcribed. Data were analysed by detailed scrutiny of the
transcripts to identify themes, which were then coded using
Atlas.ti. These themes were then compared with each other
in separate word processing Wles. Data were examined for
similarities and differences within themes and descriptive
accounts were written, retaining the context of the discussion.
Two researchers independently coded the transcribed data.
These codes were compared and agreement was reached by
discussion. Simultaneous sampling and analysis continued until
all categories were saturated and no new information was forth-
coming. Negative cases (examples against emerging themes)
were investigated closely. The themes that emerged from the
data are presented together with illustrative quotations. All
names have been changed to numbers to preserve anonymity.
Findings
There was strong evidence to suggest that dignity was salient
to the concerns of older people. However, it was a problematic
concept in that it was easier for people to talk about its
absence, or about being treated in an undigniWed manner.
Furthermore, terminology has changed over the years, with
alternative terms such as ‘respect’, ‘equality’ or ‘pride’ being
offered instead of ‘dignity’. Three major categories emerged
from the analysis, including (i) dignity of identity, (ii) human
rights and (iii) autonomy. It must be emphasised that these
are inter-related and each category contains several sub-themes.
Table 1. Characteristics of participants
Number of participants 72
.....................................................................................
Gender 57 female, 15 male
Age Median age – 72. Range 50–90
Marital status 31 widowed, 3 separated
22 married, 3 unmarried
5 divorced, 8 missing data
Ethnicity 67 Caucasian
4 Afro Caribbean
1 Asian
Education 10 – Degree, 13 – O level
5 – A level, 13 – CertiWcate/diploma,
32 – Missing data (unclear if missing
data or no education)
Previous occupation 25 – Manual, 5 – Missing data
42 – Non-manual
Location of current home 62 – Urban, 8 – Town, 2 – Rural
Home circumstances 29 – live alone, 6 – sheltered
accommodation
20 – live with spouse, 3 – live with
other relatives
6 – residential care home, 8 – missing
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Dignity in old age
167
The context in which dignity was talked about freely was
mainly in relation to health and social care settings. However,
informants did identify other aspects of dignity. For example,
the younger, Wt older people emphasised broader issues
associated with rights and policies for older people.
Dignity of identity
This category contained the majority of the themes and
included dignity ‘as it affected the self’, dignity in relation to
other age groups, and dignity in relation to health care
personnel. The importance to an individual’s self-identity
and self-respect was cited:
I think this is up to the person themselves, if they have lost their
dignity within themselves and they no longer think that they are a person
that matters. [U3A]
Informants discussed other people losing their self-respect,
for example, those who had ‘let themselves go’ or ‘given up’ on
their self-care or appearance. Being excluded from conver-
sations was also a sign of disrespect and participants felt
that people were belittled because they were old. Dignity in
relation to younger age groups was discussed and many
believed that their experiences should be appreciated by
younger people:
I think age, it teaches you a lot, you know a lot more. But younger
people shouldn’t disparage elderly people because young people have to
learn what the old people have already learnt. [Older People’s Forum]
Looking ‘respectable’ was important to participants to
maintain their dignity, regardless of age, illness or income.
Participants stated that lack of attention to people’s appearance
by hospital or residential staff, such as haphazard buttoning
of clothes or dishevelled dress, reduced dignity. Further-
more, dressing residents in fancy dress in care homes was
thought to be degrading:
Another thing when they dress them up in stupid fancy dress, some
like fairy dolls, oh how degrading. [Health Shop]
The visible signs of ageing were thought to lead to dis-
respect from others. For example, grey hair made people feel
anonymous, or treated as a child. Participants mentioned
disrespectful labels attached to old age such as ‘cotton buds’,
‘wrinklies’, ‘bed blockers’ and ‘geriatrics’.
Dignity was related to the interactions with health care
personnel. Dignity was often violated in hospital by staff
exposing their naked bodies to strangers when, for instance,
a hoist was used for lifting:
On the hoist and I used to say ‘can I cover myself up’ and they just
pulled your nightie down over you but the back view was wide open
to anybody. [Stroke Rehabilitation Unit]
In some cases, exposure was reduced by the staff covering
people with towels. Some participants, especially those from
nursing homes, stated that they had become accustomed
and accepted this situations; however, others suppressed
their feelings. Drawing curtains around beds was seen as a
way of maintaining a person’s dignity but this was done
inconsistently. Mixed wards and being nursed by men were
deemed undigniWed by female participants:
I don’t think that’s dignity at all. Why should men and women,
not your husband, but why should they be sleeping next door to you.
He is not your husband. When you come out of the bed and maybe
your clothes pull up and the man can see everything, there is no
privacy there. [Community Centre]
Dignity was jeopardised by suffering. Dying without
suffering (‘to go in your sleep’, or ‘as peaceful as possible’) was seen as
a digniWed death. The role of health professionals was dis-
cussed in relation to death with dignity. Washing, powdering
and maintaining verbal contact with the dying person were
given as examples of digniWed care. On the other hand,
undigniWed deaths included dying alone or staff not changing
the person into clean clothing:
They [hospital staff] knew he was going to die that night, and a
nurse came and it was a real hard sort of nurse and my friend said
‘can we wash him and put him into his clean pyjamas’, and she
said ‘oh don’t put him in clean pyjamas, he is not going to be here
much longer’. And she said to the nurse ‘it’s his dignity, I want him
washed and changed’ [Health Shop]
Forms of address either enhanced or jeopardised dignity.
The main discussion centred on being addressed in a casual
manner or by their Christian name by hospital staff. Partici-
pants felt patronised by being called ‘love’ or ‘dear’ and the use
of Christian names was seen as disrespectful and intrusive.
This was thought to be more offensive for older people due
to their upbringing:
I think that is a pity if you call an older person by their Wrst name
[Pt 12: its your testing of a relationship. To call someone by their
Christian name when you Wrst meet them . . . it won’t happen to our
generation...]. [Sheltered Home]
Possible reasons why older people did not complain
about Wrst-naming included not wanting to appear old-
fashioned and feelings of vulnerability:
Since a sizeable portion of the population would be offended by
being addressed by their Wrst name, the more formal approach
would be advisable. I don’t see it happening. Why don’t patients
complain? First of all they don’t want to be thought stuffy. Also
patients, recognising their vulnerability, will bend over backwards
not to offend the people in whose hands they Wnd themselves. When
asked to give thought to issues of dignity and psychosocial matters
you may think title is a minor expression of dignity, but it is per-
haps one of the few left to people struggling to maintain that dignity
in the face of paralysis or incontinence. [Health Council]
Other themes raised were integrity and trust, although
this was thought to be absent in today’s society:
You can’t trust nobody these days Pt 62: its about trust and that’s
related to dignity, they know who live round here alone because they
watch and they don’t see nobody with you. [Community Centre]
Human rights
This category included the themes of human dignity, human
rights and equality. Being human involves possessing an
intrinsic dignity that is inalienable. Statements such as ‘every
human being has dignity’, and ‘everyone should be treated as an
individual ’ were used to describe human dignity. Being treated
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G. Woolhead et al.
168
as an equal, regardless of age, was also important. Certain
circumstances led to inequalities, for example, the sense of
inferiority older people feel while in hospital:
It’s about elderly people in hospital. Patients don’t possess the
health, vigour or knowledge of those looking after them, which
means that they’re in an unequal situation. In fact, they’re in a
position of decided inferiority with regard to health, vigour and
knowledge. [Health Council]
The participants believed younger people are more willing
to question and exercise their right to be heard whereas
older people are reluctant to assert their views. This may
represent an inherent passivity in older people when in health
settings.
Participants highlighted the importance of the right to
choose how they lived. Furthermore, euthanasia was high-
lighted as an example of the right to end a life deprived of
dignity:
Having my dignity maintained by still being able to make those
choices about how I should die. I had no choice about being brought
into the world but I hope and want a choice about how I should
depart from it. [Health Council]
It was thought that due to advanced medical inter-
ventions, death had become medicalised:
I think we are a death denying society but I personally feel that
death is natural, it’s time to die just go, why keep prolonging it,
when doctors are taking power, they control too much, even death is
medicalised. [Health Shop]
The majority of informants were in favour of self-
determined death. Living wills were viewed positively as they
promoted individual choice on treatment alternatives:
I think this living will thing is a very good thing. As long as you
have done it when you are in your right mind and it is written on
your card that you don’t want any resuscitation. [U3A]
Government Wnances and policies were deemed inadequate
to support the rights of older people. For example, an older
woman was denied provision of two care assistants due to
lack of Wnances. The issue of pensions further emphasised
this point as participants argued that UK pensions were
insufWcient:
We maintain that normal pensions unassisted is far too low. When
we wrote to the MP’s about this, the replies I got were most unsatis-
factory and one used the demographic factor as the reason. The reason
that British pensions are too low is because we have a larger proportion
of older people in relation to young earning people contributing to the
common wheel. [Older People’s Forum]
Autonomy
The third major theme to emerge in the discussions of
dignity was capacity for independence and autonomy.
Participants wanted to remain independent, have control
over their lives for as long as possible, and maintain their
mental/thinking ability. However, it was often either their
children, Wnancial difWculties or the loss of their partner that
reduced their independence. Some participants, particularly
those in nursing homes believed that some people, because
of their upbringing, were too stubborn to give up their
independence and, therefore, become undigniWed. Those
who were not in residential or nursing homes stated that
being told to perform activities at certain times threatened
their autonomy:
I think that’s the thing about going into a home isn’t it, you’re not
independent, you can’t do what you want . . . Pt 13: Set times for
meals. [U3A]
Participants in nursing homes stated that they had accepted
the lack of autonomy associated with their changed situation
and their priority was to be kept clean and tidy to retain their
dignity. This may represent an adaptation or acceptance of their
changed life situation.
The fear of being a burden on society and family was a key
issue related to dignity.
Well they [social workers] hounded me . . . you just feel you are a
burden. I felt a complete burden, that I should stay in hospital
forever or just fade away . . . that my useful days are over, it was
condescending. [U3A]
Related to autonomy was an individual’s freedom of
choice. The following quotation about social services shows
that personal choice was denied when a person is old or
they have a disability:
They want you to do exactly what they want you to do and that’s
what I have really objected to...they are taking my choice away,
they seem to want to take your choice away, they don’t want you to
have an opinion, they want to tell you ‘you will wear pads’, ‘you will
go to a day care centre’. [Health Shop]
Discussion
The aim of this paper was to explore the beliefs and meanings
older people associate with dignity, by examining the per-
ceptions of older people from a range of different socio-
economic backgrounds, levels of health and disability, who
live in institutional and community settings. Previous studies
have tended to focus on older people with speciWc problems
or in residential or hospital settings [14]. This work forms
part of a European study examining cultural similarities/
differences of dignity in older age. As a consequence, focus
groups were used as the main method of data collection in
order to gain an insight into group norms and cultural/
social perspectives. However, caution should be taken about
the sample as they are self-selected and under-representative
of ethnic minorities.
The evidence suggests that policy documents and pro-
fessional codes are correct in emphasising the importance
of dignity for older people as the evidence clearly showed
that dignity was salient. Although participants cited
instances where their dignity was maintained, the evidence
indicates that people are being treated in undigniWed ways.
Dignity was shown to be multi-faceted and described as
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Dignity in old age
169
three different dimensions: dignity as identity, human rights
and dignity as autonomy.
The concept that appeared to be most prevalent to dignity
was ‘identity’. This evidence conWrmed results from previous
studies that dignity is challenged through negative interactions
between staff and patients [15, 16]. The informants also
reported evidence of humiliation, poor communication and
exclusion and a general insensitivity to their needs. Dignity
as autonomy was highlighted as important and participants
were concerned about maintaining autonomy and remaining
independent, without being lonely or lacking support. Older
people were particularly concerned about being a burden on
their families and the state. This appears crucial as there
is evidence not only that older people easily become dis-
empowered in health and social care settings but also, that
being included and having control in health care decisions
can result in positive health and social outcomes. Certainly
autonomy and control appear to be threatened when patients
are not given adequate information or the opportunity to
understand fully their diagnosis and make informed choices
about their care [17, 18].
There were also more general concerns expressed about
dignity as a right, which included being treated as equals and
having the right to choose how they should live and be
cared for. This identiWcation of dignity as a fundamental
human right might reXect its increasing jeopardy in health
and social care where it cannot now be taken for granted.
Alternatively, emphasis on rights may reXect the so-called
growth of the enlightened consumer and the attempts to
change the negative images of old age as hardship and
degeneration to a more positive one of old age as Wtness,
activity and fulWlment [19]. Evidence for both these images
were found in this study depending on the focus group
setting, and certainly in groups involving the young-Wt-old
there was awareness of the rights of older people. The old-
frail informants tended not to articulate dignity in terms of
rights and were more concerned about their identity being jeo-
pardised by undigniWed practices.
At a time when notions of choice, empowerment and
consumerism are high on policy agendas there is clearly
room for considerable improvement in current practice.
The introduction of the National Service Framework for
Older People [1] pinpoints at least some of the concerns
about dignity articulated by older people such as the need
to root out age-discrimination for eligibility to services and
the need to maintain a balance between care and support
and independence. It also emphasises the need for person-
centred care, which was central to the concerns of older
people in this study. However, this study indicates that person-
centred care for older people needs to be speciWcally
related to communication, privacy, personal identity [20],
and feelings of vulnerability. According to participants,
these important aspects of digniWed care are not currently
being addressed by professionals, who appear to have little
time for such ‘quality’ issues. It is important, however, that
frontline staff are not scape-goated and although training
may improve quality of care, the focus should be on the
whole system of care and how best to prevent degrading
treatment [21].
Key points
• A qualitative study of 72 older people showed that dignity
was salient to the provision of health and welfare services.
• Dignity was conceptualised as ‘dignity as identity’ (self-
respect, self-esteem, pride, integrity, trust), ‘human rights’
(equality and human entitlement to dignity) and ‘dignity as
autonomy’ (independence, self determination, freedom of
choice).
• Dignity was challenged through negative interactions
between staff and patients, a lack of privacy, poor com-
munication and a general insensitivity to their needs.
• Older people are concerned about maintaining their
autonomy but felt a burden to society and their families.
• Older people wanted to be treated as an equal but felt that
government Wnances/policies did not support their rights.
Acknowledgements
We thank all the study participants for giving their time and
information. We also acknowledge Stephanie Sivell for facilit-
ating the focus groups and helping with the analysis.
Conflicts of interest
There are no conXicts of interest in this study. South West
Local Research Ethics Committee has reviewed the ethical
standard of this study.
Funding
This project is funded by the European Commission Fifth
Framework (Quality of Life) Programme – Contract No
QLG6-2001-00888. The Department of Social Medicine at
the University of Bristol is the lead centre for the Medical
Research Council’s Health Services Research Collaboration.
References
1. Department of Health. National Service Framework for Older
People. London: Department of Health, 2001.
2. Charter of Fundamental Rights of the European Union. OfWcial
Journal of the European Communities, 2000.
3. Department of Health. The Essence of Care Patient-Focused
Benchmarking for Health Care Practitioners. London: Depart-
ment of Health, 2001.
4. Department of Health. The Report of the Committee on Inquiry
into the Personality Disorder Unit, Ashworth Special Hospital.
Cmmn. 4197–11. London: The Stationery OfWce, 1999.
5. Department of Health. Report of the Committee of Inquiry into
Allegations of Ill Treatment of Patients and Other Irregularities
at the Ely Hospital Cardiff. Cmnd. 3975. London: HMSO,
1969.
6. Health Advisory Service. Not Because They Are Old. An
Independent Inquiry Into the Care of Older People on Acute
Wards in General Hospital. London: HAS, 2000.
7. Voelker R. Elder abuse and neglect: a new research topic.
JAMA 2002; 288: 2254–6.
8. Tadd W, Dieppe P, Bayer T. Dignity in health care: reality or
rhetoric. Rev Clin Gerontol 2002; 12: 4.
at University of Portland on May 22, 2011ageing.oxfordjournals.orgDownloaded from
S. Hajat et al.
170
9. Ranzijn R, Keeves J, Luszcz M, Feather NT. The role of self-
perceived usefulness and competence in the self esteem of
elderly adults: conWrmatory factor analysis of the Bachman
Revision of Rosenberg’s self-esteem scale. J Gerontol Psychol
Sci 1998; 53B: 96–104.
10. Tadd W, Bayer A. Dignity as feature of complaints by elderly
people. Age ageing 2001; 30: 40.
11. European Commission Fifth Framework (Quality of Life)
Programme – Contract No-QLG6-2001-00888. 2001.
12. Kitzinger J. Introducing focus groups. Br Med J 1995; 311:
299–302.
13. Glaser BG, Strauss AL. The discovery of grounded theory.
Chicago: Aldine Publishing Company, 1967.
14. Chochinov HM, Heck T, McClement S, Kristjanson L, Harlos M.
Dignity in the terminally ill: a developing empirical model. Soc
Sci Med 2002; 54: 433–43.
15. Help the Aged. The Views of Older People on Hospital Care.
A Survey. London: Help the Aged, 1999.
16. Age Concern. Turning Your Back on Us. London: Age Concern,
1999.
17. Henwood M. Ignored and invisible? Carers’ experience of the
NHS. London: Carers National Association, 1998.
18. Stevenson FA, Barry CA, Britten N, Barber N, Bradley CP.
Doctor-patient communication about drugs: the evidence for
shared decision making. Soc Sci Med 2000; 50: 829–40.
19. Calnan M, Almond S, Smith N. Ageing and public satisfaction
with the health service: an analysis of recent trends. Soc Sci
Med 2003; 57: 757–62.
20. Nordenfelt L. Four concepts of dignity. Dignity and Older
European Study Publication, 2002.
21. Macdonald AJD. Whole system must be looked at to prevent
degrading treatment. Br Med J 2001; 323: 340.
Received 19 March 2003; accepted in revised form 22 September
2003
Age and Ageing 2004; 33: 170–177 Age and Ageing Vol. 33 No. 2 British Geriatrics Society 2004; all rights reserved
DOI: 10.1093/ageing/afh046
Patterns and determinants of alcohol
consumption in people aged 75 years and older:
results from the MRC trial of assessment and
management of older people in the community
SHAKOOR HAJAT
1
, ANDY HAINES
2
, CHRISTOPHER BULPITT
4
, ASTRID FLETCHER
3
1
Public & Environmental Health Research Unit, Department of Public Health and Policy,
2
Dean’s Office,
3
Department of
Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK,
4
Section of Care of the Elderly, Faculty of Medicine, Imperial College School of Medicine, Hammersmith Campus, Du Cane
Road, London, UK
Address correspondence to: S. Hajat. Fax: (+44) 20 7580 4524. Email: shakoor.hajat@lshtm.ac.uk
Abstract
Background: very little work on alcohol consumption patterns in older people has been undertaken. As a result, knowledge
about the prevalence and characteristics of regular drinkers and heavy drinkers in this age group remains limited.
Objective: to determine the socio-economic and health characteristics associated with different levels of alcohol intake in
older people.
Design: detailed screening of patients in one arm of a cluster randomised trial.
Setting: 53 UK general practices drawn from the Medical Research Council General Practice Research Framework.
Subjects: all patients aged 75 and over on the GP lists (excluding those in nursing homes or other long stay care) were
invited to participate in the study. Of the 15,358 people who received a detailed assessment in the ‘universal’ arm, 14,962 (97%)
of these answered questions on alcohol consumption. Of these, 62% were female and the median age was 80.3 years.
Methods: associations between reported alcohol intake and various socio-economic and health variables were investigated,
Wrst in univariate analyses and then controlling for other variables in logistic regression models.
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