Factors influencing older patients' participation in care: a review of the literature

Background. Over the past 10 years, there has been an increase in the literature promoting patient involvement in health care at all levels of the decision-making process. Aim. To review the literature on factors influencing patient participation in care with a particular focus on the perspective of older people. Method. Various search engines were used to conduct the review and articles were identified through the following databases; CINAHL, CSA ILLUMINA, Science Direct, Blackwell Synergy, the Cochrane Library, OVID, SAGE, AHMED, BNI and MEDLINE. Research studies ranging from 2000-2007 were selected for inclusion on the basis that they investigated patient participation and/or older peoples' involvement in health care. Findings. Seven key themes emerged from the literature: the concept of participation, the need for older people to be involved, autonomy and empowerment, patients' expectations, benefits of participation, factors influencing participation and precursors to participation. Conclusions. Although patient participation has received considerable attention in the literature, this review highlights the dearth of research from the perspective of older people. There is a general consensus that preference for participation should be assessed and not assumed, and the review offers a sobering reminder that participation should not be achieved at the expense of patient autonomy and choice. Relevance to practice. Quality care and the most productive use of resources are dependent on the public's engagement with health service providers. However, despite being central to contemporary nursing practice, this review suggests that the reality is not matched by the rhetoric. Future initiatives should focus on supporting nurses and other healthcare professionals to develop the competencies required to facilitate greater participation by older people who wish to become more involved in their care.