Decision making in an ageing society

Categories: Care.

According to the report, ‘Improving decision-making in the care and support of older people’, the traditional view that decisions are made based solely on logic and rationality is outdated, and a broader range of factors influence our decisions about care. Older people rely more on gut instinct, feelings and experience than deliberative cognitive processes when making decisions, but this does not lead to poorer decisions.

Decision making for older people involves many parties including patients, their families, neighbours, the community and formal and informal carers. Other factors include the influence of social norms, the role of habit and the desire for cognitive consistency. Decisions can be complex, and can be affected by many factors including:

  • negative stereotypes and visual images of older people
  • cultural perceptions of those in need (a hardening of attitudes)
  • attitudes to risk (and in particular, our tendency to ignore risks if we believe something will benefit us)
  • mood (negative mood is associated with risk avoidance)
  • gender (with women more likely to see risks as problematic).

The role of trust

Trust has also been seen as a major factor in decisions about care. According to the report, organisations tend to focus on preventing risk of physical harm, rather than guarding against risks to autonomy, identity, self-esteem and sense of control. Restrictions and defensive practice for the protection of older people may adversely undermine their freedom and their ability to trust organisations that care for them.

Narratives and stories have also been identified as a major aspect of trust building, as they provide patients with greater autonomy and confidence. ‘Risk statistics’ do little to change perceptions, however narratives can change attitudes and tap into emotional, value-based factors.
The full report can be downloaded from the Joseph Rowntree Foundation website.

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