Relatives’ negotiations in relation to acute hospital admission of older people

Background: When older people are acutely hospitalised, they are potentially vulnerable and may need relatives to navigate and negotiate with healthcare professionals on their behalf. Based on data from three qualitative sub-studies examining relatives’ negotiations during older persons’ acute care pathways, this study aimed to generate typologies for relatives’ negotiation power.

Methods: The study is qualitative and theoretically placed within the field of hermeneutics. Kluge inspired the analysis. The construction of typologies followed four stages: 1) Development of relevant analysis dimensions; 2) grouping the cases and analysis of empirical regularities; 3) analysis of meaningful relationships and construction of typologies and 4) characterization of the constructed typologies.

Results: The analysis enabled the construction of two, context-dependent typologies for the relatives; “Negotiation-potent relatives” have a strong mandate from the older person, strong incentives for negotiation with the healthcare professionals, and strong capacity and they act actively or even pro-actively when interacting with healthcare professionals. These relatives have a good basis to access healthcare professionals and defend the older persons’ interests.” Less negotiation-potent relatives” have ambiguous and weak negotiation power. They may have reduced mandate, incentives, capacity, and/or attitude to action. Less negotiation-potent relatives seem to have limited preconditions to defend the older person’s interests.

Conclusion: Relatives to acutely admitted older people have different negotiation power. These differences can be defined in two typologies: “negotiation-potent relatives” and “less negotiation-potent relatives.” These typologies can enable healthcare professionals to adapt to relatives’ diverse needs.