Methods: We conducted an ethnography in six hospitals in England, Ireland and the USA. The ethnography involved: interviews with patients aged ≥65, informal caregivers, specialist palliative care staff, and other clinicians who cared for older adults with advanced disease, and field work. Data were analysed using directed thematic analysis.
Results: Analysis of 91 interviews and 340 hours of observational data revealed substantial challenges to empowerment: poor communication and information provision combined with routinised and fragmented inpatient care restricted patients’ self-efficacy, self-management, choice and decision-making. Information and knowledge were often necessary for empowerment, but not sufficient: empowerment depended on patient-centredness being enacted at an organisational and staff level. Specialist palliative care facilitated empowerment by prioritising patient-centred care, tailored communication and information provision, and the support of other clinicians.
Conclusions: Empowering older people in the acute setting requires changes throughout the health system. Facilitators of empowerment include excellent staff-patient communication, patient-centred, relational care, and appropriate access to specialist palliative care. Findings have relevance for many high- and middle-income countries with a growing population of older patients with advanced disease.