Case 25: Samuel
Social, cultural and historical context
Samuel, aged 81, is originally from Grenada and came to the UK in 56 years ago. Before retirement he worked on the buses in Nottingham. He moved to London when he was made redundant 25 years ago, to be near his brother. He has not worked since then. He moved into his sheltered housing flat 10 years ago but he spends nearly all his time at the home of his partner, a retired nurse.
Participant's experience of ageing and ill health
Samuel has high blood pressure, gout, glaucoma, anaemia and suffers from constipation from time to time. In the past he has had urinary retention and had to be catheterised. He has also had cataract surgery for both eyes. He takes medication for the high blood pressure. He takes this regularly and makes sure he has medication available at both of his homes. He also has mild cognitive impairment and has been referred to the Memory Clinic for further investigations. The researcher found Samuel's information to be consistent through the interviews but he tended to repeat his stories and on the tour of the house he showed the researcher the same rooms twice.
Samuel makes repeated A&E visits, about 16 in the past year. He has attended for many reasons – vomiting, catheter problems and a possible urinary tract infection. He has been referred to the Intensive Service User clinic at the Day Hospital to try and change his behaviour. He says that if he has a problem he just goes to his GP or A&E (usually the latter). He is not clear exactly what these problems are. He says he goes if he wakes up and does not feel good. He says it is only natural that he does not feel good sometimes due to his age. He prefers A&E to the GP because they have more time for you:
"Well, well, in A and E, the time they have for you. Your normal doctor they have ten or fifteen minutes for you, that's it, but at A and E you may spend an hour there. They give you medication and they check you and everything, so I prefer to go there. Better care. Because the doctors [GPs] don't have the time, they have a lot of patients who go up there. But if I have a problem go to A and E, they check it, then they'll keep me back and make sure that everything is all right, check. You know. They have more time for you."
He recounts a recent trip to A&E for constipation:
"And after I go to the loo I stayed there, and I told them, well, I'd like to go home now. And they didn't hesitate, they said ok, if you want to go you can go. They are pretty good. They handle the situation well. I used to go to X-- hospital [A&E] but this one here is nearer, so I prefer to go to that one. I can walk it. If I go to X-- I have to take the bus."
When asked about attempts by NHS staff to get Samuel to change his A&E attendance behaviour, he states assertively "But I don't see why I should have to go my GP. That's what they [A&E] are there for." He says that A&E has beds and they make sure you are ok before sending you home. He feels safe there, and says he can walk there easily in 5-10 minutes.
People in this participant's life
Samuel's partner of 20 years, Dorothea, looks after him. He lives at her house most of the time. She cooks and does his washing and ironing and they go shopping together. He appreciates everything she does for him.
"This here is my lady. So more or less I spend more time with her, you know. Instead of being on my own. I come here and she looks after me, and I'm quite happy and content."
He has two sons and a daughter. His daughter lives in America but she phones him from time to time. One son lives about 3 miles away and one about 150 miles away. He also has his brother and sister-in-law living locally. He is very close to his brother.
"I phone him from time to time, he phone me, or I just jump on a bus and go to see him…It's no problem."
He says both his sons have good jobs – one in the civil service and one in the local council. He is relatively close to the son living locally; they visit each other about once a week. The visits can be either in Samuel's flat or Dorothea's house. This son is unmarried but has two adult sons. The son who lives farther away phones from time to time.
The researcher asked who they would call if they needed something. Samuel's partner, Dorothea, says they would call her sister, who lives in the same neighbourhood. She says they see each other often, and she and Samuel do not have to worry about anything.
Dorothea has two sons. One son will come and cook for her if she's not well, which seems to be quite often, and sometimes he gives her money.
Samuel was one of the first tenants in the sheltered housing accommodation in 1992. A lot of his friends from amongst the tenants have since died and he is the only one left of the original tenants.
Samuel also has friends that he phones and visits from time to time. He says he is happy with his social life.
What matters to this participant?
Samuel's partner is clearly very important in his life. He often refers to her as "my dear lady". It is important to him that he can live with her. Although Samuel lives and sleeps at Dorothea's house most of the time, he has always wanted to keep his flat in the sheltered housing scheme. He says he likes both. He goes to his flat about 4-5 times per week. When he visits he sits and reads, watches TV, talks to the neighbours and checks everything is ok in the flat. Dorothea goes to the flat as well sometimes.
Samuel and Dorothea enjoy going to watch West Indian dancing at the sheltered housing scheme or across the road at the an African-Caribbean community centre. It can be a late night, about 1 or 2am, so they get a taxi home.
He likes to read the newspaper every day;
"I'll read, I read a lot, extensively. I like to read me newspaper because I'm very political minded. So I read my paper and that's it. And in the evening I listen, look at the television, pick up my news."
He enjoys visiting his brother, his son and his friends. He likes to have a drink at home but he doesn't go to a pub. He sips whiskey during one of the interviews with the researcher.
Samuel used to attend a day centre on Tuesdays – they picked him up at 8:30am and brought him home about 2:00pm. He can't remember the name of the place but says he enjoyed it, chatting with other people and having a laugh, but the day centre was closed, he doesn't know why. He waited for someone to contact him about re-attending but nothing happened, and he doesn't know who to call about it:
"To be honest I don't know what happened. I thought they would get in touch with me but unfortunately they haven't done it."
Technologies in participant's home and life
Samuel has no assistive living technologies. The telephone is the main technology, via landlines at both Dorothea's house and his own flat. At Dorothea's there is a phone by the bed for emergencies. He has no mobile phone. Samuel says he does not need one in addition to the landline. The researcher asks if a mobile phone might be useful in terms of safety or contacting others in an emergency. He says he does not think so, he thinks he's "OK for now".
When asked about any other aids and technologies he mentions his umbrella:
"Well I have an umbrella. I use my umbrella for two purposes – for the rain, and I use it as a [walking] stick."
There are no daily living aids or adaptations at Dorothea's house for either Samuel or Dorothea. In his sheltered flat there are pull cords, though he can't quite remember where they are. He remembers there is one in the entrance hall, he is not sure if there is one in the bedroom. Dorothea adds that there is one in the toilet. The researcher asks if he knows what happens if he pulls the cord. He says he does - he says they will answer, you tell them what your problem is, and then they will send somebody. He thinks it is the council who answers. (In fact it goes through to the warden during office hours and the local authority telecare monitoring centre out of hours.) Samuel can't think of any ideas for gadgets that might be useful to him – he says he is very active and mobile, and the landline phone is sufficient.
The researcher describes telehealth, for example, to monitor his blood pressure and Samuel thinks this might be relevant for him. Dorothea has knowledge of pendant alarms from her district nursing days and she thinks it would be useful so that Samuel would not have to run up or down the stairs to access a telephone in an emergency if he was on his own either at her house or at his flat.
Materiality and capability
Samuel currently has no problems looking after himself and no problems with mobility. Despite his frequent visits to A&E, he feels he is ok health wise and is well supported by Dorothea:
"I am relatively all right, if I could use that word. You know, no problems. And then my good lady she is an ex-nurse, so she knows her onions."
Samuel says there are no activities he struggles with or things he is no longer able to do that he would like to. He is clear that he can get out and about in the community, lives an active life, and does things like dancing. He gets about using buses without any difficulty ("I go out and walk about, and do me own thing, because I live a very active life"). He occasionally has problems getting to the toilet at night and he uses an old style chamber pot under the bed.
Samuel's 'workaround' of using his umbrella as a walking stick is a way of reducing the number of items to be carried when out and also of disguising the need for the aid, thus maintaining the appearance of normality.
Samuel did not want to take pictures or complete the research scrapbook. He was happy to talk but did not want the burden and effort involved with these other activities.
Real incidents of using (or choosing not to use) an ALT
At first Samuel says he doesn't think he has ever pulled a cord, then he thinks he might have done but not for an emergency:
"Probably I have in case, you know there was a problem, I ring X-- Council, I could get in touch with X-- Council. Like if there is no hot water or a problem, yes, I'll ring, pull the cord yes."
Comment
Samuel's case is striking for his lack of awareness of assistive technologies (despite his partner being an ex-district nurse) and for his conviction that there is nothing he needs. Whilst this attitude may be justified today, he may well have more complex needs in the future due to his memory. Indeed, his case illustrates the potential benefits of a proactive and preventative approach to provision of assistive living technologies. At the very least, Samuel would benefit from a mobile phone for emergencies because he goes out a lot. If this and other assistive technologies (e.g. pendant alarm) were supplied soon, it would give Samuel the chance to get used to the idea of assistive technologies, experimenting with them and perhaps experiencing their benefits.
It is also striking that Samuel frequently attends the A&E department for what appear to be minor complaints, and as such is a high consumer of resources. Yet Samuel's case also illustrates why, despite the fact that he acquiesces with the suggestion that he might take his blood pressure at home, telehealth is unlikely to solve the problem of his frequent A&E visits. Samuel, who is currently mobile and enjoys going out either on foot or on the bus, feels safe and well cared for when he attends for a full (hour-long) check-up in a hospital setting. There is no evidence that he would feel similarly safe and well cared for if this pattern of behaviour were replaced with a technological solution.
The wider political economy has an impact on services to older people and their quality of life. Samuel used to attend a day centre which he enjoyed very much for getting together with friends for a laugh and a chat. That service was withdrawn. Samuel does not know why, and what is more, he expected something else to replace it. This raises the economic question of how spending on telehealth is balanced (and how it should be balanced) against spending on services which allow people to do what matters to Samuel: "have a laugh and a chat".