PATIENT SATISFACTION AND THE ELDERLY

There is considerable current interest in patient satisfaction surveys ; among other things they are often used to measure quality in health care. However, there are many unresolved issues concerning them, inclu ding how they might best be conducted. Some have challenged their rais on d'etre, arguing that they rely on unproven assumptions [1; Williams , Sec. Sci. Med. 38, 509, 1994]. In this paper we examine some of thes e assumptions in the light of a recent study of elderly patients' expe rience of the District Nursing Service. In doing so we argue that user s' capacity, or willingness, to evaluate health care services cannot b e taken for granted; that patients may have few if any expectations on which to base an evaluation of the care they receive; that the sense of dependency that patients have on service providers can impact on ex pressions of satisfaction and that, outside the acute sector in partic ular, we need to take into account the varied nature of the relationsh ips that emerge between patient and service providers. We also argue t hat elderly patients cannot be treated as consumers unproblematically. While they may be seen as an extreme example, we argue, nevertheless, that many of the issues raised are relevant to much wider populations . This has general implications for research and we suggest that appro priately chosen qualitative methods can provide a useful starting poin t in studies which aim to establish how, to what extent and whether pa tients evaluate health services. (C) 1996 Elsevier Science Ltd