Age

Abstract

There is a vast amount of information that is available to study about the subject of care between adults and children. I intend to investigate some of this research using both primary and secondary sources. The primary and secondary sources I will be using will be a questionnaire and for my secondary research I will be using other information provided by other people either on the internet or in health and social care books.

My aim of my project was to find out if “Does your age affect the way you receive care in hospitals”; to examine any evidence that could suggest that there are some reasons why your age is affected by the treatment you are given while staying in hospital. Whilst looking and categorization the evidence that I have found about care and hospitals over the years. During my project I explore how it can also affect the patients, carers and their families. I will be looking at the different types of questions that I could possibility answer in again relating back to my question.

The project concludes that your age sometimes affect the care you receive in hospitals. The consequences for the future generation could be affected by care in hospitals. Additionally in respective to whether the arguments are relevant to the research that I have included in my taken as a whole project.

Introduction

When we talk about age what do we meanI am researching on whether the age of society affects the way you as an individual are treated and cared for in hospitals. I have done a choice of project questions that I would like to find before I started to write up my entire project; ‘which is does your age affect the care you receive in hospitals’. I spent some time looking up and researching my learning outcomes that are in relation to what I want to find out.

To find out if your age does affect care expectations of the care you receive in hospitals.

The difference between adult and paediatric care

• Where are patients cared for
• How does it affect the patient itself
• What expectations patients should expect
• Attitudes to family life after hospital treatments.

I included some points such as “how does hospital care effect the family?” this shows not only is this project focused on age effecting the treatment received in hospitals and care ,but it also looks how the family’s are affected. An example of this would be; a 70 year old woman denied hospital care because she is 70 and some procedures may be considered too much of a risk to her life, the family would feel that she was fine for the procedures because of their concern to their grandmother/mother, neglecting to realise the real risk. Family members would feel that she should receive the best care the hospital can offer, and denying her right to life, are the hospitals then committing manslaughterAnd being ageist?

Points such as these are included throughout the discussion, and I will debate both sides of the argument, to gain a better understanding of how the care system works for elderly and the young patients and how it affect their families and family life

Literature review.

There is a vast amount of information that is available to study about the subject of care between adults and children. I intend to investigate some of this research using both primary and secondary sources.

What is age?

Age is a period of the human life, measured by years from birth, usually marked by a certain stage or degree of mental or physical development and involving legal responsibility and capacity: the age of discretion.

http://dictionary.reference.com/browse/age

What is the difference between adult and Paediatric care?

My own view on what I think the difference between adult and paediatric medicine is that paediatrics’ is classed as children under age of sixteen; and you then become a young adult at the age of 16. The quote below supports my own definition on what I think the difference between paediatric and adult care. “Paediatric is the branch of medicine that deals with the medical care of infants, children and adolescences”

The difference between adult and paediatric care is firstly the obvious body size difference; the smaller body of an infant or neonate is substantially different physiologically from that of an adult. This is an explanation by the university of essays to show the different between the cares children receive compared to adults.

Another major difference between paediatric medicine and adult medicine is that children are minors and or are in the jurisdictions and can’t make decisions by themselves. Likewise paediatric medicine is used to treat the parents and sometimes the family rather just the child this is because. . Adolescences are in there own legal class. (Adolescences start from the point of view of biological development, a p of time starting with puberty and concluding with maturity. Chronologically, this is usually from about 12 or 13 to 18 or 19 years of age. (Consequently, there are the informal terms teenage years and teenager.) Some authorities suggest that adolescence ends for females at about the age of 21 and for males at about the age of 22) they have the right to accept or refuse treatment in circumstances, e.g. life or death situations.

When a child is Ill you have to treat the child, just as you have to treat the mother or father this is because; when treating a child you have to do the following co-operate, have confidence, be relaxed and consent all these are to make sure that you do not make the situation worse that it could already be

The child can pick signals up from the parent that there is something wrong and this could make the child worry even more and could make the child’s condition worse than it already is, this could then lead to the child not trusting the doctor and nurse to the condition or injury that they have, this could then potentially put the child’s life in danger of them deteriorating rapidly and it then becomes life threaten

Adult medicine is the branch of medicine that deals with people over the age of sixteen. The quote below supports my comment, as it shows the basic points of what adult care is. “Adult day health care programs offer health services such as physician visits, nursing care, and podiatry, as well as rehabilitation services such as physical, occupational, and speech therapy in a secure environment.”

There model of adult care is offered to people with variety medical conditions including the following:

• adults with Alzheimer’s disease, other forms of dementia, or depression
• persons recovering from stroke or head or spinal cord injuries
• people with chronic conditions such as diabetes or cardiovascular diseaseadults with developmental
• disabilities such as Down syndrome
• adults suffering from mental illnesses
• Weak or frail older adults requiring nursing care or assistance with daily living activities

http://www.surgeryencyclopedia.com/A-Ce/Adult-Day-Care.html Clark, Chris L. Adult Day Services and Social Inclusion: Better Days. London: Jessica Kingsley Publishers, 2001

Planning and Providing Care

This area reflects an evaluation of the planning and providing of care, treatment, and rehabilitation, and how the hospital sets care goals for each patient and selects qualified personnel to provide and evaluate the care. We do not directly evaluate the care provided to an individual patient. Rather, the standards require the hospital to monitor the results of care processes.

Acute Hospital care- My definition of acute hospitals is, where there is a local accident and emergency department for all the members of the public that need help in a certain way. However on the other hand acute hospitals can provide other services; examples of this is consultants, nurses, dieticians, physiotherapists and a wide range of other professionals. My own definition is supported by the following reference they include:

“Consultation with a specialist clinicians (consultants, nurses, dieticians, physiotherapists and a wide range of other professionals); emergency treatment following accidents; routine, complex and life saving surgery; specialist diagnostic procedures; and close observation and short-term care of patients with worrying health symptoms.”

The quote shows me that there is all different health professionals that work along side of each other in the hospital to ensure that the patient has the because possible care that they need to ensure a speedy recovery. 14th December 2010 www.isdscotland.org/isd/3409.html

General practioner– GP Care is a recognised provider of community based healthcare services including diagnostics, outpatient and ancillary services to NHS and private patients;

Residential homes- Residential care in my eyes is where the elderly can no longer support themselves, so they move in to a home where they can be supported when they need to be. My reference from the website www.eastsussex.gov.uk/socialcare/…/care services/ residentialandnursinghomecare. To back up my quote on the elderly people moving in to residential care,

“Residential care is for people who can no longer manage living in their own home, even with support from home care services. You can stay in residential care for a short time (known as respite care) or over a long period. You would stay in a comfortable furnished room with staff available 24 hours a day. Meals are provided along with other facilities such as hairdressing”.

The quote I used showed that when staying in a Residential care homes are shown that the service user can have the rights and freedom to come and go as they please.

A nursing home A nursing home in my eyes is where care 25 hours is given24 hours a day to seriously ill people who have not long left of there life due to ill health my reference from the website: answers.yahoo.com › … › Community Service support and back my quote by saying

“Provides skilled nursing care and rehabilitation services to people with illnesses, injuries or functional disabilities.Most facilities serve the elderly. However, some facilities provide services to younger individuals with special needs such as the developmentally disabled, mentally ill, and those requiring drug and alcohol rehabilitation. Nursing homes are generally stand alone facilities, but some are operated within a hospital or retirement community”.

My quotes supports me on my definition on a nursing home shows it just does not accommodate the elderly when they are in need.

Outpatients- Outpatient department’s are where if you have a medical problem or concern that needs to be sorted and for further treatment then your family GP will refer you. The reference I used to get my information on to back up my own quote is from www.dvh.nhs.uk › Our services › A to Z of services

“The aim of the NHS service is to provide an efficient, skilled, safe and convenient service to patients and clinicians in a professional, caring and responsive manner and to facilitate the needs of all clinical specialties” so there fore that supports me because it is showing how affective the outpatients department works.

This quote shows me that how health care professionals work in a specific way when dealing with members of the public when using the outpatients department.

Does religion and age also affect the care you get in hospitals?

So does a religion affect the care you get in hospitalsYes it does because if there is a young child or an elderly patient who is muslin who is admitted to hospital; the hospital then has to cater for all Muslim patients with the dietary requirements that they need. You will be asked which ethnic group you belong to. This information is collected to enable the hospital to ensure that the service provided meets the needs of our patients. My quote states that is backs up my personal quote about religion and age in hospitals.

“It is important to bear in mind that some second generation Muslims will have an English meal; i.e. vegetables, fish, rice etc. but they will need to avoid pork and other impermissible foods.

“It is important to be aware that even in the cooking process, any meat or meat products such as gelatin are avoided. The use of separate utensils when cooking or serving

Halal and non -Halal food is essential” www.bradfordhospitals.nhs.uk/patients-and…/Muslims

This quote also shows that some second generation Muslims do eat some English foods while they are having treatment as an impatient in hospitals. Muslim women who are receiving treatment in hospitals need to ensure that they are not treated by a male doctor as it is against their religion. At death Muslims like the body to be wrapped in one or two plain white sheets and the bed turned to face Mecca.

Medical ethics: blood transfusions

My term when it comes to Jehovah’s witnesses and medical ethic shows that they are not allowed blood full stop but the quote I researched and used shoed that they can have other medical interventions in the place of having a blood transfusion.

“Jehovah’s Witnesses refuse blood transfusions, including antilogous transfusions in which a person has their own blood stored to be used later in a medical procedure; accepting a blood transfusion willingly and without regret is seen as a sin. The Witness concerned would no longer be regarded as one of Jehovah’s Witnesses”

This refusal to accept blood makes supports my quote that it is showing if a Jehovah witnesses is taking some risks when having operations as it can be more dangerous and causes some doctors considerable anxiety. Witnesses are willing to absolve doctors of responsibility. Jehovah’s Witness Hospital Liaison Committees maintain lists of doctors who are prepared to be consulted with a view to treatment without the use of blood transfusion. This has eased many of the tensions related to the issue.

http://www.bbc.co.uk/religion/religions/witnesses/witnessethics/ethics_1.shtml

How does hospital care affect the patient’s family and relatives?

When relatives visit patients it can be very stressful and upsetting. People react in different ways e.g. people can become withdrawn from society and other people. However family members can also become very aggressive as the stress of visiting relatives in hospital is traumatising this could be because it is seeing other sick people in hospital as it make real. In my personal experience of how hospital care can affect relatives is when a close family member died, I became very withdrawn from my close family members, I.E my mum and dad. My source of this information comes from a friend who has gone through this experience

How does it affect the patient itself?

When patients go in to hospital at first thing they find is that it is overwhelming this has come from my personal experience. I found that the nurses on the ward that I was on; were less caring then they were in the old days. However in the modern day world of nursing; of all the qualities a nurse should possess, perhaps the most important is compassion.

“Elderly people are being subjected to a catalogue of poor quality care and neglect on hospital wards”

http:/news.bbc.co.uk/1/hi/health/206270.stm

The quote above states that along with my own words on writing about how hospital and your age do affect the patient itself.

What is Medical treatment?

Medical treatment is when a person is diagnosed with a medical condition and need specific medication and treatment to be able to help their condition and improve their lifestyle. I can back this up by knowing that medical has come from medicine. The definition of medical

“Is requiring or amenable to treatment by medicine especially as opposed to surgery.”

http://uk.ask.com/web?q=dictionary%3A+medical&content=wordnetuk%7C107713&o=352&l=dir&siteid=&dm=ctry.

The quote I comment and looked above is showing if there is any alternative to surgery; than opposing to have surgery and put the patient at risk of any complications.

How does treatment affect a person’s health and wellbeing?

Sometimes in treatment can make people feel worse initially and then with time they begin to feel the benefits of the treatment. Many people may find that after having treatment it can affect the health and wellbeing of an individual. Some of the side effects of having treatment are. Feeling tired, emotional with all the treatment they are having, it could affect your sexual activity with a partner, depression and anxiety, some of these symptoms can be totally normal for people who are receiving treatment.

Some of the side effects of treatment can be;

“Many people continue with their usual activities while having treatment, for example working between injections or cycles of tablets. However, most people do find that they are more tired than normal for the first few days after treatment. You may need to take life more slowly, working part-time or cutting down on social activities. Take care not to overtire yourself, get enough rest and accept offers of help with everyday tasks”

Backing up my quote that I took in to consideration is showing that having treatment and age can affect your overall wellbeing on your personal self, and that having treatments can affect the way you are living your life at the present moment.

What expectations patients should have?

When patients are admitted to hospital for different reasons; they accept a standard of expectations from the hospital and nursing staff looking after them. I identified eight key aspects that, patients consider most important:

• Fast access to reliable health advice
• Effective treatment delivered by trusted professionals
• Involvement in decisions and respect for preferences
• Clear, comprehensible information and support for self-care
• Attention to physical and environmental needs
• Emotional support, empathy and respect
• Involvement of, and support for, family and carers
• Continuity of care and smooth transitions

We are all citizens, with a right to appropriate health care, as well as other relevant right; the rights to family life, to privacy, and to see information about ourselves. As

Citizens, we respond to questions of healthcare on the basis of its social and collective

Impacts and the value. We are also all patients, or potential patients. As patients – having current or recent Contact with the healthcare system – we respond to questions of healthcare differently. The eight areas of importance that patients identify are related less to collective. Experience is more to the individual, personal experience of receiving treatment and Care. By contrast, as citizens we would be more likely to identify the most important Aspects of healthcare as being, for example:

• Affordability – free at the point of care
• Universality and equity
• Safety and quality
• Health protection, disease prevention

As patients, we do not lose our citizen concerns at the door of the GP surgery or the

Hospital, but we do prioritise our own interaction with the system and especially with the

Health professionals who deliver our care.

Policies on age consent in hospitals

Before a doctor or any other kind of medical practitioner can treat you, they must have your consent. Although you can often be asked to sign a medical consent form, this is more to safeguard you.

Backing up my definition above the quote is showing that in some situations consent for medical treatment on a minor is needed, this is because that something could potentially go wrong with the procedure that the minor is having.

“Young people under the age of 16 can consent to medical treatment if they have sufficient maturity and judgement to enable them fully to understand what is proposed.”

http://www.brook.org.uk/information/sex-and-the-law/consent-to-medical-treatment

When it comes to the law on children and informed consent, English law assumes that you are an adult when it comes to medical treatment if the consultant treating you judges that you are capable and mature enough to make your own decisions. Therefore, there is no rigid age at which you are deemed capable of giving your consent or signing a medical consent form. Judgments about this will be determined by the consultant based on the nature of the procedure involved and whether or not they deem that the child in question is old enough to understand the treatment and any implications thoroughly to be able to give their legitimate informed consent.

There are also different laws surrounding giving informed medical consent in the case of mentally ill people and those who are suffering from other illnesses in later life, those suffering from dementia, for example.

Attitudes to family life after hospital care.

Family life after being in hospitals can be hard; this is because when a family member is in hospital they have the support from the medical professions. But likewise when the family is discharged from hospital, the families are then left to deal the care themselves.

“Some people said that having a relative or close friend critically ill in ICU had changed them as people, a few saying they were now more open about their feelings. Some felt they’d become more patient, others that they were less bothered by minor problems”

Backing up my quote it is shown that many people deal with life and death situations in many ways; examples of this can be where they open up about their feelings, may be stop talking to people, and can’t sleep at night, find that they have experience their spiritual beliefs, which had helped them accept or understand what had happened.http://www.healthtalkonline.org/Intensive_care/Intensive_care__experiences_of_family__friends/Topic/1478/

Discussion.

Care should always be given equally and fairly between patients in the hospital no matter their age, however what I’m going to discuss is whether age does in fact affect the quality of care received. In this discussion I am going to include the following points and argue if age really does matter or not. Firstly; what is the difference between adult and Paediatric care, how does hospital care affect the patient’s family and relatives, how does it affect the patient itself, what is Medical treatment, Members of hospital staff who are involved in the patient’s treatment and care and how does treatment affect a person’s health and wellbeing.

The difference between adult and paediatric care is that Paediatric is the branch of medicine that deals with the medical care of infants, children and adolescences. The difference between adult and paediatric care is firstly the obvious body size difference; the smaller body of an infant or neonate is substantially different physiologically from that of an adult; however there are other opinions that the difference between adult and paediatric care is that adult care consists of people over the age of sixteen, on the other hand my opinion on paediatric care consists of children as young as new born to the age of 15 years of age, I am now going to give an example of why I think this. E.G. if a 16 year old female came into the local accident and emergency department after being hit by a car and need life saving treatment, and the hospital staff couldn’t get hold of her parents then there Is no one to give the doctors the consent that they need to save her life; so therefore doctors will have to ask the 16 year old female as it could be a matter of life and death. This extract above relates back to my question by defining what the difference is between adults and paediatrics and this was the main priority to find out and summaries the differences and the opposites .

However religions do affect the care you receive because Doctors have accepted that Jehovah’s Witnesses, whose faith forbids them from having blood transfusions, must be allowed the right to die if they do not consent to life-saving treatment. However, children must be given blood where necessary irrespective of the parent’s wishes. Accepting a blood transfusion willingly and without regret is seen as a sin. The Witness concerned would no longer be regarded as one of Jehovah’s Witnesses; this refusal to accept blood makes some operations more dangerous and causes some doctors considerable anxiety. Witnesses are willing to absolve doctors of responsibility by signing forms with appropriate wording and Many Jehovah’s Witnesses carry a signed and witnessed advance directive card absolutely refusing blood and releasing doctors from any liability arising from this refusal. There are an estimated 145,000 Jehovah’s Witnesses in the UK and Republic of Ireland. There was a case study that I read about on the BBC news website that a 15 year old boy who was hit by a car who was a Jehovah’s witnesses and died because he sustained serious injuries and because of his religion he could not have a blood transfusion and he sadly died of his injuries and that his parents thought that he was under age to give consent to have further treatment with out his parent s be present at the hospital. This piece of text relates back to my question and research that it agrees that age does affect the care you are given in hospital settings, when it come to age consent and treatment.

Further to the following point I have just discussed I am now going to outline the two main arguments about where patients are cared for and then compare that to the planning and providing care for the same patients. Acute hospitals can provide a wide range of specialist care and treatment for patients and theses could be a nurse to a physiotherapist, but yet a general practice (local GP surgery) could provide the same possible care but within the community instead so the patients who use that same service but who go the local hospital won’t have to pay for travel just to go to appointments, although this depends on the care that the patients are receiving because some of the patients may live in residential or nursing homes so then would you still make the patients travel to hospital or make special arrangements for the nurse or physio to come in once or twice a week/month to carry out the treatment that is needed. This relates to my question by stating that not just only elderly people go in to residential but young people can go in to care as well due to having medical conditions and illnesses no matter what age you are you are entitled to any type of care that is given or received, and not to be aged discriminated simply because your either old or young.

My next point I am going to discuss is whether having a family members in hospital affect the family and relatives, when relatives visit patients it can be very stressful and upsetting. People react in different ways E.G. people can become withdrawn from society and other people.

My first point I am going to discuss I about having a young family member being in hospital, when a young family member is hospital they are allowed one parent to stay; as research by Robertson and Robertson concluded that when parent are further away that the child becomes withdrawn, anxious and scared as they are in a strange place and unfamiliar surroundings. When younger children are in hospital the ward has longer visiting hours because the children need their parents around as a sequence of having shorter hours the child could become unattached from their parents.

In relation to the point I have just discussed is that when an elderly member of the family there are different need that the family do in comparison to having a child on the children’s ward. Adult and elderly wards have shorted visiting times than what the children’s wards would; this is because the care for the elderly and adult are a lot less needing that what they would be on the children’s ward. My argument is that on adults and elderly wards they don’t have the facilities to cater for adult and family relatives to stay with them as they are over a specific age. Elderly people in hospital tend to get left, this is because that if some elderly patients are from care homes then the care home staff know how to treat and look after them; but I am arguing that if you go in to hospitals you will see elderly people on trolleys and left to die but this never happens when children are involved. This quotation backs up me answering my question by stating that age does affect your care in hospitals.

In spite of people often wonder what medical treatment is, some people say medical treatment is being diagnosed with a condition or illness and in comparison to that other people may think that medical treatment is when a patient already has a long term medical condition and that the medical treatment their having is to improve the condition they have; then again what members of the medical profession from the hospital are involved in the patients care. When children have a medical condition or illness they are more than likely to be seen first and have less waiting times for a referral, than what an adult would.

When an adult is referred from their general doctor it takes 18 weeks from the time of your first consultation to when your treatment had finished; but when a child is referred to a consultation then it should take half the time of an adults many medical professionals do not want to put a child through events that an adult would do when they are receiving treatments for medical conditions or ill health.

My next argument is going to be on the medical consent. When patients are giving medical consent it means that they are consenting to treatment. Young people under the age of 16 can consent to medical treatment if they have sufficient maturity and judgement to enable them fully to understand what is proposed. Consent to medical care in a medical emergency may not be needed to treat you if you’re an adult it depends on the situation. If your life or health is seriously threatened, and if you are mentally incapable of making decisions then the doctor will take your best interests at the heart of the consultation

When dealing with Children and young people they should be involved as much as possible in decisions about their care, even when they are not able to make decisions on their own and ask what the child wants out the care they are receiving. in spite of consent an example of this is when a 14 year old girls comes in to hospital for urgent treatment and the doctor feels that she is mature enough to give consent for treatment but on the other hand a 15b year boy comes in to hospital after having a car accident and finds that he is not mature enough to give consent so there fore the doctor is in a situation where it is involving age and consent.

My results in the table to the left show that 65% of the people I asked said yes to the question “do you think children underage should give medical consent when admitted to hospital” as it could be a life or death situation and yet on the other hand 35% of the people I asked said no because if the child is under the age of 16 they are classed as vulnerable

what do patients expect when they have health care, when patients are admitted to hospital for different reasons; they accept a standard of expectations from the hospital and nursing staff looking after them, they expect to be treated with dignity, politeness, respect no matter what their age is. An example of this would be an elderly lady with a hip fracture and suffering from dementia who is recovering in hospital; she would expect that the nurse and doctors would treat her how they would like to be treated. Patients with dementia are more likely to be referred to palliative care and less likely to receive palliative medication and other medical interventions than people without dementia. In comparison to my quote I will now argue about expectations that people without dementia and example would be a 25 year old footballer with a broken ankle, he would be treated in hospital more favorable as he is more likely to make a full recovery than a patient with dementia; an example of this would be palliative care to ensure that they get the right treatment in order to make a full recovery.

Finally my point I am going to discuss is whether family life is affected by a relative being in hospital. Having a relative in hospital can be hard, but once the relative is discharged it can be even harder on the family; as they now a personally reliable for the treatment and care of the individual. My personal belief for when family life is affected by the discharge of a patient is that they should have follow up care to ensure that the family is coping well with the treatment that the individual is receiving. Another point I am going to put my view about family life and hospitals is that I personally think that due to the nature and the stress of looking after a loved one is that the family fall apart and people stop talking about their feels to each and let them build up. Subsequently to this is think that when people are looking after a loved one who had just been discharged from hospital; they should get help, either by going to see a family therapist who specialised with the situation that the family is in. next thing the family could do is have support from a team who deals with respite, this is to give the family a rest and have some family time where the whole family can talk about how they are feeling and what could be bothering them with they way the ill individual is treated. When the elderly people are discharged from hospital they have loads of medical staff come out and asses how the elderly people would mange, but on the other hand if middle aged people was discharged from hospital then no medical staff would come out and make sure that they are getting on, finally if a children has been discharged then they would have nursery nurses coming out to asses how the child is getting on and making sure that the family is coping.

Conclusion

The findings on my project were shocking, this is because I didn’t realise how much your age does affect the care you are given while either staying in hospitals or in our patients departments. Looking back at my project proposal form I have looked at and answered the questions that I want to answer. I have also learnt to reflect back on my findings and what I need to improve on within my project; looking back at my findings I established that I needed to add more in to the each of my literature review questions to enable to answer my question in full.

I have developed on my skills while writing my project, I have done this by re-reading my work and having feedback from my assessing tutor and altering my point of view as they become very personal. The reason why I have altered my views and opinions is because I have gained a new insight in the process in creative writing in my project and finding other ways to write my project out and the order that I have put in to my questions in the ways that I think is the best. I done this with my questions by putting the most important question first and then slowly going down my list of questions that least wanted to find out about

When thinking about my literature review I had to take into consideration what had to be included and how I am going to answer the questions that I have asked in relation to my project question. When doing my project I concluded that age dose affect the care you receive in hospitals; I came to this conclusion because after doing all my research it shows that the answer to my question is yes; I came to this conclusion due to the information I had found out and from my own personal experience. I am going to agree with this answer because when an elderly person is admitted to a hospital etc, they are then put into bed and sometimes forgotten about, and could cause more injury to themselves as they could fall off the trolley bed and the elderly person because even more ill and frustrated and could potentially cause more harm to them selves while in the hospital, an example of this is a elderly lady with dementia who is unaware of where she is and falls out of bed and hurts herself. Nevertheless on the other hand if this was a middle aged person then I would be a different case story as the nurses will be watching watch the children will be doing so the children do not fall out of the bed and hurt themselves.

Evaluation

After many weeks of hard work and research I finally finished my project “Dose your age affect the care you receive in hospitals” and presented my findings as a power point presentation and a written document. When doing my project I came across a number of hurdles that I had to overcome when finding out information on my question “does age affect the way you receive in hospitals”, I am now going to explain what went well, what didn’t go well and how I could overcome any inconveniences that arose from doing my project.

The things that didn’t go well in my project were that I had a lot of time off sick due to medical problems and Ill health and had lack of motivation due to the tutor going through the work and then sending us off to do it on our own. This made this very difficult to catch up on the class work and all the handouts that were given out in the class lesson. The things I did to overcome this problem is that I worked at home to try my very best to complete parts of my project that I already had information on at home, with further guidance I emailed my tutor. This meant I had to research on my own with out any guidance of how I could possibility carry on doing my project. To defeat this milestone I sat down with my parents and asked their advice on what other sources of research I could use and add in to my project relatively than just the internet. The effects I have learnt from having time off are that I should try and challenge myself to come in college so I would not miss any important documents or information that is being given out.

What well on my project is very modest; this because I had more difficulties with my project than I thought. But the points in my project that did go well were the following with the aim of once I had done my research I found it easy to pick out points that would be relevant to my literature review questions and that I was able to adapt my research with my questions. What could have gone better with finding the relevant points is that I could have used different perspectives of what the quote was when backing up my own explanation of the question. I have learnt from this are that I would not use the whole quote that I am using to back up my points in my literature review but to use the significant information only. In future reference I would change this simply because those adding more information that was irrelevant and subsequently leading me off the point.

To achieve my aims in my project I did a lot of assessments about my aims. However I didn’t achieve all my aims. This is because that some of my aims that I was looking at had limited amount of information, which was good but didn’t get to the point that I was asking and wanting to quote. The aims that I did mage to answer and find information were the following; having a member in hospitals affects the family as a whole; where are patients cared for and finally how is affects the patient itself. Looking back at my aims, the negative of doing them is I could not find the right information on the following aims; what expectations should patients expect; the difference between adult and paediatrics care and one question I looked at but subsequently took out of my project, why the hospital staff choose to work in the area of the hospital that they are working in. I took this question out simply because of I could not find an adequate amount of information to respond with the question. Further more to the negatives there were a lot of positives with my aims, when looking at them I found that using just simple key words would get me the answers that I needed; but like I have mentioned before I took the important points out that I needed and then corresponded with my aims.

My project question I chose to do was difficult; but however this was my first question that I thought of, my first question I wanted to ask was that do lone parents get the right support that they need. I then looked up that question and found that there wasn’t enough information on that detailed topic, so I sat down and had another think about what I would be passionate about; after a lot of thinking I thought about my future career working with children and related to that. Nevertheless when researching my question, I was restricted to information that was available to me. What I have learned from this experience of finding out information and a project question, I would look at information in higher dept, instead of just rushing in to writing up my question.

The answer and methodology to my question was proved to be a two tailed, however it was difficult to prove simply because it contained to many variables as I found that there was an agreement for and an agreement against my question. Submitting out a questionnaire to 25 people and looking at the result when I got the questionnaires back I established that many people had different views on the question I was asking. The positive things that went well was that the information I had gained showed me an insight to what other people think about the age and care you would get in hospitals; conversely it also showed that there was no specific answer to the question I was asking. Things I would do differently when looking at the methods would be to look at any journals, case studies and subsequently if possible patients and relatives own experiences of how they felt while in hospital receiving care.

References

1. Dictionary.com Online dictionary retrieved Wednesday 6th October 2010
2. http://dictionary.reference.com/browse/ag
3. Surgery encyclopaedia. Online surgery encyclopaedia. Clark, Chris L. Adult Day Services and Social Inclusion: Better Days. London: Jessica Kingsley Publishers, 2001
4. http://www.surgeryencyclopedia.com/A-Ce/Adult-Day-Care.html
5. Community services retrieved 13th October 2010 www.dvh.nhs.uk › Our services › A to Z of serviceswww.bradfordhospitals.nhs.uk/patients-and…/muslims
6. http://www.bbc.co.uk/religion/religions/witnesses/witnessethics/ethics_1.shtml
7. http:/news.bbc.co.uk/1/hi/health/206270.stm
8. Ask.com Online search engine retrieved 27th October 2010 http://uk.ask.com/web?q=dictionary%3A+medical&content=wordnetuk%7C107713&o=352&l=dir&siteid=&dm=ctry.
9. Leicestershire country and Rutland PCT trust retrieved 27th October 2010
10. http://www.lcr.nhs.uk/Library/36ReviewofSwineFluPandemicIncludingLessonsLearntandAssuranceAroundStaffVaccinationProgrammePaperB.
11. Bradford hospital NHS website retrieved 2nd march 2011 http://www.bradfordhospitals.nhs.uk/patients-and-carers/chaplaincy-new/faith-requirements-information/muslims
12. BBC website, religions website retrieved 2nd march 2011  http://www.bbc.co.uk/religion/religions/witnesses/witnessethics/ethics_1.shtml
13. Health talk online website November 2010 http://www.healthtalkonline.org/Intensive_care/Intensive_care__experiences_of_family__friends/Topic/1478/ retrieved 2nd march 2011
14. http://www.brook.org.uk/information/sex-and-the-law/consent-to-medical-treatment retrieved 2nd march 2011

Introduction to Urban Tourism

Urban areas often emerge as a central hub which connect surrounding areas and open them up to business opportunities, trade and information exchange and utilisation (Page & Hall, 2003). Urban areas, unlike rural areas, are known to be densely populated areas. With an area of such importance, it can be expected that services to support different kinds of transactions would emerge (Law, 2002) for example, people will be more likely to live there and businesses would be set up.

Urban areas also serve another purpose. They serve as a meeting place for a highly diverse crowd of people in several different capacities, be it leisure, business, education of even health (Page & Hall, 2003). Cities often hold records of culture and heritage of the people who inhabit it or have previously done so. They are also said to usually have a wide range of leisure facilities (Law, 2002). For whatever reason, visitors show interest in a city and cities exploit these visitors as much as they can. While this sort of interaction has been occurring for centuries, academic study of it has only recently been recognised.

This is where urban tourism as we know it today stems from (Selby, 2004). Given that urban areas are defined as such, saying that urban tourism is simply tourism of any kind which takes place in urban areas (towns and cities), however, from an academic point of view at least, urban tourism is more complicated than that when consdering all the possible aspects and perceptions on the demand and supply side, in policies and planning, and everything else inbetween (Law, 2002; Page & Hall, 2003; Selby, 2004).

Looking at it from this perspective, urban tourism may be defined as the combination of several forms of tourism (such as heritage and cultural, place-specific and special interest, business tourism, etc) concentrated geographically and managed by an interlinked network of government organisations, planners and specialised firms (Ashworth, 2009; Law, 2002).

This report talks about tourism and urban areas in from a demand side point of view. More specifically, it will be discussing the motivating factors that affect tourism in urban areas. The focus will be the tourists of the city of Bath and what inspires demand for the destination.

Aim of the Research

The aim of this research is to investigate what motivates people in different age groups to visit Bath. This research also aims to confirm or disprove the belief that older age groups are more motivated to visit Bath.

Objectives

Find relevant literature on what motivates tourists and what determines the demand of the destination
Investigate which age groups visit Bath and their reasons for doing so
Arrive at a conclusion on why different age groups visit Bath
Literature Review

Tourism is a general term for a range of activities which are the determinants of a destination’s demand. These determinants can be placed in three broad categories; economic determinants; socio-psychological determinants and; exogenous determinants (Page & Hall, 2003, Page, 2003). These categorisations imply that a tourist might be in a city due to its economic convenience, its potential socio-psychological effects or due its business environment and its prospects (Page & Hall, Managing Urban Tourism, 2003).

A decision to spend one’s disposable income on one leisure activity rather than another, on entirely different alternatives, involves several “psychological determinants” (Kotler et al, 1996). Psychological determinants of tourism demand are most closely linked to leisure tourism (Bowen & Clarke, 2009). Ryan (2003) suggests that taking a holiday enables a tourist to fulfil deep psychological needs. These needs might be anything from wanting to gain some social status to simple relaxation (Kotler et al, 1996).

Within the socio-psychological category as a determinant of demand, there are a number of variables which can be studied (Kotler et al, 1996). Tourist motivation and behaviour are ultimately determined by these variables (Ryan & Glendon, 1998). However, demographic variables and motivations will be most closely considered.

These needs have been further elaborated by other authors, sometimes under different headings (Page & Hall, 2003; Ryan, 1991; Kotler et al, 1996; Holloway & Robinson, 1995). In these sub-categories, it is easy to see that determinants are interrelated and sometimes over-lap each other (Ryan, 1991). A psychological need to escape ones everyday surroundings might lead to falling into a majority demographic due to the sort of holiday a destination offers (Ryan, 2003; Page & Hall 2003).

In the discussion of the determinants of demand, the motives for visiting are rarely ignored. The variables that affect demand in general are categorized by Holloway & Robinson (1991) as psychographic and demographic. Looking at the psychographic variables, tourists visit a destination due to certain factors with are categorized into either push factors or pull factors (Page, 2003).

Researchers focusing on tourist motivation often hold the belief that a tourist might be “pushed” to leaving the area where they usually reside, and therefore escape, or “pulled” by the desire to be at another location (Ryan, 2003; 84; Goossens, 2000). Therefore, a push factor indicates that a tourists motivation for go on a vacation or to escape their usual routine or environment (Goossens, 2000; McCabe, 2000). It may even indicate a journey of self discovery or re-discovery as a group, in a family for example (Kotler, 1995; Ryan, 2003). The pull factor, however, signifies that a tourist’s motivation is more adventurous, meaning the tourist “seeks new experiences” (McCabe, 2000; 1049).

There is reason for the pull motives to be researched as extensively as it is. This is because when a tourist is pulled to a destination, it show that there are certain elements about it that where attractive (McCabe, 2000). Therefore, for marketing purposes, researchers tend to focus on what makes a destination attractive (Goossens, 2000). However, this has led to a substantial gap between the amount of research done between push and pull factors of motivation (Goossens, 2000). The research covering the motivation of the ‘escapist tourist’ has been somewhat neglected in comparison.

The demand for a destination is usually affected by various categories of demographics, most notably the status or income demographic, the gender demographic and the age demographic (Lee & Hwang, 2010). In the age demographic, segmentation is taken in six groups, namely the infants, tweens and teens, young adults, early middle ages, late middle ages and over 65’s (Kotler et al, 1996).

An alternative is Pooler’s (2002) segmentation into three key, all encompassing, groups. These groups are the baby boomers and seniors, who, in this day, are represented in Kotler et al (1996) as late middle age and over 65 (Lamb et al, 2008); generation X, the generation after the baby-boomers classified as young adults and early middle aged (Kotler et al, 1996; Lamb et al, 2008) and finally; Generation Y, often associated with young adults, teenagers and preadolescents and called the Internet generation (Lee & Hwang, 2010), who in this age, statistically (Pooler, 2002) more computer literacy than the previous generation did at the same age (Lamb et al, 2008).

Pooler (2002) and Lamb et al (2008) draw attention to the characteristics of each of these three groups and how they are motivated. For example, generation Y spends more on entertainment and clothing. The group also centres a lot of activities on one form of technology and are more susceptible to internet marketing (Lamb et al, 2008). The baby boomer generation however have a need to interact and require more attention (Lamb et al, 2008). Generation X, where generation Y and baby boomers meet, are generally disloyal to brands and are most known for their extensive product search when deciding on any product (Pooler 2002; Lamb et al, 2008).

In terms of research on tourist motivations as they relate to specific destinations, Kozak (2002) has studied push and pull motivations of german and british tourists in two popular holiday destinations. The study found that pleasure and relaxation were the highest ranked motivations in both groups in both detinations. This suggests that the major motives for taking a holiday, regardless of nationality and destination, was the need to relax, possibly with loved ones, and escape from stressfull situations to seek pleasure (Kozak, 2002). It was also found that, again regardless of the nationality, the tourists in both destinations were drawn there mainly because of the weather. These findings imply that tourists prefer to spend time in more temperate regions when they are on holiday (Kozak, 2002).

Among the variables discussed, this research project, the focus will be mainly on the socio-psychological elements of a city’s demand, specifically within certain age groups. Within these age groups, the research will be examining how demand determinants differ within different age groups. More specifically, it will be exploring the various motivating factors and how they affect each age group, as well how different they are.

Background

With a declining wool industry, Bath had to find alternative means of boosting its economy in the mid-18th century. This was when the city began to focus on the largely underdeveloped spa trade (Hirschfelder, Borsay, & Mohrmann, 2000). Bath began re-branding itself as a tourism city. Though the city had always had these spas, it was only at this time they were specifically developed for mass commercialisation (Hard & Misa, 2008).

Within thirty years, the city had become the foremost “health and leisure resort in Britain” (R. & Russell, 2010, p. 18). This fame was however, short-lived. Although many European resort cities benefited in the long run from using celebrity culture as a marketing tool, Bath was not one of them (Borsay, 2000). In the mid-nineteenth century, Bath’s allure was lost as people became uninterested in the medicinal qualities of its spas and moved on to the next craze.

The city itself was also revitalized, with many support facilities also being developed simultaneously. Like most other European destinations of its type, Bath was mainly marketing itself as a fashion resort (R. & Russell, 2010). The trend at that time was the ‘medical’ or ‘cold’ baths which allegedly improved the health (Hard & Misa, 2008). The market segments that where interested in this trend included celebrities and the celebrity-minded (R. & Russell, 2010). Naturally, high class facilities were developed to support the main market.

Though, Bath has been credited as being an early example of a modern tourist industry (Hard & Misa, 2008), the tourism industry’s structure has changed since its fame declined. Bath has therefore found new ways to market itself. It focuses mainly on historic tourism (Page & Hall, 2003), marketing its roman heritage more than any other aspect (City of Bath, 2008).Today, Bath’s early retirement or retirement age-groups are increasing (City of Bath, 2008), suggesting the market would be shifting to meet the demands of a growing population (Kotler et al, 2005), in turn, attracting tourists in similar age groups.

Methodology

Based on the research design of Kozak (2002), which studied the tourist motivations by nationality, A 33 item questionnaire was formulated. This comprised three sections. The first contained 8 general demographic questions about the respondent as well as the level of familiarity they have with the city of Bath.

The next two sections outlined potential pull and push factors and used a 5-point Likert scale to determine the level to which the respondent was influenced. It is suggested that respondents are more likely to understand a questionnaire with words rather than values (Haley & Case, 1979. As such, the questionnaire was designed with words representing the figures on the scale and presented thus: (1) strongly disagree, (2) disagree, (3) neither agree nor disagree, (4) agree (5) strongly agree.

The second section consisted of 10 potential push factors. This section was again based on Kozak’s (2002) design, excluding factors which were not applicable to a non-temperate region. These included enjoying good weather, engaging in sports and experiencing nature. These are not actively present in the chosen destination and were therefore removed from the list of items.

In the final section, a 15 item table of potential pull motives were outlined. Though Kozak (2002) uses open-end questions to determine what the pull motives of respondents are, in this study, a table was formulated and respondents were to use the Likert scale to demonstrate their opinions. The reason for this modification is the presence of a list of factors which were generated from Kozak’s (2002) open-end questions. The list outlines what the most common pull motives are. Therefore, the list was used as a reference point for the table in this section.

Following, the completion of the questionnaire design, a pilot test was conducted. 5 questionnaires were given to 2 staff members who had visited Bath previously, 2 staff members who had not ever visited Bath, and a Lecturer of the Hospitality and Tourism department at St. Patrick’s College London. These questionnaires were assessed for content and accuracy of the questions.

Data Analysis and Results

The data analysis was conducted using pie charts and tables. Section one was represented in 8 pie charts (appendices 1-8) which illustrate the characteristics of the respondents. In sections two and three, the numerical values of the Likert scale were put in tables and subsequently put in stacked bar charts (appendices 9 and 10). During the data collection, 150 questionnaires where filled in by visitors in Bath. Out of this sample, 8 (5%) questionnaires were unusable due to the fact that they were wrongly filled in. The 142 questionnaires were further divided into those who were in Bath specifically for leisure purposes, which was 86 (58%) of the respondents.

Analysis of the remaining 142 questionnaires more than half of the respondents, 34% could be said to be within the retirement age of over 45 years. The 17% made up the baby boomer generation of over 55 years. Those in the middle age bracket who are described as the generation X in the literature review made up 38% of the respondents. Those aged 25 and under were under made up a relatively high 28% of the respondents. They were the highest percentage out of all the age groups that answered the questionnaires.

In section 2, the five age groups in the questionnaires were put into three broader age groups of under 25 years (generation Y), 35-44 years (generation X) and 45 years and over (baby boomers), as discussed in the literature review. This section asked respondents to rate push motives. In the generation Y group, the motives with the highest agreement rate were to spend time with loved ones (67.3%); to get away from home (67.3%); to have fun (61.9%); and to relax (57.9%). Those with the lowest agreement rate were to be active (9.7%); to socialize with tourists like me (10%); and to experience culture first-hand (12.3%).

The generation X group had the highest agreement rate for the motivating factors of having fun (64.5%), spending time with loved ones (56.4%); and relaxing (54.2%). The group’s motives with the lowest agreement rate where to socialize with tourists (12.4%) and to be active (15.9%). Finally, in the baby boomer group, respondents were most motivated by the need to relax (78.3); to spend time with loved ones (55.9%); and to experience heritage and culture first hand (51.6%). The where least motivated by the need to socialize with tourists of similar interests (3.6%); to seek adventure (9%); and to learn and experience new things (11%).

During the analysis of section 3, it was discovered that there was insufficient data to analyse as a significant number of the questionnaires (34) had not been filled or were ticked as “someone else’s decision”. In at least two of the age groups, the sample size was insufficient to come to a reasonable conclusion. For this reason, section 3 was analysed collectively. There was no special analysis for each age group. sOn average the highest rated pull motives which had a agreement rating of at least 40% were cleanliness (51.3%); attraction range (43.8%); accommodation (42.2%); and the Roman Baths (41.7%). The lowest rated were weather (4%) and nightlife (13.9).

Discussion and Conclusion

From the findings, it can be assumed that the perception of older tourists visiting Bath more frequently than younger ones might be wrong as over 50% of the respondents were under 34 and only 17% of the respondents could be at retirement age. The implication is that an older resident population may not necessarily translate to an older tourist population (Lynch, Duinker, Sheehan, & Chute, 2011). The initial perception might have been born from the idea that an older age group is usually attracted to a historical tourist destination (Lynch, Duinker, Sheehan, & Chute, 2011), which is what the City of Bath is. Apart from this misconception, it would seem that Bath’s residents may be mistaken for tourists more often than not, as observed during the data collection period.

In addition, more than half of the respondents were under the age of 34, which contradicts the city’s resident demographics report which suggest that there is a decline in the number of people that fall under this age bracket, due to a number of them moving out of the area. It is possible that while Bath residents in this age group relocate, they still keep in touch with family and friends in the area and visit on a regular bases, which would explains the high number of tourists in the group. This is back up by the results of the survey which show that 56.3% agreed that they were in Bath to spend time with loved ones.

The most significant push motive was the need to relax. This has also been observed in Kozak’s (2002) study, where the significance of relaxation in the motivations of a holidaying tourist was noted. However, contrary to Kozak’s findings, escape motives hardly influenced the decision of the respondents in Bath. This may be due to how different destinations in both instances are. The majority of the respondents were home visitors, with only 6% of internationals making up the respondents. In Kozak’s study, 100% of the sample population were away visitors. Kozak has also noted the link between an away holiday and the escape push motive. In this study, it is suggested that tourists are more likely to go farther if their motivations are escape related.

Rather than the escape motive, in would seem the visitors to bath were more influenced by the need to spend time with someone, be it those living in Bath or those visiting with family. The large number of home visitors could possibly be the reason for this.

Limitations

This study was limited by various factors. The city of Bath attracts a variety of tourists. One of the major limitations during data collection was the language barrier between the researcher and many of the tourists. Because the data collection tool was in only one language, a significant section of the target group was not able to answer the questionnaire. In addition, as the data was collected during an off-peak period, there might have been a significant loss of certain key respondents.

Beyond these two factors, the sample size might have been insufficient when considering that Bath host hundreds of thousands of visitors each year. In the future, it is hoped that another survey examining the leisure motivates of visitors with families in Bath would be conducted as it seems this is a key area which should be explored further.

References

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Bowen, D., & Clarke, J. (2009). Contemporary Tourist Behaviour: Yourself and Others as Tourists. Oxfordshire: CABI.

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Goossens, C. (2000). Tourism Information and Pleasure Motivation. Annals of Tourism Research 27 (2), 301-321.

Hard, M., & Misa, T. (2008). Urban machinery: inside modern European cities. Massachusetts: MIT Press.

Hirschfelder, G., Borsay, P., & Mohrmann, R. (2000). New directions in urban history: aspects of European art, health, tourism and leisure since the Enlightenment. Berlin: Waxmann Verlag.

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Kozak, M. (2002). Comparative Analysis of tourist motivations by Nationality and Destinations. Tourism Management 23, 221-232.

Lee, J. H., & Hwang, J. (2010). Luxury Marketing: The influences of psychological and demographiccharacteristics on attitudes toward luxury restaurants. International Journal of Hospitality Management, 1-12.

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Page, S. J. (2003). Tourism Management: Managing for Change. Oxford: Butterworth-Heinemann.

Page, S. J., & Hall, M. C. (2003). Managing Urban Tourism. Essex: Prentice Hall.

Pooler, J. A. (2002). Demographic Targeting: The Essetial Role of Popularion Groups in Retail Marketing . surrey: Ashgate.

R., B., & Russell, R. (2010). Giants of Tourism. Oxfordshire: CABI.

Ryan, C. (1991). Recreational Tourism: A Social Science Perspective. London: Routledge.

Ryan, C. (2003). Recreational Tourism: Demand and Impacts. Clevedon: Channel View.

Ryan, C., & Glendon, I. (1998). Application of Leisure Movitation Scale to Tourism. Annals of Tourism Research 25 (1), 169-194.