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    Gateway to health: promoting the physical and psychosocial wellbeing of older adults and people with long-term conditions

    Hartley, Sandra Elaine (2019) Gateway to health: promoting the physical and psychosocial wellbeing of older adults and people with long-term conditions. Doctoral thesis (PhD), Manchester Metropolitan University.


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    The ageing population and predicted increase in the number of people with long-term conditions (LTCs) presents a challenge to healthcare systems when faced with demands to provide more cost-effective and sustainable services. Optimising citizens’ health and wellbeing (HWB) could offer an efficient way to provide holistic care; however, it is not clear as to how to achieve this. This thesis demonstrates how my publications have helped to contribute to knowledge within the HWB arena for older adults and people with LTCs, and, specifically, to gain more understanding of their physical and psychosocial health needs and models of care that can promote their HWB. To offer context to these publications, this thesis provides a critical review of the relevant theory. This includes an appraisal of healthcare policy to highlight the issues faced by current health services, drivers for change and approaches to models of care. The concept of HWB has also been deliberated including a critical evaluation of its role in relation to healthy ageing and the wellbeing agenda. Six publications are contained within this thesis and, as a collective, reflect a mixed methods research design as they involve interviews, a focus group and surveys. The final publication, a theoretical paper, is an amalgamation of all the research findings discussed within the context of a critical review of the literature and linked explicitly to the physiotherapist’s role in long-term condition management. The findings of the publications are from insights gained from the perspectives of people with LTCs, though, mainly from those with neuromuscular disorders and mental ill-health, as well as older adults. The publications’ findings demonstrate the capacity of voluntary, community and social enterprises (VCSE) to provide integrated care that meets the holistic needs of those who access them whilst, potentially, addressing the social determinants of health. They also highlight the necessity for supporting people with LTCs to improve their life circumstances through their own personal empowerment. This includes the ability to facilitate their readiness to take on the responsibility with partnership working between the individual and the healthcare worker and psychological support when needed being identified as key. Developing the person’s social skills and aptitude to build interdependent relationships have been determined as the ultimate goal to enhance capacity for community engagement and further access to HWB resources. The publications’ findings also show that capitalising on the power of social networks to foster older adults’ adherence to community physical activity (PA) groups may promote HWB and, thus, the ability to age healthily. It was also found that if older adults become embedded within the PA group’s network they could shape the environment to fulfil their own needs. In addition, the findings advocate the necessity for a transformation in physiotherapy practice including enhancing the physiotherapists’ role as health promoters. It is proposed that only by doing so; they can remain contemporary and continue to support the optimisation of the HWB of older adults and people with LTCs. Further to the publications, this thesis comprises a critical commentary that includes how VCSE can support healthcare services by promoting the HWB of people with LTCs and older adults. Finally, this thesis culminates in a critical discussion of the implications, for practice and policy, of the findings from my publications, with recommendations for further research.

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