I undertook a qualitative study to explore and subsequently increase understanding of the social construction of patient-centred health and social care for vulnerable older people living in the community. The study involved focus groups held between September 2004 and December 2005 with older people, volunteers and health and social care professionals. The discussions were recorded, transcribed and analysed using methods informed by the constant comparative method (Glaser, 1965) and by Wolcott’s (1994) three stages of qualitative data ‘transformation’, namely: description, analysis and interpretation. The computer assisted qualitative data analysis software package NVIVO (version 2.0) was used to store and manage data.

My findings led to a typology of co-existence of patient-centred care and vulnerability in old age. This typology separates vulnerability into two main concepts: insider and outsider. Development and exploration of this typology led to three main conclusions. Firstly, older people who feel vulnerable do not consider their care to be patient-centred. Secondly, those older people who see their care as patient-centred do not feel vulnerable. Thirdly, there is inadequate evidence to support the construction of patient-centred care for vulnerable older people from the perspective of professionals. Reasons for this are discussed, one such reason being uncertainty on the part of professionals working in the community as to what comprises patient-centred care in the most complex cases.

Theoretically, my findings make a link between patient-centred care and vulnerability in old age which has hitherto not been made. These links are mostly with ‘insider’ vulnerability, highlighting and therefore reinforcing previous research which has demonstrated an important distinction between insider and outsider vulnerability. For older people, the following are important parts of patient centred care: ‘getting back to normal’, improving their functional ability, being made to feel good about themselves, and being treated in a way that allows them not to feel as if they are getting old. It is recommended that practitioners should ask older people if they feel vulnerable and if so when and in what situations as part of the assessment process. This would then allow them to target their input according to these ‘felt’ vulnerabilities.