How ‘place’ influences acute coronary syndrome outcome among older people? A mixed-method study.

The impact of acute coronary syndrome has been increasingly recognised since the introduction of the National Service Framework in 2000. Interest in the relationship between place of residence and health has grown although a sound conception of what place is and how the health of older people with acute coronary syndromes relates to where they live is lacking. This thesis aims to understand the nature and effect of place in relation to health inequalities on daily lives for older people recently diagnosed with ACS. An exploratory sequential mixed methodology was utilised across Yorkshire and Humber. This consisted of iterations of quantitative and qualitative data collection, analysis and data synthesis. The relationship between place and survival was first explored using secondary data analysis. In-depth experiences and perceptions of the dimensions of place effect and recovery from ACS were then explored using postal questionnaires at two times and qualitative interviews and community mapping discussions with ten participants. Conceptual data synthesis was ongoing. This informed the development of the study and built a layered picture of place effect. A second iteration of secondary data analysis explored how representations of conceptual place effect were associated with survival rates. Where a person lived effected how they dealt with changes created by ACS and their survival. Conceptualisation of place was summarised from the synthesised data as: place usability; personal connection to place; level of adjustment; perceived level of support; support; and population density. By developing the different interrelated layers of place effect, these findings enable future evaluation to be more representative of the impact ACS has on an older person’s daily life within their place of residence.