Referral to physiotherapy as part of a general practitioner's management of back pain.

The aim of this survey was to investigate how general practitioners (GPs) manage their back pain patients and if they refer them for physiotherapy. The research instrument was a self-administered postal questionnaire. This was sent to 580 GPs, one quarter of the GPs in the Republic of Ireland. Two hundred and ninety three questionnaires (n=293)were returned, which constituted a 50.5% response rate. Two hundred and sixty one questionnaires (n=261) were usable. The main findings of the study were that the respondents consider that physiotherapy has a major role in the management of back pain. However there was limited availability of physiotherapy for the GPs' public patients. One hundred and thirteen GPs (over 43% of respondents) have referred back pain patients to alternative practitioners for manipulation. One hundred and forty four respondents (52%) believe that physiotherapists should not treat back pain patients without the patient first consulting their doctor.

Feeling old versus being old: views of troubled aging.

This paper describes the results of an ethnographic study which explored the experiences of aging constructed by five older people, their adult children and a team of health professionals involved in evaluating their health status. Older participants made a clear distinction between being old and feeling old whereas their children did not. None of the five older people, who ranged in age from 69 to 86, identified themselves as old although each of them identified specific and transient episodes of feeling old. Their children, on the other hand, identified the older people as being old when they perceived them as having lost a characteristic which had been a central factor in the children's experiences of them as parents. Contrary to the older people's experience of feeling old as a temporary phenomenon, the children's identification of their parents as old included the understanding that their parents were in a process of inevitable and irreversible decline for which something needed to be done. In an effort to help, the children referred their parents to a geriatric assessment clinic to identify the cause of their problems and to recommend solutions for resolving them. The involvement of the assessment clinic generated yet another construction of the older people's problems. The study explores the impact which these sometimes conflicting views had in unwittingly precipitating an additional burden of trouble for both older people and children. Conversely, the study also demonstrates the power of the participant families' definitions of themselves and their situations to withstand the weight of opposing constructions generated by the clinic staff. Finally, the phenomenon of troubled aging is seen as a feature of the children's experience of their parents' aging rather than as a central aspect of the older people's experience.