Table 3. Characteristics of the qualitative studies.

Author(s) and Year	Aim of Study	Population	Method	Main Findings
(Aasen et al., 2011) [58]	To explore how elderly patients with end-stage renal disease undergoing treatment with haemodialysis for the rest of their lives perceive patient participation in a dialysis unit.	• n = 11 • Patients: Haemodialysis patients • Ages: 72–90	• Data Collection: Transcribed interviews • Location: Five hospitals in Norway	• Health care teams exercised control and power over the patients. This included withholding information. This power imbalance caused: • Some patients to feel powerless to make their own healthcare decisions–despite trusting the healthcare team. • Patient identity to be threatened over the years of treatment. • Most patients to desire more dialogue about the future. • Barriers to shared decision making about treatment–subsequently threatening patient well-being and quality of life.
(Black et al., 2018) [42]	To explore the ‘lived experience’ of a group of patients with palliative care needs who had recently been in-patients in one acute hospital trust in the north-west of England.	• n = 20 • Patients: Cancer Patients • Ages: 43–87	• Data Collection: Transcribed interviews • Location: UK	Older patients felt that: • Healthcare staff acted compassionately and utilised responsive, patient centred care. This assisted the patients in feeling safe and valued as individuals rather than as a commodity. • These acts of compassion were expressed through small actions such as taking the time to talk and care for the patient while ensuring the patients felt comfortable and treated as a human. • However, over-stretched staff, resources, and modes and manner of communication such as lack of information and poor healthcare provider continuity further negatively impacted patient experience.
(Brooks et al., 2016) [62]	To explore the views and experiences of older adults with varying health literacy levels who had attended a falls clinic on their overall experience of the falls clinic, access to the service, and provider–patient interaction.	• n = 9 Patients: Older adults using a falls clinic Ages: 79+	• Data Collection: semi-structured interviews • Location: UK	• Patients felt being recognised as an individual, such as including individual qualities and interests in written communications, was important for building trusting relationships with patients. This positively impacted on the patient’s willingness to engage with healthcare professionals and follow their recommendations. • This trust synergised with perceived Healthcare professional credibility, further enhancing patient willingness to participate and follow healthcare professional recommendations. • However, patients felt dissatisfaction with impersonal and overly medicalised written and verbal communications that may not have suited their learning style, preferring clear and simple information delivery.
(Butterworth & Campbell, 2014) [63]	To explore older patients’ trust in their GPs and their perceptions of shared decision making.	• n = 20 Patients: From GP surgeries Ages: 65 +	• Data Collection: Interviews • Location: UK	• Trust was an important influencer for shared decision making. • Patients preferred a GP who they could view as a trusted ‘ally’. A GP who could care for patients competently throughout the vulnerable ageing process and their participants’ increasing health-information requirement was important. • Factors that negatively impacted patient trust in their GP also impacted patient involvement. Common aspects that influenced trust in the GP were GP communication skills and characteristics, consultation duration, and continuity of care. • Patients expressed trust in GPs who appeared both competent and confident in their abilities. GPs who reaching a mutual understanding regarding utilising patient-centred care facilitated patient involvement.
(Choi et al., 2016) [43]	To explore experiences related to hearing loss and barriers to hearing health care among older Korean Americans (KAs)	• n = 19 Patients: Older Korean Americans Ages: 58+	• Data Collection: Interviews (focus groups) Location: US	• Older Korean Americans often had difficulties participating in the medical setting due to poor English-speaking skills which prevented them from communicating their health needs. • Patients stated that their Korean-speaking community GPs were unable to accept any new patients due to being overburdened with the increasing number of older KA’s. • Patients felt there was a lack of collaborative communication present even with Korean-speaking physicians. This was perceived to be due to a combination of KA’s inclination to endure discomfort or pain and the paternalistic physician-patient relationships held in these clinics. • Most patients held negative opinions about hearing aids. This served as a barrier to initially obtaining hearing care. • Patients felt uncertain about what they needed to do to address their hearing loss symptoms. This was due to a lack of knowledge and health literacy in the hearing health care options available to them. This further served as a clinical communication barrier.
(Clarke et al., 2014a) [44]	To gain more insight into how older adults living with chronic pain in the community (and not attending pain clinics) perceive their encounters with healthcare professionals, with a view to informing and improving these interactions.	• n = 23 Patients: >65 years with self-reported musculoskeletal chronic pain Ages: >65	• Data Collection: Interviews Location: Scotland	• Healthcare professionals that were being dismissive rather than supportive and supplying information caused patients to feel anxious. This caused patients to feel their treatments were based on assumptions instead of knowledge of the patients experiences and bodies.
(Clarke et al., 2014b) [45]	To consider (1) perceived sources of, and explanations for, satisfaction and dissatisfaction with primary care physicians and (2) the strategies that older adults with multiple chronic conditions employ to maximize the care they receive	• n = 35 Patients: Older adults with multiple morbidities Ages: 73 to 91	• Data Collection: Interviews • Location: Canada	• Most patients felt they received insufficient care due to actions such as medical consult constraints, ageism, and poor physician qualities. • Many (51%) of patients reported that they felt comfortable with GP’s who held certain personal qualities. These included being friendly, open, and trustworthy. Patients felt they could discuss their medical concern with these doctors freely and easily. • However, not all patients felt that their doctors were supportive to all their health care needs. This led to patients feeling uncomfortable when discussing sensitive topics such as sexuality or mental health, as patients felt that their doctors were not willing to adequately address these topics. • Many (43%) patients felt that the complexities of their chronic conditions were not compatible with time constraints of medical consultations. Many spoke about the difficulties in having to make decisions on which acute or chronic health issues to discuss during appointments with GPs. • Some, (26%) of the patients felt that the societal devaluation of older adults (i.e., ageism) was causing barriers to healthcare communication. This was either (1) internalised ageism–where patients viewed themselves as “a drain on the health system” unworthy of physician attention or (2) perspectives of societally generated gendered ageism–where older adult female patients felt male physicians’ lack of thoroughness was due to the OAP’s female gender. • To combat this, several participants, especially women, utilised several strategies to manage their doctors’ impressions of them and maximize the care they received. For example: • Some (28%) used lists during appointments to assist in the prioritization of their multiple health concerns. • Some (11%) utilised companions in their appointments. • Many (34%) utilised other information sources about their conditions. This included the Internet, library books, pharmacists, and other health care professionals. • Some (22%) described assertively asking for specialist referrals or diagnostic tests. • However, most (60%) attempted to manage doctors’ impressions of them as genuinely compliant patients. This was done by behaving compliant, “being cooperative” and “doing what they were told”.
(Costello et al., 2012) [46]	To explore the perceptions of independent-living older adults regarding their physicians’ role in promoting physical activity (PA).	• n = 31 Patients: Independently living older adults (either physically inactive or active) Ages: 60+	• Data Collection: Focus group discussions • Location: United States	• Despite raising the topic, patients felt they did not have routine conversations about physical activity with their doctor. Those that did felt that the conversation was not helpful or rewarding.
(Dilworth et al., 2012) [47]	To explore the experiences of older people who have been readmitted to hospital following recent discharge to their homes.	• n = 3 Patients: Older patients who were discharged from a large tertiary referral hospital in NSW Australia and readmitted Ages: 65+	• Data Collection: Interviews • Location: Australia	• Participants felt powerless, unheard, disrespected, and left out during their experience of being in hospital. This was mainly due to actions such as: • A lack of information sharing from healthcare professionals to patients. • Patients having their knowledge, values and preferences ignored by healthcare professionals. Receiving mixed messages.
(Ellins & Glasby, 2014) [48]	To understand the lived experiences of older people moving across service boundaries by utilising an in-depth narrative approach and adopting a participatory action research method.	• n = 24 Patients: People who had experienced a recent hospital stay as a patient (or a family member providing care and support) Ages: 60–79	• Data Collection: Interviews (alongside retrospective cohort case studies) Location: UK	Patients felt: • A need for humanistic and person-centred approaches to their care. • There were, at times, difficulties accessing translating services.
(Evans et al., 2012) [49]	To examine older patients’ attitudes towards, and experiences of, patient-physician end-of-life (EoL) communication in three European countries.	• n = 30 Patients: British, Dutch and Belgian patients with a terminal illness Ages: 60+	• Study Design: Qualitative • Data Collection: Interviews (secondary analysis) • Location: UK, Germany, and Belgium	Patients felt: • Patients’ confidence and trust in healthcare professionals were reinforced by the doctor’s time availability, and genuine attention given to the patient. • Poor communication styles from physicians hindered patients’ ability to communicate and participate in consults.
(Gerlich et al., 2012) [60]	To explore the needs of older patients with advanced heart failure, and their experiences with health care delivery in Germany.	• n = 12 Patients: Older patients with advanced heart failure Ages: 73 +	• Study Design: Qualitative Data Collection: Interviews Location: Germany.	• Patients at times played a ‘strong role’ to avoid speaking about their illness and associated fears. • Patients wished for information to be communicated in an understandable manner. They found it difficult to discover healthcare professionals who meet their information needs. However, patients also stated that too much information may be overwhelming.
(Gordon et al., 2018) [50]	To explore older people’s accounts of how they talk about depression and possible symptoms to improve communication about depression when seeing GPs.	• n = 16 Patients: Older patients aged over 65 with depression. • Ages: 67–88	• Study Design: Qualitative Data Collection: Interviews (secondary analysis) Location: North-east England.	Some older patients appeared to: • Deny or minimalize their depression due to the perceived stigma and personal insecurities about having depression. This prevented full disclosure in clinical communications. • Due to having depression, believed themselves have greater knowledge about depression than healthcare staff. This subsequently caused anger and distrust of healthcare staff. • Have trouble expressing their feelings and depression and appeared unengaged about working on doing so. • Accept their depression as a part of their personality with no desire to explore their feelings or understand their depression and had no hope about their depression changing or improving.
(Pennbrant et al., 2012) [51]	To describe how elderly patients experience their meetings with their doctor in a hospital setting	• n = 20 Patients: OAPs discharged from medicine and geriatric hospital care in Sweden Ages: 68 to 95	• Study Design: Qualitative Data Collection: Interviews Location: Sweden	• OAPs better understood their doctors’ information with their relatives help. • OAPs were interested in shared decision making and taking an active role in healthcare discussions. However, doctor-patient power relationships often made the patient feel powerless and subordinate to their doctors. • Active interaction improves OAP understanding of their health. OAPs feel that doctors have an obligation to encourage patients active involvement in consultations and show patients that they are the focus of attention. • Older patients are sensitive to the doctors’ body language, with negative body language such as appearing rushed reducing patient trust in the doctor.
(Schröder et al., 2018) [59]	To analyse socioeconomic differences in patients’ experiences along the treatment pathway for coronary heart disease (CHD).	• n = 41 Patients: CHD sufferers Ages: 59–80	• Study Design: Qualitative Data Collection: Interviews Location: Germany	• Socioeconomic status (SES) influences OAP health literacy. OAPs with a lower-SES were less informed about their treatment, which impacted their understanding of health conversations or their health reports in comparison to their higher-SES counterparts. • SES influences OAP participation. Lower-SES patients tended to delegate their responsibility for treatment. This resulted in patients not participating in clinical communications or questioning treatment decisions. In comparison, high SES OAPs felt more responsible for their own treatment and made informed health decisions alongside their GP.
(Tobiano et al., 2015)* [52]	To explore hospitalised medical patients’ perceptions of participating in nursing care, including barriers and facilitators.	• n = 20 Patients: Varied characteristics Ages: 18+ (Only data from those >65 was extracted for this study)	• Study Design: Qualitative Data Collection: Interviews Location: Australia	• Some older patients undertook strategies to gain knowledge from various sources such as nurses, doctors, families, self-education and listening to their bedside handovers from nurses to doctors. This increased health knowledge and enabled patients to become healthcare partners with their nurse. • Some older patients identified that power imbalances consistent with a paternalistic model of health care acted as a barrier to patient participation in clinical communication. These included: • Some OAPs self-perceived that ‘nurses held all the power’ and that patients participating in their clinical communications would only serve as a burden. • Some OAPs perceived some nurse behaviours as negative, which established a passive role in the patient and prevented patient participation. * Only data that exclusively involved the OAPs (66+) was extracted from this article.
(van Ee et al., 2018) [53]	To provide insight into older men’s experiences with prostate cancer in order to improve personalised care.	• n = 22 Patients: older men with prostate cancer Ages: 70+	• Study Design: Qualitative • Data Collection: Interviews • Location: Netherlands	• Some OAPs felt appreciative of the use of humour in conversations from healthcare professionals. OAPs looked forward to appointments with these healthcare professionals and reported almost seeing them as outings. • Despite generally positive views of the hospital care, older patients would have preferred to be presented with more information about treatment and support options.
(Waterworth et al., 2017) [54]	To determine which aspects of primary nurse–patient telephone communication are viewed positively or negatively in terms of meeting the older persons’ needs	• n = 21 Patients: older patients from General Practices Ages: 66–90	• Study Design: Qualitative • Data Collection: Interviews (and a focus group) • Location: New Zealand	• Accessibility to a healthcare professional was a significant factor in initiating contact with them. Being able to utilise the telephone to access the clinic nurse instead of travelling to the practice in person acted as an enabler to patient contact. • However, potential waiting times for a call back if the nurse was not available was a significant influencer in the decision-making process to initiate contact. Patients often wondered when they would get a call back, or if they ever would. • The financial cost of seeing a GP and its impact on initiating contact was mentioned by several participants. These financial barriers lead to missed opportunities for early intervention. • OAPs were attributing symptoms to ageing and as a result that their symptoms were not urgent or did not matter. Due to this, they felt uncertain about the need to initiate contact with healthcare professionals such as doctors and nurses.