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‘Pathways to choice’ of care setting


This article aims to encourage critical reflection about the limitations of the rational choice approach as an explanatory insight to understanding older people's choice-making about their health or social care requirements. It develops an interpretive framework examining how older people engage in the process of choice-making when selecting a care option. Choice-making is conceptualised as a temporal, processual phenomenon, influenced by others, and characterised by an individual's behavioural responses to changing circumstance and lifecourse events. Data are from qualitative interviews with 29 older adults whose choice of care option involved moving to an extra-care setting in Wales (United Kingdom). Transcripts were coded using in-case and constant-comparison approaches, and analysis was undertaken using concepts of engagement and temporality as elements of the choice-making process. Using an inductive approach, a typology of six different ‘pathways to choice’ of care setting was identified; these findings suggest that choosing a care option in later life is a diverse, interactive and time-bound social phenomenon, inadequately captured by the rational choice approach where it is understood more as an individualised, linear and logical process. Recognising that choice-making evolves through time as part of a process shaped by others means service providers will be better positioned to offer opportunities for more preventative-focused interventions which empower older consumers to make planned and informed choices about care options.

Corresponding author
Address for correspondence: Sarah Hillcoat-Nallétamby, Centre for Innovative Ageing, College of Human and Health Sciences, Haldane Building, Singleton Campus, Swansea University, Swansea SA28PP, UK. E-mail:
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Ageing & Society
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