How older adults with physical impairments maintain their autonomy in nursing homes

Abstract

Autonomy is important to persons, including when they are living in nursing homes. Especially the relational dimension of autonomy is crucial for older adults with physical impairments. They generally have the decisional capacity to make choices about how they want to live their lives, but are often unable, or only partially able, to exercise these decisions themselves. To execute decisions, older adults are dependent on those who support them or care for them. However, little is known about how nursing home residents maintain autonomy in daily life and how others are involved in the decisions and execution of the decisions. To examine how older adults with physical impairments living in nursing homes maintain autonomy in daily life, shadowing, a non-participative observational method, was used. Seventeen older adults were shadowed during the course of one day. The observation ended with a brief interview. After the shadowing, the detailed observation notes were typed out, combined with the verbatim transcript resulting in one extensive report per shadowee. All 17 reports were coded and analysed thematically. Six elements for how older adults maintain autonomy in relation with others were identified, i.e. ‘being able to decide and/or execute decisions’, ‘active involvement’, ‘transferring autonomy to others’, ‘using preferred spaces’, ‘choosing how to spend time in daily life’ and ‘deciding about important subjects’. For all six elements established in this study, it was found that older adults with physical impairments living in nursing homes could only maintain autonomy in daily life when others, such as staff, family and friends, were responsive to signals of the needs of older adults.

Development and content validation for a self-assessment instrument of care quality in long-term care facilities for older adults

“…The environmental dimension encompasses structural aspects that allow privacy, space for socialization, comfort, and safety, preventing accidents and favoring work processes, as seen in other studies 12,23 . The work team dimension addresses ILPI workers, including caregivers, who must be trained and motivated, essential for quality care 12,13,24 .…”

Construção e validação de conteúdo de instrumento de autoavaliação da qualidade do cuidado em instituição de longa permanência para pessoas idosas

“…A dimensão ambiente engloba aspectos da estrutura que permitem privacidade, espaço para socialização, conforto e segurança, podendo prevenir acidentes e favorecer os processos de trabalho, como visto em outros estudos 12,23 . A dimensão equipe de trabalho aborda os trabalhadores de ILPI, incluindo os cuidadores, que devem ser capacitados e motivados, essenciais para uma assistência de qualidade 12,13,24 .…”

Public Spaces for Older People: A Review of the Relationship between Public Space to Quality of Life

“…Autonomy as a domain of QoL is widely studied in the literature [57][58][59][60]. It has been proposed that autonomy has a physical as well as a psychological dimension [61].…”

“…For example, autonomy is defined as 'the perceived ability to control, cope with and make personal decisions about how one lives on a day-to-day basis, according to one's own rules and preferences' [3]. Various phrases have been used to define the term such as 'control', 'agency', 'mastery', 'self-management', 'self-determination', 'independence, and 'choice' [58,62,63]. The definition by Knight et al [64] may best define autonomy from the perspective of the environment.…”