Older people’s perceived autonomy in residential care: An integrative review

Abstract

Autonomy has been recognised as a key principle in healthcare, but we still need to develop a consistent understanding of older people’s perceived autonomy in residential care. This study aimed to identify, describe and synthesise previous studies on the perceived autonomy of older people in residential care. Ethical approval was not required, as this was a review of published literature. We carried out an integrative review to synthesise previous knowledge published in peer-review journals in English up to September 2019. Electronic and manual searches were conducted using the CINAHL, Philosopher’s Index, PubMed, SocINDEX, Scopus and Web of Science databases. The data were analysed using the constant comparison method. The review identified 46 studies. Perceived autonomy referred to the opportunities that older people had to make their own choices about their daily life in residential care, and achieving autonomy promoted both health and quality of life. Autonomy was linked to older people’s individual capacities, including their level of independence, physical and mental competence, personal characteristics, and whether relatives shared and supported their perceived autonomy. Professionals could facilitate or hinder older peoples’ autonomy in a number of ways, including providing opportunities for autonomy, how daily care needs and activities were managed, and controlling older people’s choices. Professionals’ characteristics, such as education and attitudes, and the older people’s living environments were also associated with their perceived autonomy and included organisational characteristics and physical and social care facilitators. Older people’s perceived autonomy promoted health and quality of life in residential care. However, their autonomy was associated with a number of protective and restrictive individual and environmental factors, which influenced whether autonomy was achieved.

Preserving client autonomy when guiding medicine taking in telehomecare: A conversation analytic case study

“…In our analysis, this happened as the arrangement of VM equipment and guiding practices pushed the client to ask for help, which has been recognised as a potential threat for situational autonomy in residential care. 6 Situating the equipment and medicine closer to each other eliminated the problem of simultaneous engagement in interaction and medicine taking (Extract 2). Furthermore, compared to straightforward guiding, the stepwise approach portrays the client as a knowledgeable participant who thus has more time to locate the medicine.…”

“…4,5 For instance, the care practices that drive older adults to ask for help have been recognised as potential risks for client autonomy in residential care for older adults. 6 On the other hand, respecting others' rights to determine their own course of action has been found to enhance client autonomy. [7][8][9][10][11][12] This is achieved, for example, by using suggestions rather than straightforward orders in care work 9 and taking into consideration the guided person's ability to comply with the directions.…”

Life Conditions as Mediators of Welfare State Effect on Mental Wellbeing among Oldest Old in Europe

“…A welfare state can facilitate ageing in place by ensuring adequate income, suitable housing options, access to services and social support within and outside of the home [ 53 ]. It is equally important to ensure autonomy within the context of residential care in terms of people’s decisions about their daily activities, maintaining dignity and upholding human rights [ 54 , 55 ]. Welfare state support is especially important in relation to high support needs.…”

The association between falls and autonomy in older adults is mediated by self-efficacy

“…Perceived low autonomy is also associated with basic education (< 6 years), slightest or no social support, anxiety, cognitive deterioration, low educational level and limitations in ADL [24]. It is noteworthy that older adults' perceived autonomy can be affected by different factors some of which are unchangeable such as educational level or marital status while other factors like physical and mental health, mobility and skills as well as self-efficacy are components on which interventions could be focused on [43]. In addition, our study revealed some other interesting associations.…”