Perceived enactment of autonomy of nursing home residents: A German cross‐sectional study

Abstract

Recognizing the ageing of populations and expected increase in prevalence of dementia, the necessity of research involving persons with dementia is widely agreed upon. Autonomy is key to nursing home residents' well-being and quality of life, but this phenomenon has not been thoroughly assessed from the residents' perspective. The aim of this cross-sectional study was to investigate perceived autonomy of nursing home residents. Data on 560 randomly selected residents in 40 nursing homes in two German federal states were generated by face-to-face interviews, psychological and physical assessments, analysis of nursing records, and acquisition of institutional parameters. This paper reports on a subsample (n = 179) that met screening requirements, including subjects with and without mild cognitive impairment (Mini Mental Status Examination score 30-18), who completed the Hertz Perceived Enactment of Autonomy Scale (HPEAS). The mean score of HPEAS was 101.1 ± 14.5 (range 54-122). In our population, Cronbach's alpha was 0.89. Scores in HPEAS were not related to demographical factors but positively associated with increasing self-efficacy and absence of pain. The novel findings contribute to an understanding of autonomy from the residents' perspective.

Residents’ Self-Reported Quality of Life in Long-Term Care Facilities in Canada

“…This study affi rms other research fi ndings that direct measurement of QoL is the preferred approach (Crespo, Bernaldo de Quirós, Gómez, & Hornillos, 2012 ;Kane et al, 2005 ). The residents' self-reported QoL ratings confi rmed previously published reports that LTC facility residents value their autonomy, personal choice, and autonomy (Boisaubin, Chu, & Catalano, 2007 ;Iris, DeBacker, Benner, Hammerman, & Ridings, 2012 ;Wulff et al, 2013 ) and that LTC facility staff may inadvertently neglect residents' sense of autonomy in the course of delivering care (Mullins & Hartley, 2002 ). In our study, only 35 per cent of residents provided positive ratings on their ability to have a bath or shower as often as they wanted, and only 62 per cent reported positively that they could control who entered their room.…”

People with dementia in nursing home research: a methodological review of the definition and identification of the study population

“…In these articles, the term “dementia” was used consistently in the title, abstract, key words and research questions. Four articles focused their research question on residents with CI without any specification of etiology, which means they did not clearly define dementia residents as their study population [ 37 – 40 ]. However, in these articles the terminology was not consistent throughout the article: the term dementia and CI were used interchangeably.…”

“…A broad range of cutoff scores for dementia severity was reported for the MMSE. Seven studies referred to an MMSE of < 25 [ 37 , 40 , 48 – 51 ], 6 studies used a cutoff of ≤ 24 [ 85 – 90 ], 8 articles referred to a cutoff of < 24 to detect mild dementia [ 76 – 80 , 82 , 91 , 92 ], and 4 articles referred to a more conservative cutoff. [ 39 , 41 , 83 , 93 ] One article specified a higher cutoff value of ≤ 27 but conducted confirmatory testing with the Geriatric Depression Scale (GDS) for residents with an MMSE between 24 and 27 [ 84 ].…”

“…To us, it was unclear why some studies focused on the population of people with CI but not on people with dementia because the authors did not elaborate on the question whether the etiology of CI played a role with respect to their research focus. In 2 publications, the terms “dementia” and “CI” were used interchangeably [ 39 , 40 ]. If the authors did not explain why they defined their population based on a disease or a symptom and later failed to distinguish between the 2 conditions, one may ask whether the question was sufficiently addressed.…”

Dignity at stake: Caring for persons with impaired autonomy

“…9 Autonomy can thus be seen as the interaction between a person’s self-governance and their ability to perform the activities of daily living. 10 Lechowski et al 11 have described how cognitive impairment and age results in loss of autonomy, and thus loss of ability to perform the activities of daily life.…”