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

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.