Autonomy Of Older People Research Articles

Key professional stakeholders roles in promoting older people's autonomy in residential care.

Older people's autonomy is an ethical and legal principle in everyday residential care, but there is a lack of clarity about the roles and responsibilities of the key professional stakeholder groups involved. This study aimed to identify and define the roles and responsibilities of the key professional stakeholder groups involved in promoting older people's autonomy in residential care settings. We used a Delphi method with two iterative rounds of online group discussions and collected data from experts in older people's care in Finland in summer 2020. The data were analyzed using deductive-inductive content analysis methods. According to Finnish legislation, this type of research did not need approval from a research ethics committee. Informed consent from the participants was obtained and they were informed about the voluntary nature and confidentiality of the study and their right to withdraw at any time. Key professional stakeholders had different roles and responsibilities, but their shared, integrated goal was to achieve older people's autonomy in residential care settings. Their combined roles and responsibilities covered all aspects of promoting older people's autonomy, from care and service planning and daily decision-making to service structures that included ethical competencies and monitoring. Multipronged, variable, coordinated strategies were required to identify, assess, and promote autonomy at different levels of care. Key professional stakeholders need to work together to provide an unbroken chain of care that provides older people with autonomy in residential care settings. In future, more knowledge is needed about how to create structures to achieve the shared goal of older people's autonomy in these settings.

Health communication and shared decision-making between nurses and older adults in community setting: An integrative review.

To explore the role of health communication in Shared Decision-Making (SDM) between nursing staff and older people in the community setting. Society and healthcare services are marked by an exponentially ageing population, leading to a significant proportion of patients being older adults with highly demanding care needs. Scientific literature supports shared decision-making as a process that engages patients in their care. However, the increasing use of technology and the consequences of the COVID-19 pandemic have influenced how nurses communicate with older patients. Therefore, it is crucial to understand how to develop health communication to reach effective, shared decision-making processes. Whittemore and Knafl's integrative review method, the literature search comprised five databases: PubMed, CINALH, Web of Science, Scopus and PsycINFO. The 12 included studies were synthesised into three study patterns: (1) nurse-older patient health communication relationship, (2) older patients' perspectives and (3) nontherapeutic communication in end-of-life care. This review underscored the crucial role of effective health communication in shaping SDM dynamics between nursing staff and older people in the community setting. Key elements included transparent information exchange, establishing trust and maintaining communication channels with informal caregiving networks. SDM actions were aligned with preserving older people's autonomy, but communication challenges persisted, particularly in end-of-life situations. Advanced care planning was recommended to address these shortcomings and improve communication among older people, healthcare professionals and families. Implementing educational measures based on verbal and nonverbal health communication in nursing training could be beneficial. Nursing research could continue to develop and refine specific communication strategies adapted to the social determinants of health for diverse clinical situations regarding older adults in the community setting. The authors have adhered to relevant EQUATOR guidelines through the PRISMA 2020 checklist. No Patient or Public Contribution.

Digital Ageism: Emerging Challenges and Best Practices of Age-Friendly Digital Urban Governance

The ageing of urban populations poses serious challenges for policymakers and urban planners alike. While the number of people over 65 is increasing in urban areas, the digital transition in cities raises concerns about the persisting digital divide facing older citizens, as well as the digital inequality and ageism inherent to most digital domains. As ageing in place and place attachment play a significant role in the social engagement and well-being of older people, the purpose of this research is to shed light on the novel approaches taken by local governments to foster active participation among senior residents in the digital public sphere. Using semi-structured interviews with public officials from three age-friendly cities in Spain, we have explored innovative urban projects for digital inclusion, active ageing, and autonomy for older people. The findings of the study reveal the importance of coordinated multi-stakeholder initiatives in promoting digital literacy and overcoming barriers rooted in ageism in the digital world. True representation of older people in local governments, the promotion of co-creation initiatives led by seniors, and the standardisation of universal design and accessibility are some of the key contributions made by Spanish cities in their transition toward places that are digitally inclusive and age-friendly.

Degree of autonomy in making independent choices by frail older people with intellectual disabilities in a care home: A descriptive ethnographic study.

We aimed to gain more insight into autonomy of older people with intellectual disabilities in a residential care facility in making choices. We performed a descriptive ethnographic study in a residential facility in the Netherlands for 22 persons, aged 54-89 years, with mild to moderate intellectual disabilities (IQ <70) and low social-emotional development levels. We combined participant observations and qualitative interviews. Based on the observations, the main themes for the interviews were established. Residents indicated to be free to make independent choices, and experienced less autonomy with regard to health issues and finances. Support staff stated that residents' level of autonomy depends on residents' characteristics, needs, preferences, the attitude of support staff and the rules of the care institution. Residents had a clear view on their autonomy in making independent choices. Support staff is mindful of preserving residents' autonomy, which in practice is limited.

Nursing support for older people's autonomy in residential care: An integrative review.

Nurses play a crucial role in enabling older people's autonomy in residential care. However, there is a lack of synthesised knowledge about how nurses can support older people. The aim of this study was to identify and synthesise nursing support for older people's autonomy in residential care. An integrative review was carried out by searching the CINAHL, Philosopher's index, PubMed, SocINDEX, Scopus and Web of Science databases, supplemented by manual searches. The searches focused on peer-reviewed scientific empirical research papers published in English, without date limitations. The constant comparison method was used for the analysis. The review identified 24 papers, and these showed that older people's autonomy was based on dignity. Nurses protected older people's autonomy in eight different ways. They protected their right to make their own decisions, acted as advocates, respected their wishes, provided opportunities for autonomy, fostered independence, gave information to residents and relatives, provided individualised care practices and protected older people's safety. However, there were also barriers that needed to be overcome. Nurses used multiple, individually tailored activities to support older people's autonomy, but they also had different reasons for supporting or hindering it. Work and leadership structures are needed to ensure that older people's autonomy is driven by ethical practices. The results of this review can help nurses who provide residential care for older people to recognise the different nursing activities that can be used to support older people's autonomy and to develop strategies to apply them in different daily care situations. However, further research is needed to determine how these activities can be realised in daily care and how they cover different aspects of older people's lives in residential care.

Action on Elder Abuse: A New South Wales Pilot Project on the Role of Legal and Health Practitioners in Elder Abuse Screening, Response and Prevention

This article reports on a pilot project that involved legal and health practitioners (n=17) in an intervention that aimed to improve detection of and response to elder abuse. Interviews and focus groups elicited practitioners’ experiences and their views on the use of structured screening processes to identify abuse or risk situations. Participants reported they mostly encounter financial exploitation and psychological abuse, perpetrated by adult children against older parents. No practitioners reported the use of an elder-abuse-specific screening tool, but perceived the benefits of screening to enable earlier identification of problems. Barriers to screening included practitioners’ concerns about communication strategies, professional role boundaries, and inadequate response options. Participants supported a ‘triage’ approach, with screening questions and responses scaled to the immediacy and severity of the problem. Respect for the autonomy of older people was emphasised, along with professionals’ role in providing advice and resources to empower their older clients.

A systematic review of ethical and legal issues in elder care.

Ethical and legal issues are increasingly being reported by health caregivers; however, little is known about the nature of these issues in geriatric care. These issues can improve work and care conditions in healthcare, and consequently, the health and welfare of older people. This literature review aims to identify research focusing on ethical and legal issues in geriatric care, in order to give nurses and other health care workers an overview of existing grievances and possible solutions to take care of old patients in a both ethical and legally correct way. Using a systematic approach based on Aveyard, a search of the PubMed, CINAHL, and Ethicshare databases was conducted to find out the articles published on ethical and legal issues in geriatric care. The approval for the study was obtained from UMIT-The Health and Life Sciences University, Austria. Only 50 articles were included for systematic analysis reporting ethical and legal issues in the geriatric care. The results presented in this article showed that the main ethical issues were related to the older people's autonomy, respect for their needs, wishes and values, and respect for their decision-making. The main legal issues were related to patients' rights, advance directives, elderly rights, treatment nutrition dilemma, and autonomy. Further education for professional caregivers, elderly people, and their families is needed on following topics: care planning, directive and living wills, and caregiver-family member relationships to guide and support the elderly people within their decision-making processes and during the end-of-life care.

Could Ozone Be Used as a Feasible Future Treatment in Osteoarthritis of the Knee?

Osteoarthritis (OA) is one of the most disabling and incapacitating diseases on the autonomy of older people, affecting their quality of life. OA produces great impact on pain, function and use of resources, being considered as an important problem of Public Health. OA is a degenerative and progressive disease without treatment nowadays. The goals in OA treatment are to ameliorate symptoms and diminish articular damage. In knee OA, there is destruction of cartilage and subchondral bone, with the consequent narrowing of articular space. Knee OA is multifactorial. Besides the bio mechanic factors, trauma and obesity; it is believed that inflammation plays an important role. Future treatments should act on the regulation of inflammation to diminish progression of OA. There is evidence on several studies and years of experience that state that Ozone acts on the modulation of inflammation. The objective of this paper is to review the main pathophysiological mechanisms involved in knee OA, and to postulate ozone as a promising and ideal conservative treatment, since it could act on several therapeutic targets, besides inflammation.

The use of ICT devices by older people with a special focus on their type and respondents’ age: A Czech case study

ABSTRACTThe recent demographic trends show a rapid increase of aging population, especially in developed countries. Therefore, there is an urgent need to look for the opportunities of maintaining the quality of life of this aging population. One of the solutions seems to be the use of information and communication technology (ICT) devices, which can promote autonomy of older people by facilitating the execution of many routine activities such as shopping or communication. The purpose of this study is to explore the use of ICT devices among older people in the Czech Republic with respect to their type and respondents’ age. The methods include a questionnaire survey, as well as statistical processing of data collection. The results indicate that present seniors are becoming more digitally literate, especially in the use of mobile phones. However, the use of the technological devices then dramatically drops at the age of 75 years. In addition, the results indicate that future research should focus on the use of mobile phones, respectively smartphones, and its effectiveness on the improvement of quality of life of older generation groups.

‘I’d rather die happy’: residents’ experiences with food regulations, risk and food choice in residential aged care. A qualitative study

Background: Food regulations exist to protect older people in residential aged care, leading to the restriction of potentially hazardous foods. The impacts of malnutrition, resident centred care and the importance of maintaining individual autonomy for older people are well documented. By contrast, there is scant literature describing residents’ perceptions of food regulations and food risks in the residential aged care setting. Aims: The aim of this study is to explore resident perceptions of food choice and food restrictions in residential aged care. Methods: Using a qualitative, hermeneutic phenomenological design, semi-structured interviews were conducted with six participants recruited from two residential aged care facilities. Interviews were audio-taped, transcribed verbatim and thematically analysed. Results: The following key themes emerged in this study: participants were largely unaware of food regulations and risks, yet expressed the desire to make their own choices. Participants provided contradictory accounts of their experiences with food in residential aged care, which emphasises the ongoing challenge of meeting individual preferences. Conclusion: These themes warrant further investigation, particularly in relation to the impact of food regulations on food choice and the meaning of risk to older people in residential aged care. This research provides new insight into the perceptions of residents regarding their individual autonomy and independence against legislated risk minimization strategies.Impact statementThis article raises the issue of risk taking and food choices from the perspective of residents in a residential aged care facility.

Autonomy and Capacity: About Human Rights of Older Persons in Dependency Situations

Fil: Dabove, Maria Isolina. Consejo Nacional de Investigaciones Cientificas y Tecnicas; Argentina. Universidad de Buenos Aires; Argentina

Factors influencing older people's experiences of participation in autonomous decisions concerning their daily care in their own homes: areview of the literature.

To review the literature on how older people perceive opportunities and limitations with regard to participation in autonomous decisions concerning their daily care in their own homes. The perception of personal control plays a critical role in an older person's health and well-being. Little is known about factors that facilitate or hinder older people's autonomous decision-making in their own homes. The study has been carried out as a literature review. The following databases were used: CINAHL, PubMed, PsykInfo, Cochrane, SweMed, Embase. Research studies range from 2009 to 2014. The review includes 12 publications. Four core themes are generated: older person's autonomy in their own home; autonomy and relationship; the balance between autonomy and dependency; older people's autonomy and the organisation of home care. Older people have a strong inner drive to maintain autonomy in their own home. The autonomy is challenged when the person becomes increasingly dependent on help. The relationship with carers is of vital importance with regard to the person's ability to make autonomous decisions. The organisation of home care restricts older people' scope for autonomy. Older people's own perspectives on autonomous decisions can contribute to the ongoing debate about how nursing care can be developed with respect to their autonomy. Nursing care demands attention to an older person's desire for autonomy despite dependency. A framework for systematic ethical discussions among carers may improve awareness about factors that facilitate or hinder good personalised care. The organisation of nursing care needs to be shaped in line with best practice for older people.

Effectiveness of Ozone in Osteoarthritis of the Knee

Osteoarthritis (OA) is a degenerative disease that is very prevalent, and it usually increases exponentially with age [1]. OA affects weight bearing articulations as the knee, and is very common in women [1]. Knee OA affects negatively the function and autonomy of older people [2], decreasing patient’s quality of life [3]. OA produces a great use of limited health resources [3]. The normal knee is composed by cartilage, subchondral bone, synovial tissue and articular capsule. Knee OA produces destruction of articular cartilage and sclerosis of subchondral bone [2]. Knee OA diminishes the articular space, and it favours the formation of osteophyte and subchondral cysts [2]. To date, there is neither effective treatment nor cure for OA. The objectives on treating Knee OA are to ameliorate pain, rigidity, inflammation and to avoid articular damage and joint destruction [2]. Recently, OA is related to chronic inflammation, besides mechanical and biological factors. In that scenario, future OA treatments must regulate inflammation to avoid OA progression. Fernandez-Cuadros et al state that Ozone acts on the modulation of inflammation [2], based on several studies and years of clinical experience. It is believed that Ozone acts on the articulation as a stimulator, repairing the fibroblastic tissue. Moreover, Ozone could reduce inflammation and promote growth of new cartilage [2]. We present the case of an 83 years-old female, with Kellgren-Lawrence 3rd degree, and with joint narrowing space and subchondral cyst, and moderate-severe pain on the knee. After a two series of ozone therapy (20 cc of a mixture of OxygenOzone 95-5%, at 20 ug concentration, 4 weekly sessions) separated by six months, the recovering of the joint space and of the subchondral cyst and a decrease in pain is been observed (Figures 1-3). This case report and many years of experience demonstrate that Ozone is capable of diminishing pain and inflammation. Ozone acts on the repair of articular cartilage and subchondral bone, because it increases vascularisation of the articular cartilage [2].

The level of development of nursing assistants’ value system predicts their views on paternalistic care and personal autonomy

The quality of care is substantially influenced by the staff‘s value priorities. The purpose of this study was to identify and characterize value systems among nursing assistants and nurses’ aides, and to assess relations between their value systems and views on good care. A cross-sectional, quantitative study in a Swedish municipality was performed (N=226). Three distinct value systems were identified, and they corresponded to early (n=121), middle (n=88), and late (n=17) conventional stages ofego development. Early conventional value systems emphasized strict rules, routines and working conditions of staff, while middle and, in particularly, late conventional value systems stressed individualization and autonomy of older people. Assessment of value system, socio-demographic, and occupational variables showed that the value systems had a stronger predictive impact on views on care ethics, participation, and autonomy. The results indicate that staff with late conventional value systems prioritized older persons’ exercise of autonomy, while paternalism held priority in staff with early conventional value systems.

Coexisting principles and logics of elder care: Help to self‐help and consumer‐oriented service?

Healthy and active ageing has become an ideal in Western societies. In the Nordic countries, this ideal has been supported through a policy of help to self‐help in elder care since the 1980s. However, reforms inspired by New Public Management (NPM) have introduced a new policy principle of consumer‐oriented service that stresses the wishes and priorities of older people. We have studied how these two principles are applied by care workers in Denmark. Is one principle or logic replacing the other, or do they coexist? Do they create tensions between professional knowledge and the autonomy of older people? Using neo‐institutional theory and feminist care theory, we analysed the articulation of the two policy principles in interviews and their logics in observations in four local authorities. We conclude that help to self‐help is the dominant principle, that it is deeply entrenched in the identity of the professional care worker and that it coexists with consumer‐oriented service and without major tensions in the logics identified in their practices.

Exercise and nutritional supplements; effects of combined use in people over 65 years; a systematic review

To systematically review the evidence in the scientific literature about the influence and effects of nutritional supplements on muscle mass and strength when combined with exercise training in healthy elderly. Cross-sectional descriptive study. Was selected scientific literature databases: MEDLINE, EMBASE, ISI, CINAHL, Cochrane and LILACS Given an inclusion criterion only randomized clinical trials (RCT) and excluding documents not based their study in healthy elderly and did not implement a training program. Of the 8 articles selected for the review, some studies supplement combined with various forms of training and other supplements with different training resistance. The supplements were administered: Protein supplementation (drinkable), Creatine, Vitamin D and calcium. The resistance training was assigned with: weights, elastic bands, machines, balance, guidance exercises and aerobic exercise. - Combine exercise supplementation, regardless reinforces the effects each can have on improving strength, balance and speed. - The improvement of the musculoskeletal system enhances mobility, contributing to the prevention of Sarcopenia and prolongation of the independence and autonomy of older people. - The use of supplements should be subject to an analysis of daily nutritional intake, individual energy demands and the choice of a physical endurance exercise practiced and extended in time, to preserve the benefits.

Autonomy for older people in residential care: a selective literature review

Autonomy is an important concept because it brings dignity to peoples' lives, regardless of physical circumstances. The United Nations (UN) Madrid International Plan of Action on Ageing emphasises the need to include older adults in autonomous decision-making processes. However, many older people living in residential care find that their autonomy is curtailed. This is largely because autonomy for older people is poorly understood, and hence, nurses working with older people need to become clear about what autonomy is and how it can be facilitated. In this, the first of three papers, the literature is reviewed specifically to establish the meaning of autonomy for older people in residential care as opposed to autonomy in a wider context. This important distinction may help nurses working with older people to begin to facilitate autonomy more effectively.

CAALYX: a new generation of location-based services in healthcare

Recent advances in mobile positioning systems and telecommunications are providing the technology needed for the development of location-aware tele-care applications. This paper introduces CAALYX – Complete Ambient Assisted Living Experiment, an EU-funded project that aims at increasing older people's autonomy and self-confidence by developing a wearable light device capable of measuring specific vital signs of the elderly, detecting falls and location, and communicating automatically in real-time with his/her care provider in case of an emergency, wherever the older person happens to be, at home or outside.

The meanings older people give to their rehabilitation experience

Promoting older people's ability to manage at home is important both for themselves and for society, but few studies have explored whether geriatric rehabilitation actually meets the needs of this heterogeneous group. The purpose of this study was to investigate the meanings that older adults attribute to their geriatric rehabilitation experiences. A group of 27 older adults in inpatient rehabilitation were interviewed during the programme and after returning home. Semi-structured interviews were analysed using a qualitative method, which identified three categories of meaning. In the category ‘sense of confidence with everyday life’, rehabilitation was perceived as facilitating everyday living at home; in the category ‘sense of vacation’, rehabilitation was seen as a means of getting away from normal life and enjoying oneself; and in the category ‘sense of disappointment in the rehabilitation programme’, the participants expressed frustration with the limited opportunities to participate in the planning of their rehabilitation, and with the mismatch between the offered programme and what was needed. To promote older people's autonomy and to enhance their ability to live at home, professionals must involve their clients to a greater extent in the planning of the rehabilitation than is currently the case, and also individualise the rehabilitation regimen.

Malnutrition in our hospitals

This months issue of Nursing &amp; Residential Care focuses on the need to respect the dignity and autonomy of older people.