Striving for purposeful autonomy: a qualitative method to enhance autonomy measurement in older adults

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BACKGROUND: The global aging population faces challenges in preserving autonomy because of chronic disease and frailty, affecting quality of life and health outcomes. Current autonomy assessments focus on functional aspects but fail to capture the broader concept of autonomy in older adults, showing limited sensitivity in individuals with severe loss of autonomy. This study aimed to redefine autonomy among older adults, providing a foundation for future comprehensive assessment tools in geriatrics. METHODS: This qualitative study was conducted at a university hospital in Paris from June 2023 to February 2024. A focus group of geriatric healthcare professionals discussed autonomy assessment, with analysis by grounded theory. Four individual interviews with older patients and family caregivers were conducted at home, with analysis by interpretative phenomenological analysis. The integration of these perspectives led to comprehensive models for understanding and assessing autonomy loss in older adults. RESULTS: Healthcare professionals reported that the Katz ADL scale was insufficient for assessing autonomy in older adults and emphasized the need for more comprehensive tools. Patients and caregivers highlighted that autonomy was often preserved through compensatory strategies until external assistance became necessary, leading to diminished decision-making capacity and eventual institutionalization. The process of autonomy loss involved a decline in functional abilities, changes in self-perception and personality traits, and a redefinition of life purpose, all of which further exacerbated autonomy reduction. Caregivers were also identified as key experts in understanding the older adult's condition. CONCLUSIONS: To effectively assess autonomy in older adults, the focus must be on life goals and insights from caregivers. Our future tool may address this gap in clinical practice by capturing these essential aspects, ultimately enhancing quality of life in older adults.

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