An Exploration of Autonomy and Independence among Community Dwelling People Aged 85 and Over

Abstract

IntroductionThe number of people aged over 65 in Westernised countries is increasing year by year and the population of those over 85 years is growing even more rapidly (Ministry of Social Development, 2015). Statements from governments concerning this have included affirmations that older adults are an esteemed and valuable resource for our communities along with exhortations to those older adults to optimise their health and to continue to contribute to society (Office for Senior Citizens, 2014 ; United Nations, 2002). This optimistic approach is opposed by more negative cultural strands in Western society which focus on the losses of old age, and see the ageing population as an economic threat. The pervasive negativity may be internalised by older adults. Research has found that older people are sometimes still the subject of abuse and neglect, and that these situations develop from negative beliefs and attitudes about older people (Breitholtz, Snellman, & Fagerberg, 2013; Dwyer, Gray, & Renwick, 2000). The ability to be autonomous and independent is a significant factor in how adults negotiate the challenges of old age. A qualitative research project was therefore conducted in New Zealand in 2015 to investigate the meaning of autonomy and independence among a small group of older adults.BackgroundAutonomy literally means 'self-rule' (Welford, Murphy, Rodgers, & Frauenlob, 2012) and is a commonly cherished value in Western societies today (Agich, 2003). In health care literature, the concepts of autonomy and independence are frequently found together or used interchangeably and their definitions tend to vary according to the discipline in question (Agich, 2003; Sandman, 2005). One useful conceptualisation of independence is presented as one of four aspects of autonomy in which a person has the capacity to act on the decisions they have made (Sandman, 2005). The other three aspects of autonomy are self-determination where a person acts according to their own choices, freedom which refers to the realistic alternatives a person has, and desire fulfilment which means that the person obtains what they really want.Studies investigating the opinions of older adults about their independence and decision-making have shown that it is highly important to older adults to maintain independence and control in their lives (Doyle, 2010; Haak, Fange, Iwarsson, & Ivanoff, 2007; White & Groves, 1997). A determination to stay out of residential care is supported by strenuous efforts to do everything necessary to keep their independence (Heathcote, 2000; Wiles, Leibing, Guberman, Reeve, & Allen, 2012). For example, Haak et al. (2007) interviewed independent people in their 80s who lived at home, and expressions of determination included forcing themselves to be as independent as possible, because they believed independence equated with a life worth living.Strategies used by older adults for achieving the goal of maintaining independence may include relinquishing less important activities due to a reduction in function (Mallers, Claver, & Lares, 2014). When help at home is needed, researchers have found that if older adults have control over how the help is received then dependence on others is acceptable to them (Haak et al., 2007; White & Groves, 1997). A lack of control results in disempowerment and one Australian study described an exacting home help service that exerted control over the clients' living space, daily timetable, relationships and pets to the point where one client described herself as a 'stressed outsider' in her own home (Doyle 2014).On a government level in New Zealand, a response to the growing population of older adults was to commission research in 1999 investigating the factors that enabled older adults to maintain their independence (Dwyer et al., 2000). The report by Dwyer et al. (2000) revealed that experiences and choices throughout the person's lifespan have a significant impact on how they will manage the challenges of old age. …