Table 2.
Summary of the selected studies.
| Author(s), country | Aim | Method, data and care facility | Concept(s) | Main results | Quality score |
|---|---|---|---|---|---|
| Ryden,20 United States | To delineate characteristics of residents’ interpersonal, organisational and physical aspects of autonomy | Semi-structured questionnaire for older people (n = 113), professionals (n = 137) and managers (n = 10) | Autonomy | Older people had the least control with regard to the everyday issues of grooming and eating in the facility. | 5/6 |
| Saup,21 Country not stated | To examine how older people experienced lack of autonomy and stress and how they coped with them | Survey of older people (n = 35) | Autonomy | Older people’s coping strategies for stress varied in relation to how the facility emphasised personal autonomy. | 5/6 |
| Grow Kasser and Ryan,22 United States | To examine how personal autonomy and social support were correlated | Survey of older people (n = 50) | Autonomy, Self-determination | Autonomous self-regulation was positively correlated with subjective health. Social support correlated positively with autonomy. | 6/6 |
| Barkay and Tabak,23 Israel | To describe autonomy and participation experienced by older people in institutions | Survey of older people (n = 39) | Autonomy | Older peoples’ autonomy positively influenced social functioning and satisfaction with life. | 6/6 |
| Scott et al.,24 United Kingdom | To examine older people’s views about autonomy, privacy and informed consent | Survey design with structured interviews with older people (n = 101) Self-completed questionnaire for professionals (n = 160) |
Autonomy | Only 15% of older people reported that professionals had always given them information during some treatment procedures. Older people who were more educated received more often information from professionals than others. According to the older people, professionals did not provide them with opportunities to make decisions about pain relief methods. | 5/6 |
| Scott et al.,25 Finland, Germany, Greece, Spain, United Kingdom | To examine autonomy in healthcare institutions in European countries | Survey design with structured interviews with older people (n = 573) Self-completion questionnaire for professionals (n = 887) |
Autonomy | Opportunities to make decisions varied from country to country. They were highest in Spain and lowest in Germany. | 2/6 |
| Boyle,26 Ireland | To explore older people’s experience about whether they had choice and control over the support they received | Structured surveys (n = 214) and interviews (n = 45) with older people | Autonomy | Older people in institutions had greater autonomy to make decisions than people cared for in their own homes. | 5/6 |
| Boyle,27 United Kingdom | To examine the extent of depression and mental health among older people in long-term care | Structured interviews with residents in an institution (n = 214) and older people receiving care in their own homes (n = 44) | Autonomy | Older people in institutions seemed to have higher perceived opportunities for their own choices than people who received care in their own homes. Older people with poor mental health perceived fewer choices. | 5/6 |
| Hwang et al.,28 Taiwan | To explore factors related to older people’s autonomy | Questionnaires for people living in a home for senior citizens (n = 121) | Autonomy | Older people’s autonomy was affected by social support, functional abilities, attitudes and their educational level. | 5/6 |
| Sikorska-Simmons,29 United States | To explore how organisational policies affected residents’ perceptions of autonomy in assisted living | Questionnaires for residents in facilities (n = 412) | Autonomy | Choice-enhancing policies improved older people’s experience of autonomy in assisted living facilities. | 6/6 |
| Andersson et al.,30 Sweden | To describe older people’s experiences of daily life in a care home | Interviews with residents (n = 13), relatives (n = 10) and contact persons (n = 11) | Self-determination | Older people felt that their self-determination was unsatisfactory in care homes. | 5/6 |
| Boisaubin et al.,31 United States | To explore perceptions of autonomy, dignity, quality of care and decision-making | Pilot study with semi-structured interviews with older people in long-term care (n = 4), family members (n = 10) and healthcare professionals (n = 9) | Autonomy | Older people felt that they should keep their authority and responsibility for decision-making as long as possible. When they were no longer capable, then relatives should make decisions for them. | 4/6 |
| Hellström and Sarvimäki,32 Sweden | To describe how older people in sheltered housing experienced self-determination | Interviews with residents (n = 11) | Self-determination | Older people had negative experiences about how their self-determination was acknowledged in the facility and how the environment did not support their self-determination. | 5/6 |
| Chan and Pang,33 China (Hong Kong) | To examine perceptions about individual dignity and autonomy, quality of care and financing of long-term care | In-depth semi-structured interviews with older people (n = 6), family members (n = 10), administrators (n = 6) and healthcare professionals (n = 7) | Autonomy | Older people were unanimous, that they should be allowed to make final decisions. They were concerned about whether their wishes and needs were taken into account. Older people’s decisions were often compromised by relatives’ opinions. | 5/6 |
| Zhai and Qiu,34 China | To study perceptions about long-term care for older people | Descriptive interviews with older people (n = 6), relatives (n = 10), assistant nurses (n = 4), physicians (n = 3) and managers (n = 3) | Autonomy | Older people felt that their autonomy should be respected, but this did not mean that the older person was the only decision-maker. | 3/6 |
| Andresen et al.,35 Denmark | To evaluate individually tailored programmes on autonomy for institutionalised older people | Blinded randomised trial for older people (n = 50) | Autonomy | Individualised support can enable institutionalised older people’s autonomy. | 5/5 |
| Hawkins et al.,36 United Kingdom | To examine how healthcare workers supported residents’ autonomy by enabling their independence | Ethnographic approach, with qualitative observations, semi-structured interviews (14 staff members and 8 older residents), documentary analysis | Autonomy | Older people’s autonomy was supported by enabling independence. However, conflicts between the staff’s duty to care and support autonomy was acknowledged. | 6/6 |
| Nakrem et al.,37 Norway | To describe residents’ experiences of their nursing home and the quality of care they received | Descriptive, exploratory design, in-depth interviews with older people (n = 15) | Self-determination | Older people recognised it was challenging to balance self-determination and dependency. Feelings of indignity and depreciation of social status were reported. | 6/6 |
| Custers et al.,38 Netherlands | To examine older people’s experiences of relatedness, autonomy and competence in the caring relationship. The social nature of human beings and how they connect | Questionnaire (n = 75) and semi-structured interviews with older people (n = 35) | Autonomy, self-determination | Relatedness was perceived to be more important than autonomy and competence. Subjective health and cognitive functioning were correlated with relatedness, autonomy and competence. | 5/6 |
| Candela et al.,39 Italy | To identify the links between autonomy and daily living activities in institutionalised older people | Survey of older people (n = 40) | Autonomy | Older people seemed to have sufficient cognitive abilities to maintain their autonomy. Older people who had low levels of perception of their physical functioning had low levels of autonomy. | 5/6 |
| Riedl et al.,40 Austria | To examine what nursing home residents needed when they moved to nursing homes | Interviews with older people (n = 20) | Self-determination | Older people said that decisions were taken away from them and that they needed to fight for their independence. | 5/6 |
| Wulff et al.,41 Germany | To investigate perceived autonomy of nursing home residents | Survey of older people (n = 560) | Autonomy | Older people chose when they wanted to be active in decision-making and when they preferred to leave the decisions for others. Their health status restricted their opportunities for autonomous decisions. | 5/6 |
| Cobo,42 Spain | To examine the influence of institutionalisation on autonomy and quality of life | Quasi-experimental and longitudinal survey of older people (n = 104), lasting 20 months | Autonomy | The relationship between older people’s autonomy and independence was identified and both factors deteriorated due to institutionalisation. | 5/6 |
| Ferrand et al.,43 France | To examine older people’s psychological satisfaction and the relationship between that and well-being | Survey of older people (n = 100) | Self-determination | Older people’s autonomy was linked to their satisfaction with their need for relatedness and their purpose in life. Autonomy and satisfaction with their need for relatedness were identified as indicators of well-being. | 5/6 |
| Hillcoat-Nallétamby,44 United Kingdom | To examine older people’s understanding of independence and autonomy in a residential setting | Interviews with older people (n = 91) | Autonomy | Older people linked independence to accepting help and doing things alone. Delegated, executional, authentic, decisional and client autonomy were identified. | 6/6 |
| Taverna et al.,45 United States | To examine the effect of autonomy on residents’ oral hygiene | Mixed-method approach, with individual structured interviews and open ended and Likert-type scale questions for older people (n = 12) and professionals (n = 7) | Autonomy | Older people’s autonomy was used to resist professional assistants taking charge of their oral hygiene. | 4/5 |
| Wikström and Emilsson,46 Sweden | To explore opportunities for autonomy in institution-based housing | Focus group interviews (n = 50), observations on residents (n = 17), family members (n = 10), staff (n = 12) and managers (n = 11) | Autonomy | Older people’s ability to maintain control over their lives was influenced by ambivalent missions, symbolic power and professionals’ ageist approaches. | 5/6 |
| Chang,47 Taiwan | To examine how self-determination and social support with regard to leisure activities were related to stress | Face-to-face surveys for nursing home residents (n = 141) and older people supported in their own homes (n = 322) | Self-determination | Older peoples’ self-determination and social support with regard to leisure choices were negatively linked with stress. | 5/6 |
| Ayalon,48 Israel | To address older adults’ experiences of the transition to continuing care in a retirement community | Interviews with older people (n = 32) and their relatives (n = 19), older people and adult children dyads (n = 34) | Autonomy | Older people’s autonomy was demonstrated by their ability to exercise independent decisions and a degree of capacity. | 5/6 |
| Bollig et al.,49 Norway | To study how residents and their relatives perceived ethical challenges in nursing homes | In-depth interviews with older people (n = 25), focus groups with relatives (n = 18) | Autonomy. self-determination | Older people’s experiences of autonomy varied between individuals. Some older people felt that they could make their own decisions, while others felt that they did have not much to decide. | 6/6 |
| Donnelly and MacEntee,50 Canada | To explore how residents adapted to care and felt about it | Observations and interviews with older people (n = 23) | Autonomy | Older people reported violations of their autonomy and identified poor care practices that threatened their dignity. | 5/6 |
| Gjerberg et al.,51 Norway | To explore coercion in a nursing home from the point of view of older patients and their family members | Individual interviews with older people (n = 35) and focus groups for relatives (n = 60) | Autonomy | Half of the respondents accepted the use of coercion and believed that the professionals acted in the best interest of the patient. | 4/6 |
| Nord,52 Sweden | To examine free choice among older people in residential care | Interviews with older people (n = 13) | Self-determination | Older people’s networks made their choices possible. Older people had high autonomy levels about decisions to move in residential care. | 4/6 |
| Souesme et al.,53 France | To examine older people’s perceptions of support for autonomy and depressive symptoms | Surveys of older people (n = 100) | Autonomy, Self-determination | Low social support for autonomy correlated with depressive symptoms and apathy. | 5/6 |
| Tuominen et al.,54 Finland | To describe older people’s experiences of free will in nursing homes | Interviews with older people (n = 15) | Free will | Older people saw free will as the opportunity to make their own decisions and maintain their rights. Free will was focused on daily activities. Barriers to free will were their dependency on care, other residents, professionals and institutional rules. | 6/6 |
| Walker and Paliadelis,55 Australia | To investigate older people’s experiences of living in residential care | In-depth interviews with older people (n = 18) | Autonomy | Older people were excluded from decision-making and this meant that they found it difficult to uphold their autonomy. | 5/6 |
| Bennett et al.,56 United States | To explore how having visitors affected residents’ autonomy in assisted living | Ethnographic study with observations and informal, in-depth and open-ended interviews with older people (n = 68), relatives (n = 47), professionals (n = 65) and managers (n = 18) | Autonomy | Older people struggled to maintain their former social networks. The facility’s rules and restrictions made social visits complicated and their visitors were mainly family members. | 5/6 |
| Cho et al.,57 South Korea | To explore older people’s perceptions of their daily lives in nursing homes | Semi-structured individual interviews with older people (n = 21) | Autonomy | Older people experienced limited autonomy, which was linked to quality of life and homelike environments. | 5/6 |
| Paque et al.,58 Belgium | To examine nursing home residents’ autonomy, social functioning and social environment | Structured questionnaire for older people (n = 391) | Autonomy | Older people had more autonomy when they were able to perform daily living activities independently, than those who had limited capacity and struggled without assistance. Older people with depressive feelings also had limited autonomy. | 5/6 |
| Caspari et al.,59 Denmark, Sweden and Norway | To examine older people’s experiences of freedom in nursing homes | Interviews with older people (n = 28) in Denmark, Sweden and Norway | Freedom | Older people emphasised the importance of their autonomy and having their dignity acknowledged. However, older people felt that their care dependence and the paternalistic attitude displayed by professionals were barriers to their freedom. | 6/6 |
| Chang,60 Taiwan | To examine the effects of self-determination and social support with regard to leisure on stress | Face-to-face survey of older people (n = 139) | Self-determination | Being able to choose leisure activities was negatively correlated with stress. | 6/6 |
| Lin and Yen,61 Taiwan | To assess the relationship between leisure activities and adjustment to residential care | Survey of older people in long-term care (n = 136) | Autonomy | Taking part in leisure activities helped older people to gain autonomy and control how they adjusted to residential care. | 6/6 |
| Tufford et al.,62 Canada, Germany, Norway and United Kingdom | To examine locked door practices and how they were justified in long-term care facilities | Observations of, and interviews with, older people, relatives and professionals (n = 285) | Autonomy | Older people’s ability to move within and outside facilities depended on the locked door practices and accessibility. Lock doors could also provide security for older people. | 4/6 |
| Buckinx et al.,63 Belgium | To evaluate isometric strength levels on autonomy among nursing home residents | Survey of older people (n = 662) | Autonomy | Being unable to use knee and ankle extensors independently predicted loss of autonomy. | 5/6 |
| Kloos et al.,64 Netherlands | To examine relationships between subjective well-being and satisfaction with autonomy, relatedness and competence | Questionnaire for older people (n = 128) | Self-determination | Older people’s autonomy was associated with life satisfaction and loss of autonomy was associated with depressive feelings. | 6/6 |
| Schenell et al.,65 Sweden | To examine perceptions of quality of care and self-determination | Cross-sectional study with questionnaire for older people (n = 112) and relatives (n = 83) | Self-determination | Older people wanted to keep their decision-making power for themselves and seldom wanted to hand it over to relatives or professionals. | 6/6 |