Skip to main content
Top
Published in: BMC Geriatrics 1/2014

Open Access 01-12-2014 | Research article

Shifting between self-governing and being governed: a qualitative study of older persons’ self-determination

Authors: Isabelle Ottenvall Hammar, Synneve Dahlin-Ivanoff, Katarina Wilhelmson, Kajsa Eklund

Published in: BMC Geriatrics | Issue 1/2014

Login to get access

Abstract

Background

Older persons’ right to exercise self-determination in daily life is supported by several laws. Research shows that older persons’ self-determination is not fully respected within the healthcare sector. In order to enable and enhance older persons’ self-determination, extensive knowledge of older persons’ self-determination is needed. The aim of this study was to explore experiences of self-determination when developing dependence in daily activities among community-dwelling persons 80 years and older.

Methods

Qualitative interviews were performed in accordance with a grounded theory method, with 11 persons aged 84–95 years who were beginning to develop dependence in daily activities.

Results

The data analysis revealed the core category, “Self-determination - shifting between self-governing and being governed”. The core category comprised three categories: “Struggling against the aging body”, “Decision-making is relational”, and “Guarding one’s own independence”. Self-determination in daily activities was related to a shifting, which was two-fold, and varied between self-governing and being governed by the aging body, or by others.

Conclusions

The findings imply a need to adopt a person-centered approach where the older persons’ own preferences and needs are in focus, in order to enhance their possibilities to exercise self-determination.
Appendix
Available only for authorised users
Literature
5.
go back to reference Suhonen R, Valimaki M, Katajisto J: Developing and testing an instrument for the measurement of individual care. J Adv Nurs. 2000, 32: 1253-1263. 10.1046/j.1365-2648.2000.01596.x.CrossRefPubMed Suhonen R, Valimaki M, Katajisto J: Developing and testing an instrument for the measurement of individual care. J Adv Nurs. 2000, 32: 1253-1263. 10.1046/j.1365-2648.2000.01596.x.CrossRefPubMed
6.
go back to reference Morgan S, Yoder LH: A concept analysis of person-centered care. J Holist Nurs. 2012, 30: 6-15. 10.1177/0898010111412189.CrossRefPubMed Morgan S, Yoder LH: A concept analysis of person-centered care. J Holist Nurs. 2012, 30: 6-15. 10.1177/0898010111412189.CrossRefPubMed
7.
go back to reference Ekman I, Swedberg K, Taft C, Lindseth A, Norberg A, Brink E, Carlsson J, Dahlin-Ivanoff S, Johansson IL, Kjellgren K, Liden E, Ohlen J, Olsson LE, Rosen H, Rydmark M, Sunnerhagen KS: Person-centered care–ready for prime time. Eur J Cardiovasc Nurs. 2011, 10: 248-251. 10.1016/j.ejcnurse.2011.06.008.CrossRefPubMed Ekman I, Swedberg K, Taft C, Lindseth A, Norberg A, Brink E, Carlsson J, Dahlin-Ivanoff S, Johansson IL, Kjellgren K, Liden E, Ohlen J, Olsson LE, Rosen H, Rydmark M, Sunnerhagen KS: Person-centered care–ready for prime time. Eur J Cardiovasc Nurs. 2011, 10: 248-251. 10.1016/j.ejcnurse.2011.06.008.CrossRefPubMed
8.
go back to reference Flick U, Fischer C, Neuber A, Schwartz FW, Walter U: Health in the context of growing old: social representations of health. J Health Psychol. 2003, 8: 539-556. 10.1177/13591053030085006.CrossRefPubMed Flick U, Fischer C, Neuber A, Schwartz FW, Walter U: Health in the context of growing old: social representations of health. J Health Psychol. 2003, 8: 539-556. 10.1177/13591053030085006.CrossRefPubMed
9.
go back to reference Ekdahl A, Andersson L, Wirehn A-B, Friedrichsen M: Are elderly people with co-morbidities involved adequately in medical decision making when hospitalised? A cross-sectional survey. BMC Geriatr. 2011, 11: 46-54. 10.1186/1471-2318-11-46.CrossRefPubMedPubMedCentral Ekdahl A, Andersson L, Wirehn A-B, Friedrichsen M: Are elderly people with co-morbidities involved adequately in medical decision making when hospitalised? A cross-sectional survey. BMC Geriatr. 2011, 11: 46-54. 10.1186/1471-2318-11-46.CrossRefPubMedPubMedCentral
10.
go back to reference Teeri S, Leino-Kilpi H, Valimaki M: Long-term nursing care of elderly people: identifying ethically problematic experiences among patients, relatives and nurses in Finland. Nurs Ethics. 2006, 13: 116-129. 10.1191/0969733006ne830oa.CrossRefPubMed Teeri S, Leino-Kilpi H, Valimaki M: Long-term nursing care of elderly people: identifying ethically problematic experiences among patients, relatives and nurses in Finland. Nurs Ethics. 2006, 13: 116-129. 10.1191/0969733006ne830oa.CrossRefPubMed
11.
go back to reference Janlöv AC, Hallberg IR, Petersson K: Older persons’ experience of being assessed for and receiving public home help: do they have any influence over it?. Health Soc Care Community. 2006, 14: 26-36. 10.1111/j.1365-2524.2005.00594.x.CrossRefPubMed Janlöv AC, Hallberg IR, Petersson K: Older persons’ experience of being assessed for and receiving public home help: do they have any influence over it?. Health Soc Care Community. 2006, 14: 26-36. 10.1111/j.1365-2524.2005.00594.x.CrossRefPubMed
12.
go back to reference Boyle G: Facilitating choice and control for older people in long-term care. Health Soc Care Community. 2004, 12: 212-220. 10.1111/j.1365-2524.2004.00490.x.CrossRefPubMed Boyle G: Facilitating choice and control for older people in long-term care. Health Soc Care Community. 2004, 12: 212-220. 10.1111/j.1365-2524.2004.00490.x.CrossRefPubMed
13.
go back to reference English V, British Medical Association: Medical Ethics Today: The BMA’ s Handbook of Ethics and Law. 2004, London: BMJ Books, 2 English V, British Medical Association: Medical Ethics Today: The BMA’ s Handbook of Ethics and Law. 2004, London: BMJ Books, 2
14.
go back to reference Elander G, Hermeren G: Autonomy and paternalistic behaviour in care. Scand J Caring Sci. 1989, 3: 153-159. 10.1111/j.1471-6712.1989.tb00286.x.CrossRefPubMed Elander G, Hermeren G: Autonomy and paternalistic behaviour in care. Scand J Caring Sci. 1989, 3: 153-159. 10.1111/j.1471-6712.1989.tb00286.x.CrossRefPubMed
15.
go back to reference Rynning E: Consent to Medical Care and Treatment: A Legal Study. PhD Thesis. 1994, Uppsala: Uppsala University Rynning E: Consent to Medical Care and Treatment: A Legal Study. PhD Thesis. 1994, Uppsala: Uppsala University
16.
go back to reference Ekelund C, Dahlin-Ivanoff S, Eklund K: Self-determination among older people - a concept analysis. Scand J Occup Ther. 2014, 21: 116-124. 10.3109/11038128.2013.853832.CrossRefPubMed Ekelund C, Dahlin-Ivanoff S, Eklund K: Self-determination among older people - a concept analysis. Scand J Occup Ther. 2014, 21: 116-124. 10.3109/11038128.2013.853832.CrossRefPubMed
17.
go back to reference Andersson I, Pettersson E, Sidenvall B: Daily life after moving into a care home-experiences from older people, relatives and contact persons. J Clin Nurs. 2007, 16: 1712-1718. 10.1111/j.1365-2702.2007.01703.x.CrossRefPubMed Andersson I, Pettersson E, Sidenvall B: Daily life after moving into a care home-experiences from older people, relatives and contact persons. J Clin Nurs. 2007, 16: 1712-1718. 10.1111/j.1365-2702.2007.01703.x.CrossRefPubMed
18.
go back to reference Eisemann M, Eriksson M, Molloy DW, Nordenstam M, Richter J: Attitudes towards self-determination in health care - a general population survey in northern Sweden. Eur J Publ Health. 1999, 9: 41-44. 10.1093/eurpub/9.1.41.CrossRef Eisemann M, Eriksson M, Molloy DW, Nordenstam M, Richter J: Attitudes towards self-determination in health care - a general population survey in northern Sweden. Eur J Publ Health. 1999, 9: 41-44. 10.1093/eurpub/9.1.41.CrossRef
19.
go back to reference Levasseur M, St-Cyr Tribble D, Desrosiers J: Meaning of quality of life for older adults: importance of human functioning components. Arch Gerontol Geriatr. 2009, 49: 91-100. 10.1016/j.archger.2008.08.013.CrossRef Levasseur M, St-Cyr Tribble D, Desrosiers J: Meaning of quality of life for older adults: importance of human functioning components. Arch Gerontol Geriatr. 2009, 49: 91-100. 10.1016/j.archger.2008.08.013.CrossRef
20.
go back to reference Breitholtz A, Snellman I, Fagerberg I: Older people’s dependence on caregivers’ help in their own homes and their lived experiences of their opportunity to make independent decisions. Int J Older People Nurs. 2013, 8: 139-148. 10.1111/j.1748-3743.2012.00338.x.CrossRefPubMed Breitholtz A, Snellman I, Fagerberg I: Older people’s dependence on caregivers’ help in their own homes and their lived experiences of their opportunity to make independent decisions. Int J Older People Nurs. 2013, 8: 139-148. 10.1111/j.1748-3743.2012.00338.x.CrossRefPubMed
21.
go back to reference Hellström UW, Sarvimaki A: Experiences of self-determination by older persons living in sheltered housing. Nurs Ethics. 2007, 14: 413-424. 10.1177/0969733007075888.CrossRefPubMed Hellström UW, Sarvimaki A: Experiences of self-determination by older persons living in sheltered housing. Nurs Ethics. 2007, 14: 413-424. 10.1177/0969733007075888.CrossRefPubMed
22.
go back to reference Holstein BE, Due P, Almind G, Avlund K: Eight-year change in functional ability among 70- to 95-year-olds. Scand J Public Health. 2007, 35: 243-249. 10.1080/14034940601072372.CrossRefPubMed Holstein BE, Due P, Almind G, Avlund K: Eight-year change in functional ability among 70- to 95-year-olds. Scand J Public Health. 2007, 35: 243-249. 10.1080/14034940601072372.CrossRefPubMed
23.
go back to reference Reuben DB: Warning signs along the road to functional dependency. Ann Intern Med. 1998, 128: 138-139. 10.7326/0003-4819-128-2-199801150-00010.CrossRefPubMed Reuben DB: Warning signs along the road to functional dependency. Ann Intern Med. 1998, 128: 138-139. 10.7326/0003-4819-128-2-199801150-00010.CrossRefPubMed
24.
go back to reference Avlund K, Damsgaard MT, Sakari-Rantala R, Laukkanen P, Schroll M: Tiredness in daily activities among nondisabled old people as determinant of onset of disability. J Clin Epidemiol. 2002, 55: 965-973. 10.1016/S0895-4356(02)00463-8.CrossRefPubMed Avlund K, Damsgaard MT, Sakari-Rantala R, Laukkanen P, Schroll M: Tiredness in daily activities among nondisabled old people as determinant of onset of disability. J Clin Epidemiol. 2002, 55: 965-973. 10.1016/S0895-4356(02)00463-8.CrossRefPubMed
25.
go back to reference Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB, Walston JD: Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc. 2004, 52: 625-634. 10.1111/j.1532-5415.2004.52174.x.CrossRefPubMed Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB, Walston JD: Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc. 2004, 52: 625-634. 10.1111/j.1532-5415.2004.52174.x.CrossRefPubMed
26.
go back to reference Gill TM, Gahbauer EA, Allore HG, Han L: Transitions between frailty states among community-living older persons. Arch Intern Med. 2006, 166: 418-423. 10.1001/archinte.166.4.418.CrossRefPubMed Gill TM, Gahbauer EA, Allore HG, Han L: Transitions between frailty states among community-living older persons. Arch Intern Med. 2006, 166: 418-423. 10.1001/archinte.166.4.418.CrossRefPubMed
27.
go back to reference Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G: Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004, 59: 255-263. 10.1093/gerona/59.3.M255.CrossRefPubMed Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G: Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004, 59: 255-263. 10.1093/gerona/59.3.M255.CrossRefPubMed
28.
go back to reference Ekelund C, Mårtensson L, Ekelund K: Self-determination among frail older persons – a desirable goal older persons’ conceptions of self-determination. Qual Ageing. 2014, 15: 90-101. 10.1108/QAOA-06-2013-0015.CrossRef Ekelund C, Mårtensson L, Ekelund K: Self-determination among frail older persons – a desirable goal older persons’ conceptions of self-determination. Qual Ageing. 2014, 15: 90-101. 10.1108/QAOA-06-2013-0015.CrossRef
29.
go back to reference Charmaz K: Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. 2006, London: SAGE Charmaz K: Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. 2006, London: SAGE
30.
go back to reference Glaser BG, Strauss AL: The Discovery of Grounded Theory: Strategies for Qualitative Research. 1967, New York: Aldine de Gruyter Glaser BG, Strauss AL: The Discovery of Grounded Theory: Strategies for Qualitative Research. 1967, New York: Aldine de Gruyter
31.
go back to reference Strauss AL, Corbin J: Basics of Qualitative Research: Grounded Theory Procedures and Techniques. 1990, Newbury Park, Calif: Sage Strauss AL, Corbin J: Basics of Qualitative Research: Grounded Theory Procedures and Techniques. 1990, Newbury Park, Calif: Sage
32.
go back to reference Dahlin-Ivanoff S, Gosman-Hedstrom G, Edberg AK, Wilhelmson K, Eklund K, Duner A, Ziden L, Welmer AK, Landahl S: Elderly persons in the risk zone. Design of a multidimensional, health-promoting, randomised three-armed controlled trial for “prefrail” people of 80+ years living at home. BMC Geriatr. 2010, 10: 27-10.1186/1471-2318-10-27.CrossRefPubMedPubMedCentral Dahlin-Ivanoff S, Gosman-Hedstrom G, Edberg AK, Wilhelmson K, Eklund K, Duner A, Ziden L, Welmer AK, Landahl S: Elderly persons in the risk zone. Design of a multidimensional, health-promoting, randomised three-armed controlled trial for “prefrail” people of 80+ years living at home. BMC Geriatr. 2010, 10: 27-10.1186/1471-2318-10-27.CrossRefPubMedPubMedCentral
33.
go back to reference Sonn U, Åsberg KH: Assessment of activities of daily living in the elderly. A study of a population of 76-year-olds in Gothenburg, Sweden. Scand J Rehabil Med. 1991, 23: 193-202.PubMed Sonn U, Åsberg KH: Assessment of activities of daily living in the elderly. A study of a population of 76-year-olds in Gothenburg, Sweden. Scand J Rehabil Med. 1991, 23: 193-202.PubMed
34.
go back to reference Sonn U, Grimby G, Svanborg A: Activities of daily living studied longitudinally between 70 and 76 years of age. Disabil Rehabil. 1996, 18: 91-100. 10.3109/09638289609166023.CrossRefPubMed Sonn U, Grimby G, Svanborg A: Activities of daily living studied longitudinally between 70 and 76 years of age. Disabil Rehabil. 1996, 18: 91-100. 10.3109/09638289609166023.CrossRefPubMed
35.
go back to reference Haak M, Fange A, Iwarsson S, Ivanoff SD: Home as a signification of independence and autonomy: experiences among very old Swedish people. Scand J Occup Ther. 2007, 14: 16-24. 10.1080/11038120601024929.CrossRefPubMed Haak M, Fange A, Iwarsson S, Ivanoff SD: Home as a signification of independence and autonomy: experiences among very old Swedish people. Scand J Occup Ther. 2007, 14: 16-24. 10.1080/11038120601024929.CrossRefPubMed
36.
go back to reference Hammarström G, Torres S: Being, feeling and acting: a qualitative study of Swedish home-help care recipients’ understandings of dependence and independence. J Aging Stud. 2010, 24: 75-87. 10.1016/j.jaging.2008.10.002.CrossRef Hammarström G, Torres S: Being, feeling and acting: a qualitative study of Swedish home-help care recipients’ understandings of dependence and independence. J Aging Stud. 2010, 24: 75-87. 10.1016/j.jaging.2008.10.002.CrossRef
37.
go back to reference Cardol M, De Jong BA, Ward CD: On autonomy and participation in rehabilitation. Disabil Rehabil. 2002, 24: 970-974. 10.1080/09638280210151996.CrossRefPubMed Cardol M, De Jong BA, Ward CD: On autonomy and participation in rehabilitation. Disabil Rehabil. 2002, 24: 970-974. 10.1080/09638280210151996.CrossRefPubMed
38.
go back to reference McCormack B: A conceptual framework for person-centred practice with older people. Int J Nurs Pract. 2003, 9: 202-209. 10.1046/j.1440-172X.2003.00423.x.CrossRefPubMed McCormack B: A conceptual framework for person-centred practice with older people. Int J Nurs Pract. 2003, 9: 202-209. 10.1046/j.1440-172X.2003.00423.x.CrossRefPubMed
40.
go back to reference Sen A: Commodities and Capabilities. 1985, Amsterdam: North-Holland Sen A: Commodities and Capabilities. 1985, Amsterdam: North-Holland
41.
go back to reference Sen A: Inequality Reexamined. 1992, New York: Russell Sage Foundation Sen A: Inequality Reexamined. 1992, New York: Russell Sage Foundation
42.
go back to reference Sen A: Capability and Well-Being. The Quality of Life. Edited by: Sen A, Nussbaum MC. 1993, Oxford: Oxford University Press, 30-53.CrossRef Sen A: Capability and Well-Being. The Quality of Life. Edited by: Sen A, Nussbaum MC. 1993, Oxford: Oxford University Press, 30-53.CrossRef
43.
go back to reference Fan R: Self-determination vs. family-determination: two incommensurable principles of autonomy: a report from East Asia. Bioethics. 1997, 11: 309-322. 10.1111/1467-8519.00070.CrossRefPubMed Fan R: Self-determination vs. family-determination: two incommensurable principles of autonomy: a report from East Asia. Bioethics. 1997, 11: 309-322. 10.1111/1467-8519.00070.CrossRefPubMed
Metadata
Title
Shifting between self-governing and being governed: a qualitative study of older persons’ self-determination
Authors
Isabelle Ottenvall Hammar
Synneve Dahlin-Ivanoff
Katarina Wilhelmson
Kajsa Eklund
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2014
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/1471-2318-14-126

Other articles of this Issue 1/2014

BMC Geriatrics 1/2014 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.