title: A new perspective on threatened autonomy in elderly persons: the disempowering process.
abstract: This study explored factors other than medical condition and treatments which contributed to the discharge experiences of 12 rural and 9 urban patients. Interpretive research methodology included document review, observation and in-depth interviews of all key participants. The purposefully selected sample consisted of a total of 21 patients, 22 informal caregivers, and 117 professionals involved in the hospital and/or home setting. Findings document a new perspective on how patients and professionals together contribute to the patient's threatened autonomy. Lack of clarity about goals, aspirations, and purpose in life and a generally negative frame of mind in the elderly combine with professional practice approaches to create a disempowering process. Faced with the biomedical orientation and paternalism of professionals, patients with a positive mindset and sense of direction and purpose in life did not experience threat to their autonomy. The researchers conclude that empowerment strategies must encompass a patient-centred approach, which includes an understanding of the patient's mindset, goals, aspirations, and sense of purpose within a larger life context. This consideration is essential to enable elderly patients to maintain autonomy despite continued health care requirements.
authors.affiliation: Centre for Studies in Family Medicine, University of Western Ontario, London, Canada.
authors.forename: C L
authors.initials: CL
authors.lastname: McWilliam
authors.forename: J B
authors.initials: JB
authors.lastname: Brown
authors.forename: J L
authors.initials: JL
authors.lastname: Carmichael
authors.forename: J M
authors.initials: JM
authors.lastname: Lehman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005610:Freedom; D006699:Home Care Services; D006801:Humans; D008297:Male; D026706:Paternalism; D010358:Patient Participation; D026684:Personal Autonomy; D010817:Physician-Patient Relations