Participation, autonomy and control are shared concepts within older people's interpretations of independence: a qualitative interview study

To date, support for independence in older people has been largely focused on achieving practice- and policy-orientated goals such as maintenance of function, remaining in one's own home and reducing the impact of receiving care. Uncertainty about what independence means to older people means that these goals may not align with what matters and should be considered for a more person-centred approach to independence. This study aimed to improve understanding of the meaning and facilitators of independence from older people's perspectives. Semi-structured interviews were conducted with 14 community-dwelling people aged 75+, purposively sampled for maximum variance in demographic characteristics. Interviews, conducted by phone or online, were recorded and transcribed. Analysis was conducted using a framework approach to organise, and facilitate comparison of, inductively and deductively generated codes. Patterns were identified and interpreted into themes. Transcripts and themes were reviewed with the research team. Disagreements in interpretations were resolved through discussion. Two themes were identified. The first theme, ‘Older people draw on personal values and experiences to develop unique interpretations of independence’, was underpinned by three concepts: participation, autonomy and control. The concepts reflected patterns identified within participants’ meanings of independence. The second theme, ‘It's not what you have, but how you think about it that creates independence’, represented participants’ shared prioritisation of psychological attributes over physical or environmental resources for maintaining independence. Participation, autonomy and control are shared concepts within older people's diverse interpretations of independence. This paper addresses uncertainty around what independence means to older people and contributes three key concepts that should be considered when operationalising person-centred support for independence.