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Personal comfort and autonomy in clients’ homes, compassionate professionals, and eliminating administrative barriers to patient-centred care are key factors in providing quality home care

Fjordside S and Morville A.  Factors influencing older people's experiences of participation in autonomous decisions concerning their daily care in their own homes: A review of the literature.  International Journal of Older People Nursing. 2015; 11: 284-297.

Review question

How older people perceive opportunities and limitations with regard to participation in autonomous decisions concerning their daily care in their own homes?


The aging population presents new challenges, including the increasing burden of chronic diseases requiring intervention at a community level. This demographic trend is resulting in growing demands for home care.

Maintaining control over one’s daily care routines can significantly impact the quality of life for older adults living in their own homes. However, the importance of personal autonomy is often under emphasized by those who provide daily care for older adults in their own homes.

There is currently a lack of empirical evidence related to the challenges and ethical dilemmas concerning the provision of daily care for older adults in their homes. This review aimed to provide a summary of the perceived opportunities and limitations of allowing older adults to control decisions cornering their daily home care.

How the review was done

A detailed search of a number of electronic databases for studies published from 2009 to 2014 was conducted. Studies that focused on autonomy, older people and home care were included in the review.

A total of 881 studies were identified in searches, and 12 were included in the review after assessments for eligibility.

The authors did not acknowledge any funding sources for this review.

What the researchers found

The studies in the review highlight that for many older adults, home represents a personal space that enables them to make decisions, and have a sense of control and comfort. However, older adults who need in-home daily care can require medical and technological aids which can cause their home to feel institutionalized.

The person providing that care can contribute significantly to the comfort of older adults, depending on their approach and attention to the way the older adult chooses to manage their household. In some cases, the carer limits the older adult’s autonomy by acting rigid and unresponsive to the client’s needs and desires.

The included studies also show evidence that older adults want to feel as independent as possible for as long as possible. Many of the frameworks included in the studies revealed that the related administration systems for daily outpatient care inherently restrict the older adult’s ability to make decisions concerning their own care. The decision older adults felt they had the most control over was the sequence of services provided by care providers.


The quality of home care practices for older adults can serve as an opportunity to improve the everyday lives of the aging population. The importance of personal comfort and autonomy in clients’ homes, compassionate healthcare professionals, and eliminating administrative barriers to patient-centred care should be considered key factors in providing quality home care in the future. Further investigation on the autonomy for older adults who receive care in their home is recommended.

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