doi: 10.56294/nds202378

 

Original

 

The role of nursing in promoting autonomy and independence among older adults in healthcare

 

Rol de Enfermería en la promoción de Autonomía e Independencia del Adulto Mayor en Salud

 

Sheila Betiana Giselle De Mari Barros1, María Lorena Díaz1

 

1Universidad Siglo 21, Licenciatura en Gerontología. Argentina.

 

Cite as: De Mari Barros SBG, Díaz ML. The role of nursing in promoting autonomy and independence among older adults in healthcare. Nursing Depths Series. 2023; 2:78. https://doi.org/10.56294/nds202378

 

Submitted: 05-07-2022                   Revised: 21-11-2022                   Accepted: 02-03-2023                 Published: 03-03-2023

 

Editor: Dra. Mileydis Cruz Quevedo

 

ABSTRACT

 

The objective of this study was to determine if nursing staff promote what was mentioned in article 7 which deals with the right to autonomy and Independence, of the Inter- American Convention on the protection of the rights of older adults. This was done through the method of direct observation and interview with the staff of the elderly service of the Rio Grande Regional Hospital during the months of November/December of the current year. The results showed that the staff does promote the exercise of such right and has current information about it, the main obstacle was the absence of family support to encourage the improvement of the elderly. It is also striking that, despite the objectives of the aforementioned convention, the current governments are not involved in the service due to the shortage of professionals dedicated to this task and the lack of resources for their assistance.

 

Keywords: Older Adult; Rights; Inter-American Convention.

 

RESUMEN

 

El objetivo de este estudio fue determinar si el Personal de Enfermería promueve el citado art.7 que trata sobre el derecho de Autonomía e Independencia de la Convención Interamericana sobre la Protección de los derechos del Adulto Mayor. A través, del método de observación directa y entrevistas con el personal del servicio de adulto mayor del Hospital Regional de Rio Grande, durante los meses de noviembre - diciembre del corriente año. Los resultados mostraron que el personal si promueve el ejercicio de tal derecho y poseen información actual al respecto y como principal obstáculo resalto la ausencia del apoyo familiar para incitar a la mejora del geronte, también llama la atención que, pese a los objetivos de la Convención mencionada, los gobiernos actuales no se encuentren tan involucrados en el tema, es lo que se pudo visualizar en el servicio, debido a la escasez de profesionales abocados a la tarea y los faltantes de recursos para su asistencia.

 

Palabras clave: Adulto mayor; Derechos; Convención Interamericana.

 

 

 

INTRODUCTION

Aging today is a complex and multifaceted phenomenon that has a significant impact on all aspects of society. It requires careful attention and strategic planning to address the challenges and seize the opportunities it presents. The promotion of healthy, active, and meaningful aging is essential in this context. If we are facing a future with an aging population of unprecedented proportions, a good option would be for this age group to be in the best possible condition, independent and autonomous, capable of fending for themselves as best they can, included in their communities, with social and state support.(1)

The path to healthy aging requires, on the one hand, that older adults be willing to adjust to the changing circumstances of life demanded by the times and that the society in which they live offer them opportunities to be protagonists of their actions, with self-confidence, freedom, autonomy, independence, reason, and reflection.(2) Having the ability to make decisions and live our lives as we wish, by our values and preferences, is necessary for our dignity, regardless of age.(3)

The autonomy of older adults today is a matter of great importance, as it implies their ability to make decisions about their lives, their health, and their well-being independently and autonomously. The promotion of an environment that supports their independence and the availability of resources and services that allow them to make informed decisions and live with dignity. At this point, health institutions take on great importance, as they are one of the main pillars for the promotion of this and other rights of this age group.(4)

The demographic transformation that is taking place worldwide, from which Argentina is not exempt, highlights the need for new strategies to anticipate and ensure a better quality of life for citizens. This trend has given rise to the need to promote the independence and autonomy of older adults, with intervention from one of the front lines of action, namely the health sector, taking advantage of the staff who are closest to and have the most contact with people, such as nursing staff, to assess how we are facing the future, whether we are on track to achieve our goals, and whether we are evolving in line with the challenges ahead.(5)

Aging is a public health issue that affects the entire population and represents a challenge for all healthcare professionals, who play a fundamental role in healthcare in old age. The implementation of research-based health interventions in aging poses a challenge for the profession, as it requires a holistic view of the human being. This approach enables us to achieve an understanding of models of active and healthy aging, ultimately helping older adults and the community to view the aging process as a regular part of life.(6)

Some key aspects of current population aging include:

·       Growth of the older population: The number of people aged 65 and over is increasing significantly in many societies due to longer life expectancy and lower birth rates.

·       Impact on the economy: Population aging poses economic challenges, as it can increase pressure on social security and healthcare systems and lead to a decline in the active workforce.

·       Healthcare: Healthcare and long-term care become more important as the population ages, requiring adapted healthcare policies and systems.

·       Social and welfare needs: Often faces specific social and welfare needs, such as social isolation, adequate housing, and access to support services.

·       Intergenerational challenges: Population aging can create intergenerational tensions, as the financing of pension systems and support for older generations may compete with the needs of younger generations.

 

Reaching old age involves a series of challenges that we must face as a society. We must consider and place on the agenda issues such as access to and sustainability of the pension system. We must also consider health services tailored to older people, care and attention in residential or long-term care facilities, and the prevention and punishment of all types of abuse or mistreatment of older people. These issues must be assessed and discussed from the perspective of the rights of older people.

In the specific case of health, deterioration in this area often leads to complications such as disability. Added to this is the increase in non-communicable diseases, such as diabetes or joint problems, which represent a burden for those who suffer from them and often mean that the necessary resources are not available to deal with the situation.(7)

The study of aging is a key factor for health, as knowledge of this phenomenon will make it possible to propose and improve intervention strategies, enhance care practices, and redirect current efforts.(8)

The autonomy of older adults is essential for their well-being and quality of life, and its importance will continue to grow in the future for several reasons:

·       Population aging: The world's population is aging, which means that there will be more older people who need to maintain their independence to reduce the burden on health and care systems.

·       Physical and mental health: Autonomy contributes to the physical and psychological health of older adults. Staying active and making their own decisions can reduce the risk of chronic diseases, improve mood, and prevent depression.

·       Quality of life: Autonomy allows older adults to participate in meaningful activities and maintain their social relationships, which improves their quality of life and satisfaction.

·       Care costs: Promoting autonomy can reduce the costs associated with long-term care, as older adults can remain in their homes longer and require less institutional assistance.

·       Support policies and programs: Public policies and social programs must focus on promoting and supporting the autonomy of older adults, ensuring that they have access to the resources and services necessary to live independently.

 

The autonomy and independence of older adults is not only vital to their well-being, but also has a significant impact on society as a whole by promoting healthy aging and reducing economic and social burdens.

Facing a future with autonomy means preparing older adults so that they can remain independent and make decisions about their lives effectively and safely.(9,10)

Within public health institutions, the most significant contact a patient has, in this particular case, an older adult, is with nursing staff, as they are usually responsible for providing healthcare throughout their stay. For these reasons, this staff must be trained and prepared to contribute to the cause and set an example for raising awareness among the entire population. This research aims to determine the extent to which nursing staff in a nursing home for older adults contribute to this cause, as they are the first to be part of the strategy and change proclaimed by the Inter-American Convention on the Protection of the Rights of Older Persons as an improvement to be achieved, specifically investigating Article 7 of the Convention, which deals with the autonomy and independence of older adults. Autonomy will be significant and valuable in ensuring that older adults can care for themselves and others while remaining active members of society. This society will see its young population decline, leading to a reduction in the workforce and economic productivity. For these reasons, it will be much more important for our older population to be able to care for themselves, thus ensuring that the aging population does not become a burden.

 

Statement of the problem

Population aging is one of humanity's most outstanding achievements. Still, the rise in older populations poses a significant challenge to health policies and strategies, which must meet their needs and provide them with the opportunity to live their final years with an excellent quality of life.

These challenges require us to think about building societies for all ages, modifying the role of the state regarding population aging, and redirecting public policies and systems to adapt to this aging process. It must contribute to improving the living conditions of the population, maintaining autonomy to avoid or postpone dependence as much as possible, promoting healthy lifestyles from an early age, readapting health systems, and improving the environment and adapting it to their needs.

Promoting the autonomy of older adults is key to achieving the goal of active and healthy aging. In health institutions, where there is close and trusting contact, this promotion is essential, as it not only improves their quality of life but also provides them with a sense of control and dignity at this stage of their lives. By implementing this strategy, health institutions can create an environment that not only supports the health and physical well-being of older adults but also respects and promotes their autonomy, allowing them to live more fulfilling and satisfying lives. Healthcare systems, whether public or private, due to the frequent use of healthcare services by the population, including older adults, are functional groups of people for raising awareness about this social phenomenon and through trained and up-to-date professionals who guide and support initiatives from the ground up, through face-to-face contact, providing information, encouraging the community, supporting families, and promoting active aging, autonomy, and independence.

Does the nursing staff of the geriatric service at the Rio Grande Regional Hospital (HRRG) currently contribute to the promotion of autonomy and independence among older adults? If not, what do you consider to be the obstacles to contributing to the exercise of this right?

 

General objective

To determine whether the nursing staff of the HRRG's elderly care service promotes the right to autonomy and independence of older adults in their workplace during the months of November and December 2023.

 

METHOD

For the preparation of this graduation project, a descriptive analysis with a qualitative approach and a non-experimental design was carried out with a sample of 20 participants belonging to the adult care service of the Rio Grande Regional Hospital, with the following inclusion criteria: Nursing degree qualifying them to practice, present at the time of the research (November-December 2023), currently working in the senior citizen service and willing to participate in the study. It should be noted that this is the only institution in the locality that granted authorization, meets the inclusion criteria, and corresponds to the largest sample size for the research. Written authorization was requested from the head of nursing, who is in charge of the entire staff of the institution, from the teaching and research department of the hospital. Verbal authorization was requested from both the head of the service and the staff of the Senior Citizens' Residence (RAM) who work there, requesting their voluntary participation and their full right to refuse and decline at any time. This service has a total of 20 nurses divided into four shifts (from 6 a.m. to 12 p.m., from 12 p.m. to 6 p.m., from 6 p.m. to midnight, and from midnight to 6 a.m.), with five nurses on each shift, attending a total of 14 beds. INSTRUMENTS: No specific measurement instruments were found. Therefore, taking Article 7 of the Inter-American Convention on the Protection of the Rights of Older Persons as a reference, a direct observation guide was developed with a series of steps and actions to evaluate their correct implementation by the nurses on duty with institutionalized older adults. These aspects to be assessed cover the three items involved in that article. It is constructed as follows: Article 7, "Right to Independence and Autonomy," refers to the government's commitment through programs, policies, and actions to promote mainly three points mentioned in our theoretical framework in the section "key concepts."

These were the key points taken into account in the research, where point A of Article 7 of the convention above was decisive in evaluating our approach to the problem: "Currently, RAM nursing staff contribute to the promotion and independence of older adults and whether they consider that there are obstacles to compliance." and the general objective "To determine whether nursing staff promote the right to autonomy of older adults." For the specific objectives "To analyze the fulfillment of the right to autonomy of older adults by nursing staff," "Identify possible barriers that nurses consider to hinder the promotion and fulfillment of the right to autonomy of older adults in the service," and "Describe the situation perceived from a professional point of view on the application of the right to autonomy of older adults," the three points of Article 7 were considered.

To achieve the research's purpose, an open interview was conducted with nursing staff to gather their opinions on the situation, using a series of questions that guided the study's aims.

 

RESULTS

All nurses currently working at the RAM participated, constituting a sample of 20 people.

During our observations of the service and the participants in their routine and interaction with patients, it was determined that if the right to autonomy and independence of older adults is promoted, their decisions are respected, they are informed of the health procedures to be performed, and they are assisted in their basic activities, encouraging their collaboration. The nursing staff is the only one always assisting patients, performing tasks that are beyond their responsibility due to the lack of other health specialties.

When analyzing compliance with this right, a willingness on the part of the staff was observed, as well as up-to-date knowledge on the subject and the proposals of leading global health organizations. However, despite this willingness, there was a significant lack of resources and supplies for adequate patient care (such as clothing, bedding, and personal hygiene products), coordination with other health professionals for comprehensive care for the elderly, and a significant lack of family support. It was also noted that there is no clear division within the institution regarding the care provided by nursing professionals, likely due to the lack of other professionals and the patient's family.

When interviewing staff and observing to identify possible barriers that they consider obstacles, the lack of commitment on the part of families, their involvement, and collaboration in promoting autonomy for this age group stand out, as already mentioned. To achieve widespread awareness of respect for and promotion of the rights of older adults, family participation is essential. Together with the health team, they form a fundamental bridge to achieving this goal and are the main pillars for developing the autonomy and independence of older adults themselves. Greater government participation is also necessary to address the real situation of older adults in these institutions, determining whether they are on track to achieve the proposed objectives or if actions need to be redirected to ensure the rights of older adults are applied. While comprehensive health care and family ties are fundamental pillars for the well-being of older adults and contribute to the autonomy of this age group, it is the responsibility of the State to guarantee and ensure that these rights are fulfilled, that the necessary tools are in place to achieve this, to verify the effectiveness of the policies implemented, to meet the proposed objectives, and to contribute to the development of healthier aging populations, capable of living autonomously and independently for as long as possible, mitigating the adverse effects that this aging population may cause.

Regarding the situation perceived from the point of view of staff on the rights of older adults, the majority consider that key issues remain unresolved, such as greater control between government proposals on programs, policies, and actions and what is carried out in these types of institutions, increasing resources for the care of these patients, greater involvement of the family in collaborating in the rehabilitation and care of older adults, and expanding education and awareness in the community so that they receive more dignified and respectful treatment.

 

DISCUSSION

The demographic transition continues today, with an increasingly prevalent older adult population.(3) For older adults to achieve a good quality of life, they need peace and tranquility, to be cared for and protected by their families with dignity and respect, and to have their needs for free expression, decision-making, communication, and information satisfied as social beings.(11,12)

The right to autonomy for older adults is essential to guarantee their dignity and quality of life. The ability to make their own decisions, participate in society, and maintain control over their well-being is a fundamental aspect of freedom and self-determination. Governments, institutions, and society as a whole have a responsibility to protect and promote this right by providing support and resources to enable older adults to exercise their autonomy in a complete and meaningful way. Recognizing and respecting their independence is not only an ethical imperative but also a building block for more inclusive and just societies.(5,9)

In conducting this research, we encountered numerous obstacles. No specific previous research on the subject was found, and we were unable to obtain information or guidance from the municipality to find out about the public institutions under its responsibility that work with older adults. The only institution that allowed access to carry out the study was the Rio Grande Regional Hospital. After several visits, meetings with managers, and a series of fairly strict requirements, access was granted to the Elderly Residence Service.

In this research, we sought to determine whether the nursing staff of the elderly service contributes to the promotion of the right to autonomy and independence. Through conversations with nurses and observations in the workplace, it was found that this group of health workers collaborates with a more dignified treatment, providing nursing care that supports patients and considers their opinions, and that it complies with the promotion of autonomy and independence. But the reality shows that this differs considerably from what is proposed by the leading health organizations and the protection of the human rights of older adults.

The overall objective of this research was to determine that the nursing staff at this public health institution contributes to the autonomy of older adults through care, communication, and emotional support strategies, and how these practices impact the quality of life of patients. Despite the staff's willingness, several obstacles were encountered, including a lack of resources for patient care, a shortage of professionals to assist and coordinate care, and limited family involvement in both patient rehabilitation and treatment progress updates. Another point to consider is the lack of action by the State.

The situation perceived by nursing staff today regarding the rights of older people primarily highlights the lack of government support, both in monitoring the welfare of this population and in allocating resources and materials. Family participation is also low, leading to a lack of motivation among patients in terms of their care and rehabilitation.

For the research, we worked with a small sample and in a single public institution, so we cannot conclude that the results are sufficient to generalize them to the population. Still, it is striking that the majority of nursing staff consider the same issues to be the main ones to be resolved. It is imperative to improve these issues and raise awareness throughout the community, since sooner or later we will be part of this aging population, with a reduced number of young adults who will not be able to support children, young people, and adults, and at the same time be the productive force of the country. We must be able to look more closely, coordinate efforts, and resolve the main shortcomings to face the future in the best possible way, being able to support ourselves, achieve the best possible health for the longest time possible, avoid becoming a burden on society in the not too distant future, and refute the prejudices that have accompanied older adults since time immemorial. This ability to adapt to such global change will only be achieved with well-prepared health institutions, the acquisition and renewal of knowledge, sufficient well-coordinated professionals, the provision of necessary resources, constant evaluation by the government to assess progress, trained nurses to promote autonomy, to support older people in their moments of health weakness and with support to recover and reintegrate into society, with families, communities, and a government that encourages and promotes this reintegration, a society that truly includes them and where these people feel like active, and why not, productive members. It is the obligation of the State to guarantee their rights, it is the duty of public and health institutions to consider and promote their rights, and it is the human and moral responsibility of the community to respect these rights so that they can be fulfilled.

As a final observation after conducting the research, this work was focused on evaluating a single right contemplated by the Inter-American Convention on the Protection of the Rights of Older Persons. Based on the above, the current approach does not cover what was planned by these organizations, indicating the need for more in-depth research to verify the status of other rights for this age group that they are trying to protect.

 

CONCLUSIONS

This research showed that, although the nursing staff of the Elderly Residence Service at the Regional Hospital of Río Grande actively promotes the right to autonomy and independence of older persons, this work is carried out in an adverse context, characterized by a lack of resources, institutional support, and family participation. The willingness and commitment of staff are essential to sustaining humanized practices focused on respect for the rights of older adults. Still, they are not sufficient on their own to guarantee truly dignified and autonomous aging.

The research highlights the urgent need to strengthen the health system and social programs for older people through greater coordination between the State, institutions, families, and the community. The autonomy of older adults cannot be sustained solely from the health sector; it requires a comprehensive, multidisciplinary, and intersectoral approach that includes effective public policies, adequate resources, trained professionals, and a sensitized society.

The results also call for broadening the research focus to other rights enshrined in the Inter-American Convention on the Protection of the Rights of Older Persons, to gain an in-depth understanding of the degree of compliance and actual protection these citizens receive. Only then will it be possible to design concrete strategies that ensure not only that older adults remain an active part of society, but also their full inclusion, meaningful participation, and recognition of their dignity.

Finally, addressing the challenges of population aging requires not only responding to current needs, but also anticipating future scenarios. This involves preparing resilient institutional structures, promoting active aging from an early age, and building an intergenerational society that values its elders not as a burden but as a source of wisdom, experience, and social contribution. Promoting and guaranteeing the autonomy of older adults is an ethical, social, and strategic investment in the future of us all.

 

REFERENCES

1. Comisión Económica para América Latina y el Caribe (CEPAL). Transformaciones demográficas y su influencia en el desarrollo de América Latina y el Caribe. Santo Domingo: CEPAL; 2008.

 

2. Badillo Barradas U. Proceso y teorías del envejecimiento. En: Práctica de la Geriatría. 3ª ed. México: McGraw-Hill; 2011. p..

 

3. Rofman R, Apella I. Envejecimiento poblacional y desafíos económicos para la Argentina en el mediano y largo plazo. En: Los años no vienen solos. Oportunidades y desafíos económicos de la transición demográfica en Argentina. Washington, D.C.: Banco Mundial; 2014.

 

4. Organización Mundial de la Salud. Informe mundial sobre el envejecimiento y la salud. Ginebra: OMS; 2015. Disponible en: http://apps.who.int/iris/bitstream/10665/186466/1/9789240694873_spa.pdf

 

5. Organización de los Estados Americanos. Convención Interamericana sobre la Protección de los Derechos Humanos de las Personas Mayores. Washington, D.C.: OEA; 2015.

 

6. Varela Pinedo LF. Salud y calidad de vida en el adulto mayor. Rev Peru Med Exp Salud Publica. 2016;33(2):199-201.

 

7. Organización Mundial de la Salud. Acción multisectorial para un envejecimiento saludable basado en el ciclo de la vida: proyecto de estrategia y plan de acción mundiales sobre el envejecimiento y la salud. 69ª Asamblea Mundial de la Salud; 2016. Disponible en: https://apps.who.int/gb/ebwha/pdf_files/WHA69_17-sp.pdf

 

8. Argentina. Ley N° 27.360. Ratificación de la Convención Interamericana sobre la Protección de los Derechos Humanos de las Personas Mayores. Boletín Oficial de la República Argentina; 2017.

 

9. Huenchuan S. Envejecimiento, personas mayores y Agenda 2030 para el Desarrollo Sostenible: Perspectiva regional y de derechos humanos. Santiago de Chile: CEPAL; 2018.

 

10. Aved ML. Autonomía y dignidad de los adultos mayores en Chile. Rev Med Chile. 2020;148(12):1714-7.

 

11. Pan American Health Organization. Envejecimiento saludable en las Américas. 2021. Disponible en: http://www.paho.org/journal/es/numeros-especiales/envejecimiento-saludable-americas

 

12. Pan American Health Organization (PAHO). Argentina lanza la Década de Envejecimiento Saludable con el apoyo de la OPS. 2021. Disponible en: https://www.paho.org/noticias.

 

FINANCING

None.

 

CONFLICT OF INTEREST

None.

 

AUTHOR CONTRIBUTION

Conceptualization: Sheila Betiana Giselle De Mari Barros, María Lorena Díaz.

Data curation: Sheila Betiana Giselle De Mari Barros, María Lorena Díaz.

Formal analysis: Sheila Betiana Giselle De Mari Barros, María Lorena Díaz.

Research: Sheila Betiana Giselle De Mari Barros, María Lorena Díaz.

Methodology: Sheila Betiana Giselle De Mari Barros, María Lorena Díaz.

Project management: Sheila Betiana Giselle De Mari Barros, María Lorena Díaz.

Resources: Sheila Betiana Giselle De Mari Barros, María Lorena Díaz.

Software: Sheila Betiana Giselle De Mari Barros, María Lorena Díaz.

Supervision: Sheila Betiana Giselle De Mari Barros, María Lorena Díaz.

Validation: Sheila Betiana Giselle De Mari Barros, María Lorena Díaz.

Visualization: Sheila Betiana Giselle De Mari Barros, María Lorena Díaz.

Writing – original draft: Sheila Betiana Giselle De Mari Barros, María Lorena Díaz.

Writing – review and editing: Sheila Betiana Giselle De Mari Barros, María Lorena Díaz.