Supporting autonomy for people with dementia living in nursing homes: A rapid realist review

Henny van der Weide; Marleen H Lovink; Katrien G Luijkx; Debby L Gerritsen

doi:10.1016/j.ijnurstu.2022.104382

Supporting autonomy for people with dementia living in nursing homes: A rapid realist review

Int J Nurs Stud. 2023 Jan:137:104382. doi: 10.1016/j.ijnurstu.2022.104382. Epub 2022 Oct 24.

Authors

Henny van der Weide¹, Marleen H Lovink², Katrien G Luijkx³, Debby L Gerritsen⁴

Affiliations

¹ University Knowledge Network for Older Adult Care Nijmegen (UKON), Radboudumc Alzheimer Center, Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Archipel Zorggroep, Eindhoven, the Netherlands. Electronic address: henny.vanderweide@radboudumc.nl.
² University Knowledge Network for Older Adult Care Nijmegen (UKON), Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
³ Tranzo Department, the Scientific Center for Care and Wellbeing of the Tilburg School of Social and Behavioral Sciences of Tilburg University, the Netherlands.
⁴ University Knowledge Network for Older Adult Care Nijmegen (UKON), Radboudumc Alzheimer Center, Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.

PMID: 36402057
DOI: 10.1016/j.ijnurstu.2022.104382

Abstract

Background: For people with dementia living in nursing homes, autonomy is important. However, they experience difficulty with being heard as an autonomous person, as well as with expressing their preferences and choices. The question is how to support their autonomy.

Objective: Despite extensive efforts to support autonomy in daily care for people with dementia living in nursing homes, we do not know exactly what works for whom, in which context, how and why. The objective of this realist review is to explore what is known in literature on autonomy support interventions for people with dementia in nursing homes.

Design: A rapid realist review of literature.

Review methods: To understand how autonomy is supported, a realist approach was applied that entailed identifying the research question, searching for information, performing a quality appraisal, extracting data, synthesizing the evidence and validating the findings with a panel of experts. Causal assumptions were derived from articles found in four bibliographic databases (PubMed, PsychInfo, Cochrane and CINAHL) leading to context (C)-mechanism (M)-outcome (O) configurations.

Results: Data extraction from the included articles ultimately resulted in sixteen CMO configurations on four themes: a. preferences and choice: interventions for supporting autonomy in nursing homes and their results, b. personal characteristics of residents and family: people with dementia and their family being individuals who have their own character, habits and behaviors, c. competent nursing staff each having their own level of knowledge, competence and need for support, and d. interaction and relationships in care situations: the persons involved are interrelated, continuously interacting in different triangles composed of residents, family members and nursing staff.

Conclusion: The findings showed that results from interventions on autonomy in daily-care situations are likely to be just as related not only with the characteristics and competences of the people involved, but also to how they interact. Autonomy support interventions appear to be successful when the right context factors are considered.

Keywords: Autonomy; Dementia; Family caregivers; Nursing home; Nursing staff; Realist review; Residents.

Publication types

Review

MeSH terms

Dementia*
Family
Humans
Nursing Homes
Nursing Staff*