The Experience of Autonomy by Institutionalized Older Adults in Residential Care Settings: Perspectives and Ethical Challenges for Nursing Care
Abstract:
Population aging in Portugal and worldwide has brought major challenges for maintaining the autonomy and dignity of older adults. As life expectancy increases, so does the number of institutionalized elders, demanding new ethical and humanized approaches from nursing teams. This study aimed to understand the experience of autonomy among elderly residents in residential care facilities, identifying factors that promote or restrict it and discussing the ethical implications for nursing care. This is a qualitative case study conducted in two residential care facilities (ERPI) in northern Portugal, involving 14 participants aged between 70 and 94 years. Data were collected through semi-structured interviews and analyzed using Bardin’s content analysis method. Results show that autonomy for institutionalized elderly people is relational and dynamic, often limited by institutional routines but strengthened through empathy, dialogue, and nursing care grounded in ethics and respect for individuality. Nursing practice guided by an ethics of care is essential for promoting autonomy and improving the quality of life and active aging among institutionalized older adults.
KeyWords:
Aged; Personal Autonomy; Institutionalization; Geriatric Nursing; Nursing Ethics.
References:
- Bardin, L. (2016). Content Analysis. Lisbon: Edições 70.
- Camacho, A. C. L. F., & Santos, R. C. (2020). Nursing care and autonomy of institutionalized older adults. Revista de Enfermagem UERJ, 28, e48397.
- Direção-Geral da Saúde. (2022). National Health Plan 2021–2030. Lisbon: DGS.
- Gilligan, C. (2013). In a Different Voice: Psychological Theory and Women’s Development. Cambridge, MA: Harvard University Press.
- Gomes, G. C., et al. (2021). Factors associated with personal autonomy in older adults: An integrative review. Ciência & Saúde Coletiva, 26(2), 631–642.
- Instituto Nacional de Estatística. (2024). Demographic Statistics of Portugal 2024. Lisbon: INE.
- Leineweber, M., Keusgen, C. V., Bubeck, M., et al. (2025). Ethical aspects of the use of social robots in elderly care: A systematic qualitative review. BMC Geriatrics.
- Martín Carbonell, M., et al. (2019). Autonomy in institutionalized older adults: Relationship with gender, education, and length of institutionalization. Gerokomos, 30(2), 50–55. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134928X2019000200050&lng=es&nrm=iso
- Mackenzie, C., & Stoljar, N. (2021). Relational Autonomy: Feminist Perspectives on Autonomy, Agency, and the Social Self. Oxford: Oxford University Press.
- Meleis, A. I. (2010). Transitions Theory: Middle-Range and Situation-Specific Theories in Nursing Research and Practice. New York: Springer.
- Minayo, M. C. S. (2022). The Challenge of Knowledge: Qualitative Research in Health. São Paulo: Hucitec.
- World Health Organization. (2023). World Report on Ageing and Health. Geneva: WHO.
- Portugal. Ministry of Solidarity and Social Security. (2012). Ordinance No. 67/2012. Diário da República, Series I, No. 58 (March 21, 2012), 1324–1329. https://diariodarepublica.pt
- Roy, C. (2011). The Roy Adaptation Model (4th ed.). New Jersey: Pearson.
- Simão, C. (2019). Institutionalization and (dis)identification of the older population (Master’s thesis). University of the Azores. https://repositorio.uac.pt/bitstream/10400.3/6146/1/DissertMestradoCristinaIsabelBotelhoSimao2020.pdf
- Silva, W. F., Dutra, D., & Souza, L. C. C. (2025). Physical and recreational activity in the lives of institutionalized older adults: Impacts on autonomy. Revista Saúde & Desenvolvimento, 14(2), 22–35.
- Tronto, J. C. (2015). Moral Boundaries: A Political Argument for an Ethic of Care. New York: Routledge.