A Quantitative Meta-Analysis and Qualitative Meta-Synthesis of Aged Care Residents' Experiences of Autonomy, Being Controlled, and Optimal Functioning.

Systematic review motivation nursing home self-determination theory

Journal

The Gerontologist
ISSN: 1758-5341
Titre abrégé: Gerontologist
Pays: United States
ID NLM: 0375327

Informations de publication

Date de publication:
05 Oct 2023
Historique:
received: 29 09 2022
medline: 6 10 2023
pubmed: 6 10 2023
entrez: 5 10 2023
Statut: aheadofprint

Résumé

The poor mental health of adults living in aged care needs addressing. Improvements to nutrition and exercise are important, but mental health requires a psychological approach. Self-determination theory finds that autonomy is essential to wellbeing while experiences of being controlled undermine it. A review of existing quantitative data could underscore the importance of autonomy in aged care, and a review of the qualitative literature could inform ways to promote autonomy and avoid control. Testing these possibilities was the objective of this research. We conducted a mixed methods systematic review of studies investigating autonomy, control, and indices of optimal functioning in aged care settings. The search identified 30 eligible reports (19 quantitative, 11 qualitative), including 141 quantitative effect sizes, 84 qualitative data items, and N = 2,668. Quantitative effects were pooled using three level meta-analytic structural equation models and the qualitative data were meta-synthesized using a grounded theory approach. As predicted, the meta-analysis showed a positive effect of aged care residents' autonomy and their wellness, r = 0.33 [95% CI 0.27, 0.39], and a negative effect of control, r = -0.16 [95% CI -0.27, -0.06]. The meta-synthesis revealed seven primary and three sub-themes describing the nuanced ways autonomy, control, and help seeking are manifest in residential aged care settings. The results suggest that autonomy should be supported, and unnecessary external control should be minimized in residential aged care, and we discuss ways the sector could strive for both aims.

Sections du résumé

BACKGROUND AND OBJECTIVES OBJECTIVE
The poor mental health of adults living in aged care needs addressing. Improvements to nutrition and exercise are important, but mental health requires a psychological approach. Self-determination theory finds that autonomy is essential to wellbeing while experiences of being controlled undermine it. A review of existing quantitative data could underscore the importance of autonomy in aged care, and a review of the qualitative literature could inform ways to promote autonomy and avoid control. Testing these possibilities was the objective of this research.
RESEARCH DESIGN AND METHODS METHODS
We conducted a mixed methods systematic review of studies investigating autonomy, control, and indices of optimal functioning in aged care settings. The search identified 30 eligible reports (19 quantitative, 11 qualitative), including 141 quantitative effect sizes, 84 qualitative data items, and N = 2,668. Quantitative effects were pooled using three level meta-analytic structural equation models and the qualitative data were meta-synthesized using a grounded theory approach.
RESULTS RESULTS
As predicted, the meta-analysis showed a positive effect of aged care residents' autonomy and their wellness, r = 0.33 [95% CI 0.27, 0.39], and a negative effect of control, r = -0.16 [95% CI -0.27, -0.06]. The meta-synthesis revealed seven primary and three sub-themes describing the nuanced ways autonomy, control, and help seeking are manifest in residential aged care settings.
DISCUSSION AND IMPLICATIONS CONCLUSIONS
The results suggest that autonomy should be supported, and unnecessary external control should be minimized in residential aged care, and we discuss ways the sector could strive for both aims.

Identifiants

DOI: 10.1093/geront/gnad135 PMID: 37798134
pubmed: 37798134
pii: 7293006
doi: 10.1093/geront/gnad135
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America.

Auteurs

Emma L Bradshaw (EL)

Institute for Positive Psychology and Education, Faculty of Health Sciences, Australian Catholic University, North Sydney, New South Wales, Australia.
ORCID: 0000-0001-6423-5499

Joel R Anderson (JR)

Institute for Positive Psychology and Education, Faculty of Health Sciences, Australian Catholic University, North Sydney, New South Wales, Australia.
Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia.

Ma A J Banday (MAJ)

School of Psychology, Faculty of Health Sciences, Australian Catholic University, Strathfield, New South Wales, Australia.

Geetanjali Basarkod (G)

Institute for Positive Psychology and Education, Faculty of Health Sciences, Australian Catholic University, North Sydney, New South Wales, Australia.

Rafaan Daliri-Ngametua (R)

School of Education, Faculty of Education and Arts, Australian Catholic University, Banyo, Queensland, Australia.

Kelly A Ferber (KA)

Institute for Positive Psychology and Education, Faculty of Health Sciences, Australian Catholic University, North Sydney, New South Wales, Australia.

Dylan Henry (D)

School of Psychology, Faculty of Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia.

Richard M Ryan (RM)

Institute for Positive Psychology and Education, Faculty of Health Sciences, Australian Catholic University, North Sydney, New South Wales, Australia.
Ewha Womans University, Seoul, South Korea.

Classifications MeSH