Self-determination: A utopia in frail older people with decreased cognition?

Abstract Background Self-determination in old age is essential for people’s experiences of good subjective health and quality of life. The knowledge concerning how frail older people with decreased cognition perceive their ability to be self-determined in the different dimension in daily life is, however, limited. The aim of this study was therefore to explore the relationship of self-determination and cognition in frail older people. Methods This study was a cross-sectional secondary data analysis using baseline data from a larger CGA-Swed randomized control trial with frail people 75≥. In this study, a total of 119 people responded to the self-determination assessment Impact on Participation and Autonomy-Older persons (IPA-O). The data was analysed with the Fisher’s exact test to test differences in proportions of perceived self-determination. Decreased cognition was broadly defined as a score below 25 points on the Mini Mental State Examination (MMSE). The Relative Risk (RR) with a 95% Confidence Interval (CI) was used to explore the risk of perceiving reduced self-determination. Results High degree of self-determination was identified in Financial situation, 94 per cent among participants with intact cognition respectively 92 per cent among those with decreased cognition. Regardless of cognition, approximately a third of the sample perceived low levels of self-determination in Mobility and in Social relationships. For people with decreased cognition, the relative risk for perceiving reduced self-determination was statistically significant higher in activities related to Self-care (item 6, p = 0.044, RR = 2.38), and in Social relationship (item 16, p = 0.041, RR = 3.71) when comparing with the participants with intact cognition. Conclusion Perceiving self-determination when being old, frail and having decreased cognition is possible but is dependent upon which activities that are involved. For increased perceptions of self-determination, healthcare needs should be carried out according to older people’s wants and wishes. Frail older people with decreased cognition should be treated as being experts in their own lives, and healthcare professionals should be enablers in supporting the older people to navigate them in reaching their desired direction. Trial registration: ClinicalTrials.gov, NCT02773914. Retrospectively registered 16 May 2016.