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.