Experience and Perceptions of Changes in the Living Environment by Older People Losing Their Autonomy: A Qualitative Study in the Caribbean.

rationaleAlthough the literature recognizes the importance of older individuals' subjective perceptions about their living environments, past studies on the subject have been primarily restricted to nursing home settings.

objectiveThis study aimed to better understand the experiences, perceptions, coping mechanisms, and needs of older people living in Martinique who had to modify their living environment because of a decline of autonomy.

designQualitative study using content analysis.

methodsSemi-structured one-on-one interviews were conducted with older people living in three different types of environment i) at home with professional support, ii) in a foster care family, iii) in a nursing home. Interviews were conducted until data saturation was reached. A conventional content analysis approach was used.

resultsThirty-four participants were interviewed. Subjects perceived ageing as a factor leading to changes in their living environment. However, they did not spontaneously evoke their functional/structural impairments nor their activity limitations as if the change of living environment could reduce the perceived loss of autonomy by maintaining an acceptable participation. Participants mostly experienced change as both inevitable and as a relief as it took them out of isolation and domestic hardship. This reaction was somewhat facilitated by spiritual beliefs as the changes were interpreted as the will of spiritual forces. Family and social relationships appeared to be more important determinants of participants' perception of changes in living environment than was health status. We found differences between the three groups regarding familial relationship, fear of death, acceptance of change, and unmet needs. Unmet needs were particularly expressed by those living in foster care. The concept of "feeling at home", which emerged as essential for all participants, was lacking in foster care families.

conclusionPerceived autonomy, including not only functional/structural impairments, but also, social interactions, should be carefully considered when developing support services for older individuals.