Using Mixed Methods to Inform our Understanding of Independence in Older People

Abstract

Introduction: Older people’s views are often missing from interpretations of independence and the instruments used to measure it in policy, health, and social care settings. Therefore, it is unclear whether services designed to promote independence are promoting an independence that is important and meaningful, to older people. This thesis aims to deepen understanding of how older people individually perceive independence and how those understandings are influenced over time and whether they align with the concept of independence that informs policy and practice.

Methods: Community-dwelling older people aged 75+ were recruited from the Community Ageing Research 75+ (CARE75+) cohort. Fourteen participated in repeat interviews conducted twelve months apart, and data from the whole cohort (N=1277) contributed to the quantitative analysis. Framed by the meta-paradigm of dialectical pluralism, the project followed a sequential mixed methods design. I conducted semi-structured interviews to inform the selection of variables for the quantitative analysis. Using a novel longitudinal mixed-method approach I elucidated the relationship between qualitative and quantitative interpretations of independence through time.

Results: Older participants perceived independence as more than the functional abilities that are the hallmark of existing assessments of independence. Autonomy, control and participation were shared concepts within individual constructs of independence and their importance changed little over time despite disruption to individuals’ life courses. Quantitatively, depression and frailty were the strongest predictors of reduced functional independence over time.

Conclusion: Older people developed interpretations of independence unique to their experiences and values. Importantly, their constructs of independence were not constrained to the completion of everyday activities of daily living but were defined by personal values and self-standards. The results suggest a need to reframe the interpretation of existing health service assessments of independence to ask what each item means for the individual and what does it do for their representation of independence.