Promoting independence: but promoting what and how?

Abstract

‘Promoting independence’ is a central theme of recent United Kindgdom health and social care policy development but is rarely defined. Instead it is generally assumed that we know what independence means. Based on a review of the literature on independence in older age, this paper examines the terms and meanings. While the most common conceptualisation equates independence with the absence of reliance on others, for older people themselves independence is a broader concept that encompasses not only self-reliance but also self-esteem, self-determination, purpose in life, personal growth and continuity of the self. Drawing on previous work in the field of health promotion, we therefore put forward a model that takes older people's views into account and that reconceptualises independence as two intersecting dimensions representing levels of dependence and levels of independence. While dependence equates with reliance on others, independence can be seen as subjectively self-assessed lived experience. Thus it becomes possible to combine high levels of dependence with high levels of experienced or felt independence, a particularly pertinent combination for service providers. Finally we examine the ways in which independence thus conceptualised can be promoted at the individual, institutional, community and societal levels.