The concept of autonomy is essential in the practice and study of gerontology and in long-term care policies. For older adults with expanding care needs, scores from tightly specified assessment instruments, which aim to measure the autonomy of service users, usually determine access to social services. These instruments emphasise functional independence in the performance of activities of daily living. In an effort to broaden the understanding of autonomy into needs assessment practice, the province of Québec (Canada) added social and relational elements into the assessment tool. In the wake of these changes, this article studies the interaction between the use of assessment instruments and the extent to which they alter how older adults define their autonomy as service users. This matters since the conceptualisation of autonomy shapes the formulation of long-term care policy problems, influencing both the demand and supply of services and the types of services that ought to be prioritised by governments. Relying on focus groups, this study shows that the functional autonomy frame dominates problem definitions, while social/relational framings are marginal. This reflects the more authoritative weight of functional autonomy within the assessment tool and contributes to the biomedicalisation of aging.

中文翻译：

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评估工具会影响政策偏好吗？分析政策框架对老年人自主概念化的影响

自治的概念在老年学的实践和研究以及长期护理政策中是必不可少的。对于护理需求不断扩大的老年人，旨在衡量服务使用者自主性的严格指定的评估工具的分数通常决定了他们获得社会服务的机会。这些工具强调日常生活活动中的功能独立性。为了将自主性的理解扩大到需求评估实践中，魁北克省（加拿大）在评估工具中添加了社会和关系元素。在这些变化之后，本文研究了评估工具的使用与它们改变老年人如何定义他们作为服务使用者的自主权的程度之间的相互作用。这很重要，因为自治的概念塑造了长期护理政策问题的制定，影响了服务的需求和供应以及政府应该优先考虑的服务类型。依靠焦点小组，这项研究表明，功能自主框架主导问题定义，而社会/关系框架是边缘的。这反映了评估工具中功能自主权的权威性，并有助于老龄化的生物医学化。