Exploring the Ethical Dimensions of Care Dependency in Older People: A Transpersonal View

Care dependency in older adults is a growing global concern, driven by population ageing and the increasing prevalence of chronic conditions. Beyond its clinical implications, care dependency involves ethical, cultural, and transpersonal dimensions that shape the lived experiences of individuals and caregivers. This study aims to refine the concept of care dependency through an explicitly transpersonal and culturally sensitive lens, informing practice, education, and policy.

Following Walker and Avant's concept analysis framework, a systematic review of the literature was conducted. Key attributes, antecedents, and consequences were identified through an iterative process of data synthesis and theoretical reflection, including the development of model, borderline, and contrary cases to explicitly illustrate conceptual application.

The analysis identified four defining attributes: loss of autonomy; erosion of identity and self-image; biographical rupture; and negative coping. Antecedents include physiological ageing, chronic degenerative disease, cognitive decline, and psychosocial/cultural factors that constrain autonomy. Consequences extend beyond functional limitations, affecting emotional well-being and generating ethical and context-specific decisions. The cases demonstrate a continuum from full dependency to complete autonomy and make visible how context and culture shape these attributes.

Care dependency emerges as a multidimensional, ethically situated phenomenon, shaped by relationships, culture, and context. The proposed conceptual framework offers practical guidance for applying a transpersonal approach, prioritizing mutual presence, active listening, cultural attunement, and shared decision-making to preserve dignity, meaning, and connection in daily care. Future research should explore the framework's applicability through qualitative studies in diverse settings to translate it into actionable, ethically grounded tools and interventions.