The Brazilian population is aging, necessitating a reevaluation of healthcare in the country. In therapeutic processes, there are technically qualified healthcare professionals to propose appropriate treatments. However, often, the elderly cannot express their preferences due to illnesses, and healthcare decisions may be influenced by family or close individuals. This raises questions about how to protect the will of elderly patients and ensure their capacity to make decisions, especially in a caregiving culture that tends to underestimate the elderly's ability to manage their health. The term "autonomy" has been interpreted in various ways, with some interpretations broader than others. Autonomy in the elderly is defined as their capacity to confront, control, and make personal decisions according to their daily preferences. From a gerontological perspective, autonomy is seen as the ability to judge and act and can be approached from two perspectives: as an ethical responsibility for the elderly and as a moral requirement for their caregivers. Autonomy is a fundamental need related to aging, and the social environment significantly impacts how this life stage is experienced. Not all elderly patients who depend on others for care have compromised autonomy. Often, they are not given the opportunity to express their desires, which conflicts with the beliefs of healthcare professionals or the wishes of the family. Several studies have been conducted to analyze the impact of autonomy at different life stages, with particular attention to the elderly population due to sociocultural and physiological transformations affecting the aging process. The perception of autonomy in old age is influenced by individual, psychosocial, and sociodemographic factors. Race and age are factors influencing the perception of autonomy, with white elderly individuals having a greater perception of autonomy compared to individuals of other ethnicities. Furthermore, younger elderly individuals tend to have greater autonomy compared to the older elderly. As the level of education increases, elderly individuals are more likely to make active decisions. General health and quality of life have a significant impact on their perception of autonomy. The ability to communicate and express desires is essential for autonomy, but the elderly may face difficulties due to the loss of mobility, hearing, and vision, as well as the lack of control over daily situations. Loneliness and chronic non-communicable diseases can also lead to communication difficulties. Additionally, in some cases, the loss of cognitive functions may be related to lifestyle or daily situations, such as isolation during the COVID-19 pandemic, highlighting the importance of the mental health of the elderly. In summary, the autonomy of the elderly is an important issue, and ensuring that they have the capacity to make active decisions and express their preferences is essential for satisfactory aging and, consequently, quality of life.
