How Older Adults with Intellectual Disability and Mild Dementia Experience Self-Determination in Long-Term Residential Care in Chile

Increased life expectancy among people with intellectual disability has led to a growing number of individuals aging with dementia, raising critical questions regarding how self-determination is experienced under these conditions. This qualitative study explored perceived self-determination among adults with mild to moderate intellectual disability and mild dementia residing in long-term residential care facilities in Chile. Semi-structured interviews were conducted with 91 participants, using accessible communication strategies and visual supports. Data were analyzed through reflexive thematic analysis, guided by Causal Agency Theory. Five interrelated themes described how self-determination was expressed through everyday choices and preferences, goal-directed action, beliefs regarding personal control, relational and environmental conditions, and perceived changes over time. Findings show that self-determination is articulated through concrete, situated experiences rather than abstract notions of capacity, and is shaped by support practices and institutional contexts, highlighting the importance of enabling environments for sustaining autonomous participation.