I applaud Theresa A. Harvath's respect of her patient's wish to spend the rest of her life in her own home rather than in a nursing home ("What if Maslow Was Wrong?" Viewpoint, April). While creating care plans for older patients, nurses must understand older adults' fear of losing autonomy and incorporate that understanding into the care given. And just as the Family Preference Index is an important approach for measuring a family's preferences in the care given to elderly relatives, a Patient Preference Index would help nurses to understand how much an older patient values independence, even when ill. The need for self-actualization sits at the apex of Maslow's pyramid, and the need for autonomy and dignity are integral to it for many older adults.

Pratima Gupta

San Francisco