Maintaining the Dignity and Autonomy of Older People in the Healthcare Setting

Maintaining the Dignity and Autonomy of Older People in the Healthcare Setting

• TribecaCare
• 11th Apr 2025

This series will explore key issues in the quality of health care for older people. The basis of these articles is the extensive literature reviews undertaken to inform the development of a national service framework for NHS care of older people in England.

 

As a result of an investigation by the Observer newspaper in 1997, the UK Health Advisory Service published a report with 17 recommendations, including the establishment of the national service framework, made up of key indicators of quality care and service provision.

 

Background work for the framework covered evidence about quality in the organisation and delivery of health care for older people. It included health promotion; disease prevention; primary health care; general hospital care; specialist care by geriatric, psychogeriatric, and palliative care services; intermediate care and long term care in the community; and residential and nursing homes.

 

Detailed attention was also given to the care of older people with stroke, falls and their consequences, depression, and dementia. Advice was based not only on evidence based practice but also on the value of fair access to care, a person-centred approach, and whole systems working. This series will focus on four areas relating to health care for older people. This first article examines issues relating to the dignity and autonomy of older people”.

 

Insensitivity and disrespect

 

“Health services should aim to preserve dignity and autonomy and minimise distress among patients. Yet the literature suggests that, in many cases, these objectives are not being reached. Although the empirical evidence on dignity is limited, many valuable qualitative data are available. Surveys conducted primarily by older people’s advocacy groups have directly obtained the views and experiences of older service users and their carers. They show an alarming picture of older people being treated unacceptably—insensitively and disrespectfully—by healthcare staff (see box for examples).

 

Owing to the anecdotal nature of the data, it is difficult to assess how widespread such bad practice is. The international authorship, however, of articles on older people’s dignity and autonomy in health care suggests that difficulties in maintaining high standards may be a global problem”.

 

Negative comments of older service users and their carers (Examples from Research Study)

 

• “She was left to lie in her excrement and urine”
• “An old boy about 90 . . . had wet himself. On changing him, they left him lying on the bed (naked), curtains all open”
• “I was both shocked and appalled at the callous attitude of the nursing staff on the ward”
• “I found my mum’s dignity was non-existent in their eyes”
• “There were problems with preserving dignity and individuality when meeting patients’ essential needs”
• “The GP just says ‘confused.’ She’s never explained it”

The Difference between Dignity and Autonomy

 

“Although interrelated, dignity and autonomy are slightly different concepts.
Dignity refers to an individual maintaining self-respect and being valued by others. Autonomy refers to individual control of decision making and other activities.

 

Literature suggests that both the dignity and the autonomy of older people are often undermined in healthcare settings. Dignity is challenged primarily through negative interactions between staff and patients, a lack of regard for patients’ privacy, and a general insensitivity to the needs and desires of an older population. Autonomy is threatened when patients (and their carers) are not given adequate information or the opportunity to understand fully their diagnosis and to make informed choices about their care. Older people in particular easily become disempowered in healthcare settings”.

 

Raising standards

 

“How can standards in geriatric health care be raised? One way is to examine the examples of good practice that exist and identify elements that can be generalised to health services globally. Much of the qualitative information already mentioned, along with several documents focusing specifically on good practice, reports positive comments made by older people and their carers about care received. Such comments shed light on elements of service provision that allow older people to feel that they are retaining their dignity and autonomy.

 

The feedback shows that information provision and the quality of interactions between staff and patients are key issues.”

 

Tackling negative attitudes through training

 

“The qualitative data cited in this article suggest that attitudes of staff greatly affect both the quality of treatment of older people and the regard given to maintaining their dignity and autonomy. This is a concept well supported by scientific literature: “A nurse’s pessimistic viewpoint can translate into a loss of dignity, identity and decision-making power for seniors.”

 

And indeed, the evidence suggests that a considerable proportion of medical professionals hold pessimistic views of older people. A survey of nurses and students working with older people in the clinical setting concluded that the sample “expressed stereotypical views about old people in general.” Such findings are supported by the recent report by the UK Health Advisory Service: “We did encounter examples of prejudiced attitudes towards older people and their care at almost every level of the service system.” Researchers conducting literature reviews have reached similar conclusions. Alarmingly, some research has suggested that many professionals hold more ageist attitudes than the general population.

 

The literature shows that a key means of tackling poor attitudes by staff towards older people is through extensive and continued training. One study reported that more positive attitudes towards older people were found among nurses working in elderly care than among those working in acute care (which covers all ages) and attributed this to a more specialised training in gerontology.

 

Swedish researchers reported that after a year of special education, medical trainees came to view older people with dementia as “unique human beings” rather than “a homogeneous group.” Another study reported more favourable attitudes towards the care of older people among students attached to a geriatric ward than among those attached to a general ward.

 

It seems, then, that training in geriatrics has a positive effect on the attitudes of staff. In fact, the evidence shows that mere exposure to certain groups of older people is beneficial. Older students and those with grandparents as role models have been found to have better attitudes towards older people. Indeed, several authors have written about the importance of healthcare staff being exposed to older people who are healthy as well as to those who are patients. Increased and improved training and exposure to older people is also likely to do much to raise the status of geriatrics. Improved status is likely to have a positive impact on attitudes and encourage more individuals into the field, which in turn will benefit older patients”.

 

What Eldercare Service Providers Need to Consider

 

Reputed Eldercare companies base their services on extensive and in-depth training. Quality nursing care, helpfulness, politeness and above all, kindness have to become second nature to a caregiver. The most important aspect about looking after elderly people is that they are often ill, unhappy, irrational and if undergoing mental deterioration as in the case of sufferers of Dementia, then they can be just plain difficult to handle.

 

However, they are human beings, they are still people. They must be treated respectfully and with patience. Asking the same question repeatedly because the patient has Alzheimer’s is related to his or her physical and clinical conditions – he or she cannot help the way they behave. The same patience is required of primary caregiver-members of the families, as well.

 

Tribeca Care, Eastern India’s largest service care provider in the eldercare space has a rigorous training programme for all levels of staff and caregivers. In addition, there is monitoring of such care providers, 24/7. “Happy Members, Respected Members” is the credo by which all Care Staff at Tribeca Eldercare look after their seniors.

 

Tribeca Care’s Vision:

 

• At Tribeca Care, we believe we can transform the lives of the Elderly. To create a world where they feel nurtured, a place where dignity and grace live.
• To forge a sense of family so they never feel the absence of their own.
• Every life we touch we will touch with compassion and passion.
• Every relationship we build will be a meaningful one.
• We make a difference because we believe we can.