While people express a desire to be “treated with dignity” or others plead to have dignity “maintained,” it’s not always clear what this means in practical terms.
There are six definitions for dignity in the dictionary, and the word can start to sound a bit posh. Perhaps this one seems to be the most relevant: “bearing, conduct, or speech indicative of self-respect or appreciation of the formality or gravity of any occasion or situation.” Another way of putting it would be that one person’s actions show they care about another.
“To me, dignity means a recognition of the person: as valued, and as an equal in any interactions, regardless of any infirmity or disability,” says Dr. G. Allen Power, M.D., a geriatrician, dementia expert and author of “Dementia Beyond Drugs: Changing the Culture of Care.” “It means recognizing that all people have certain basic rights. In the case of health care, these include the right to be informed of one's medical diagnoses, the right to make choices regarding not only treatment decisions, but also all aspects of daily living.”
Treating people with dignity extends to those who no longer seem able to self-advocate. “Dignity also means recognizing older people and those living with dementia as adults; not infantilizing, talking down to, or seeing them as childlike,” Dr. Power says. “We support our parents and assist them to be as capable as possible, but we do not "parent" them.”
Treating people with kindness and caring seems obvious and simple, but one man’s dignity is another man’s insult. Pride and dignity, while distinctly different feelings, can be in conflict when a person has to rely on another in some capacity.
“There are many societal stigmas around both aging and dementia,” Dr. Power explains. “Society tends to value older people less than those who are younger and who are gainfully employed. We also attach a great deal of worth to our cognitive abilities, and those who are less able are devalued and marginalized.”
Within society is a complex healthcare system that, according to Dr. Power, does not always set up people for dignified moments.
“Our care systems that are more focused on tasks than people and are often very rigid,” he says. “As a result, the desires and needs of the individual are often lost in an inflexible care system, and many of the practices that result also rob people of their dignity. A perfect example is rotating care staff at our convenience, which subjects people to receiving showers and other personal care from a parade of strangers.”
Dementia can add another layer of challenges for all parties when striving for dignity. “There are many myths and stigmas around dementia that fuel people's fears, and lead them to believe that the person is "fading away," is incapable of being engaged meaningfully, or having input and choice in daily living. These beliefs set up a series of self-fulfilling prophecies, where we expect less of people and therefore do not provide an environment in which they can be more, and then their inability to do more reinforces our view that they are incapable,” he says.
If you have a loved one who needs care and are concerned about respecting their dignity, try Dr. Power’s suggestions for how to consciously treat them with the decency that they want:
*Learn and use optimal communication techniques so that people are well understood and can understand you. Also learn how they prefer to be addressed.
*Never enter a person's room or apartment without identifying yourself and securing permission to enter and engage with them.
*Engage the person as an equal: at eye level, spoken to as an adult, with appropriate pacing and enunciation for them to hear you; and with body language and attention that shows your openness and sincerity.
*Always connect with the person before launching into any task.
*Solicit frequent input and have the person direct all care as far as she is able. Check in frequently. I teach the acronym "SEE": Slow down, Engage, Empower.
*Do tasks with people, not to them or for them.
*"No" means "no." Never force care on a person who is declining.
*Do not argue with or deny what people are feeling or expressing. Seek to understand their perspective.
*Engage the person during any tasks; do not treat them like an object.
*Always describe the person with words that you would want used to describe you. Do not use pejorative labels or terms that objectify or blame people.
*Be open to learning from the person. I have heard it said that in any interaction, we should always assume that the other person is smarter than we are!
If you have a story or a tip about dignity, please share.
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