Maintaining dignity

Dignity is a multifaceted concept that refers to the sense of worth, honour, and values of a person regardless of their age, gender, religion, or social status. [1] Dignity is closely related to the human rights of individuals and informs strict frameworks that aged care providers must follow. [2] For older people, dignity is often related to their independence and capacity to make decisions and control their own lives. For people who have not grown up with digital technologies, the use of technology in care delivery has the potential to threaten their sense of dignity. [3]

The Australian Royal Commission into Aged Care Quality and Safety recommends that dignity should be a priority in the delivery of aged care to ensure that all older adults feel valued regardless of their physical or cognitive abilities. [4] Maintaining dignity is important to enhance an individual’s physical, emotional, and psychological wellbeing and provide high-quality care. To support dignity, care should be delivered with respect, provide emotional support, and be sensitive of an individual’s personal life experiences to build trust. [1] When people are not treated with dignity they may experience feelings of shame, humiliation, and powerlessness. [1] For some individuals, the use of new digital systems in care delivery can make them more dependent on others and they may experience feelings of helplessness. [3] Therefore, promoting dignity in aged care can help to create a more compassionate and respectful culture within care settings. 
 

When integrating technology into the delivery of aged care services, it is important to ensure that the dignity of those receiving care is maintained. This evidence theme summarises one of the key issues we identified as part of a scoping review of research on human factors and technology in aged care. If you need more information on this topic, try using the PubMed searches below.

We identified nine articles that discussed dignity concerns for older adults when using technology in aged care settings. [5-14] The articles suggested:

• Older adults can find the concept of digital companionship to be a threat to their sense of dignity, and the thought of having a robotic pet can be potentially confronting. [5]
• The use of surveillance cameras in aged care resident’s rooms were considered to pose a risk to the dignity of older adults especially when receiving care on their beds. [6] Residents were concerned about whether recording such events was appropriate, and how older adults living with dementia would be able to provide consent for technology use. People were also concerned that family members might provide consent on their behalf which was often considered a violation of the individual’s dignity. [7] 
• The use of robots raised similar concerns for loss of dignity, as older people were concerned someone could be watching them via the robot. [8]
• The use of robotic pets with older people living with dementia raised the concern that individuals may be infantilised and feel their dignity as a human being was undermined due to their reduced cognitive capacity. [9] 
• The use of technology in aged care was also considered to change power dynamics in the relationship between the caregiver and older person. As caregivers were often considered experts in technology by care recipients; they were deemed to hold the power. [10]
• Dignity is associated with personal privacy. It might therefore be compromised if robots with recording abilities are brought in to assist with personal care activities. [14] 

Several recommendations were made in the included articles to assist in maintaining the dignity of older people in aged care. Service providers may want to consider:

• The appropriateness of using surveillance technologies that may reduce human interaction for aged care residents. [6] For more information see the Quality of human interaction theme. 
• Whether more careful consideration for the location of surveillance technologies could work to prevent any loss of dignity (i.e., not positioned directly in bathrooms or above resident’s beds) and assist to balance the need for monitoring and preservation of dignity. [11]
• How existing procedures could be adapted to protect the dignity and privacy of residents, families, and staff to support the use of technology in improving older people's well‐being, communication, and to reduce staff stress. [12] 
• Exploring what technology means to older people and providing education for the role of technology in aged care. This may encourage an understanding that technology can support staff in delivery high-quality care, and potentially support older persons’ integrity and dignity. [13]
• How everyone’s dignity should be respected regardless of their level of cognitive function and awareness of their surrounding environment. [6] The use of technology should not threaten dignity. [10]

This evidence theme has been informed by the results of a rapid scoping review intended to map the current published research in this area. We acknowledge that our findings reflect on the evidence available and that this evidence varies in quality. This theme is closely related to privacy and safety which is reported as a separate theme. 
 

1. Dignity and respect in aged care. Aust Nurs Midwifery J. 2018;25(7):24-25.
2. Meenan H, Rees N, Doron I, Aboderin I. Towards human rights in residential care for older persons: International perspectives. London, [England]: Routledge; 2016.
3. Raja M, Uhrenfeldt L, Galvin KT, Kymre IG. Older adults’ sense of dignity in digitally led healthcare. Nurs Ethics. 2022;29(6):1518-1529.
4. Royal Commission into Aged Care Quality and Safety. Final report: Care, dignity and respect - Volume 1 summary and recommendations [Internet]. Canberra, ACT: Commonwealth of Australia; 2021 [cited 2023 Mar 21]. Available from: https://agedcare.royalcommission.gov.au/publications/final-report-volume-1 
5. Waycott J, Zhao W, Kelly RM, Robertson E. Technology-mediated enrichment in aged care: Survey and interview study. JMIR Aging. 2022;5(2). 
6. Berridge C, Halpern J, Levy K. Cameras on beds: The ethics of surveillance in nursing home rooms. AJOB Empir Bioeth. 2019;10(1):55-62. 
7. Berridge C, Wetle TF. Why older adults and their children disagree about in-home surveillance technology, sensors, and tracking. Gerontologist. 2020;60(5):926-934. 
8. Poulsen A, Fosch-Villaronga E, Burmeister OK. Cybersecurity, value sensing robots for LGBTIQ+ elderly, and the need for revised codes of conduct. Aust J Inf Sys. 2020;24(0). 
9. Tan SY, Taeihagh A, Tripathi A. Tensions and antagonistic interactions of risks and ethics of using robotics and autonomous systems in long-term care. Technol Forecast Soc Change. 2021;167. 
10. Leikas J, Kulju M. Ethical consideration of home monitoring technology: A qualitative focus group study. Gerontechnology. 2018;17(1):38-47. 
11. Bradford DK, Kasteren YV, Zhang Q, Karunanithi M. Watching over me: Positive, negative and neutral perceptions of in-home monitoring held by independent-living older residents in an Australian pilot study. Aging Soc. 2018;38(7):1377-1398. 
12. Bourbonnais A, Rousseau J, Lalonde M-H, Meunier J, Lapierre N, Gagnon M-P. Conditions and ethical challenges that could influence the implementation of technologies in nursing homes: A qualitative study. Int J Older People Nurs. 2019;14(4):e12266. 
13. Siren A, Amilon A, Larsen GK, Mehlsen L. The promise of assistive technology in institutionalized old age care: Economic efficiency, improved working conditions, and better quality of care? Disabil Rehabil Assist Technol. 2021;16(5):483-489. 
14. Papadopoulos I, Ali S, Papadopoulos C, Castro N, Faulkes N, Koulouglioti C. A qualitative exploration of care homes workers' views and training needs in relation to the use of socially assistive humanoid robots in their workplace. Int J Older People Nurs. 2022;17(3):1-9.