The purpose of this discussion is to present a theoretical perspective that illustrates how threats to the dignity of community-dwelling older adults can directly contribute to the types of physiologic and cellular damage that result in accelerated aging and increased morbidity and mortality.
Dignity can be conceptualized as a form of resilient health potential that plays an important role in the maintenance of health and well-being in later life. Prior qualitative research on dignity has demonstrated that older adults’ experiences of threats to dignity and dignity loss are consistent with stress appraisal processes. Although most research to date has focused on the dignity of older adults residing in institutional settings or near the end of life, there is a need for greater understanding of the impacts of threats to dignity for community-dwelling older adults. This is important since the majority of the global aging population resides in community settings.
We conducted a search of major databases such as PubMed, CINAHL, and Web of Science for articles in English with abstracts containing the word ‘dignity’ published anytime until December 2014. A socio-ecological model of resilience among older adults developed by nurse theorists Sarah Szanton and Jessica Gill was then used as a lens for classification of relevant abstracted findings according to societal, community, family/interpersonal and individual-level threats to dignity in later life, and possible physiologic and cellular consequences of those threats.
Societal-level factors (such as global and economic inequalities, racism, classism, and other types of discrimination), community-level factors (such as deteriorating neighborhoods and lack of transportation), family/interpersonal factors (such as social isolation and inadequate caregiver support) and individual-level factors (such as illness or loss of function) can combine to form synergistic, overlapping threats to the dignity of community-dwelling older adults. When these threats to dignity are experienced chronically over time, maladaptive stress responses can lead to cellular aging, pathological changes, and increased risk of mortality
Preservation of human dignity is both a social justice issue and a nursing imperative. This model illustrates how intersections of factors at societal, community, interpersonal and individual levels affect the dignity and therefore resilience of older adult populations across the globe. Adoption of a resilience perspective on dignity also sheds light on the many opportunities nurses have to promote the health and well-being of community-dwelling older adults through intervention at multiple levels of society.