Systematic review: what interventions improve dignity for older patients in hospital?

Aims and objectives. To review the evidence for interventions to improve dignity for older patients in acute care.Background. High profile cases have highlighted failure to provide dignified carefor older people in hospitals. There is good evidence on what older people con-sider is important for dignified care and abundant recommendations on improvingdignity, but it is unclear which interventions are effective.Design. Narrative systematic review.Methods. The Cochrane library, MEDLINE, EMBASE, CINAHL, BNI andHMIC electronic databases were searched for intervention studies of any designaiming to improve inpatients’ dignity. The main population of interest was olderpatients, but the search included all patients. Studies that focused on ‘dignity ther-apy’ were excluded.Results. There were no intervention studies found in any country which aimed toimprove patient dignity in hospitals which included evaluation of the effect. Anarrative overview of papers that described implementing dignity interventions inpractice but included no formal evaluation was, therefore, undertaken. Fivepapers were identified. Three themes were identified: knowing the person; part-nership between older people and health care professionals; and, effective commu-nication and clinical leadership. The effect on dignity of improving these isuntested.Conclusions. There are currently no studies that have tested interventions toimprove the dignity of older people (nor anyone else) in hospitals. Furtherresearch using well designed trials of interventions is needed. There is also a needto develop and validate outcome measures for interventions to improve dignity.Relevance to clinical practice. At present nurses lack robust evidence on how to improve dignity. There is ample evidence on what undermines patients’ dignit