Threats to dignified care for older people with mental illness: a qualitative analysis

Abstract Background The dual vulnerability inherent in advanced age and mental illness makes the provision of dignified care critical. However, current literature has given limited attention to identifying the specific threats and compromises to dignity experienced by older adults living with mental health conditions. The aim of this study was to investigate nurses’ perceptions of threats to dignified care for older people with mental illness. Methods A qualitative interview study was conducted. Semi-structured and individual interviews with nurses (n = 27) were undertaken. Content analysis was used to make sense of the data collected. Results Threats to dignified care for older people included unavoidable personal context, inadequate organizational infrastructure, and sociocultural traumatic wounds. The first category included the traumatic nature of the illness and being a victim of ageism. The second category included lack of necessary physical space and absence of integrated end-of-life care. The third category included the dominance of culturally rooted explanatory models of illness, lack of family support, and living in an ignorant society. The reports of, and threats of, violence and abuse directed towards older people are particularly concerning. Conclusions Sociocultural dynamics pose a direct challenge to the dignity of older individuals, often culminating in the threat of undignified care. At the heart of this issue are several core influences: the effects of culturally rooted explanatory models of illness, the presence of insufficient family support, and the pervasive consequences of inhabiting a society marked by traumatic historical and cultural wounds. These components are critical determinants of the quality of dignified care received by older adults. Consequently, a focused combination of educational and sociocultural interventions is urgently needed to dismantle the cultural stigma and prejudice evident within this care context.