Dignity Therapy for Older Adults in Long-term Care Institutions

Due to the aging global population, an increasing number of elderly people are spending their remaining years in long-term care facilities. Common physical and psychological challenges in older adults increase with aging, significantly increasing their vulnerability and dependency and diminishing their sense of self and dignity. Loss of dignity is one of the most common challenges faced by older adults and can lead to various psychological issues, such as shame, depression, increased physical and mental stress, and even suicidal thoughts and behaviors. Therefore, care services for the elderly should strive to maintain and enhance their dignity and mitigate the negative impacts of this loss of dignity. Dignity therapy can help elderly people understand themselves by clarifying the value and meaning of life, fostering a sense of dignity and meaning. By creating a permanent, written record of their thoughts and words, which can be shared with important family members and friends, it can improve communication and interaction with family and friends, enhance their sense of dignity, and foster a sense of being functional, contributing, and valuable. The overall purpose of this three-year study was to investigate the effectiveness, applicability, and feasibility of dignity therapy for elderly people in long-term care facilities. The effectiveness of dignity therapy was assessed using indicators related to dignity and depression. Regarding the applicability and feasibility of dignity therapy, the perspectives of residents in long-term care facilities (experimental group), family members who received written documentation, and healthcare professionals were surveyed. The costs associated with the dignity therapy process, including labor, time, and financial costs, were assessed. This study employed a randomized controlled experimental design and recruited residents aged 65 and older from long-term care facilities in southern Taiwan. The experimental group received dignity therapy, while the control group received institutional care. The effective sample size was calculated to be 54 participants, with a minimum of 27 participants in each group. The Patient Dignity Inventory (Mandarin Version, PDI-MV) and the Patient Health Questionnaire-9 (PHQ-9) were used to assess the effectiveness of dignity therapy in residents of long-term care facilities before intervention (T0), immediately after intervention (T1), at one month (T2), two months (T3), three months (T4), and six months (T5). An 18-item semi-structured interview questionnaire was used to survey residents of long-term care facilities (experimental group), 100 family members who received written documentation, and 50 healthcare professionals regarding their opinions on the applicability and feasibility of dignity therapy. The study also calculated the associated human, time, and financial costs. This study anticipates that dignity therapy can enhance the dignity of residents in long-term care facilities and is applicable and feasible for these individuals. The study aims to provide academic and practical communities with a better understanding of the psychological, social, and spiritual needs of residents in long-term care facilities, as well as a reference for developing evidence-based care policies related to dignity therapy.