Introduction

The perspectives of older people on dignity in care have been largely overlooked in British policies, and the tendency has been to look at ways in which care providers should ‘deliver dignity’ by reference to agreed standards. For example, the Dignity Challenge developed in 2006 identified 10 dignity tests against which services could be evaluated (Cass et al, 2009). In this project, the research team took the view that a better understanding of dignity in later life was needed, which was informed by the experiences of older people, including, but not limited to, those with experiences as service users.

Four questions shaped the research:

• 1. What preparations do older adults who are facing death at a near but uncertain time make for the process of dying and death?

• 2. What accounts are given about dignity in daily life by older adults during this phase in their life?

• 3. What resources are available to these older adults to draw on?

• 4. What factors are perceived to support or undermine a sense of dignity?

Dignity has both personal and social meanings, and the two are closely interrelated. The theoretical model developed by Nordenfelt (2004) was a valuable starting point for this project, as it takes both into account. It proposes four ‘varieties’ of dignity. First, the dignity of merit refers to the high rank of individuals because of the social role they occupy (the historical meaning of dignity) as well as to dignity earned through socially valued achievements. The dignity of moral stature concerns individual conduct and is linked to self-respect, which is shaped by prevalent cultural values, giving it a social as well as personal meaning. Importantly, this type of dignity also draws attention to the conduct of staff in care services and the impact of this on their dignity and moral stature. The third variety – the dignity of identity – is as Nordenfelt expressed it, ‘the dignity that we attach to ourselves as integrated and autonomous persons’ (2009, p 33). It is evidently challenged in old age by failing health and the loss of capacity for self-care. The dignity of identity also has social as well as personal meaning, exemplified in the institutionalisation of older people and the associated loss of individual identity. The fourth of Nordenfelt's varieties is the dignity of being human.