Intended for healthcare professionals

Education And Debate

Care of older people: Maintaining the dignity and autonomy of older people in the healthcare setting

BMJ 2001; 322 doi: (Published 17 March 2001) Cite this as: BMJ 2001;322:668
  1. Kate Lothian, research assistant,
  2. Ian Philp, professor of health care for elderly people (
  1. Sheffield Institute for Studies on Ageing, Community Sciences Centre, Northern General Hospital, Sheffield S5 7AU
  1. Correspondence to: I Philp

    This is the first in a series of four articles

    This series will explore key issues in the quality of health care for older people. The basis of these articles is the extensive literature reviews undertaken to inform the development of a national service framework for NHS care of older people in England. As a result of an investigation by the Observer newspaper in 1997, the UK Health Advisory Service published a report with 17 recommendations,1 including the establishment of the national service framework, made up of key indicators of quality care and service provision. Background work for the framework covered evidence about quality in the organisation and delivery of health care for older people. It included health promotion; disease prevention; primary health care; general hospital care; specialist care by geriatric, psychogeriatric, and palliative care services; intermediate care and long term care in the community; and residential and nursing homes. Detailed attention was also given to the care of older people with stroke, falls and their consequences, depression, and dementia. Advice was based not only on evidence based practice but also on the value of fair access to care, a person centred approach, and whole systems working. This series will focus on four areas relating to health care for older people. This first article examines issues relating to the dignity and autonomy of older people.

    Summary points

    Anecdotal evidence suggests that older people's dignity and autonomy is being undermined in the health care setting

    Many healthcare professionals hold stereotypical, negative attitudes towards older people

    Tackling negative attitudes through exposure and education can help to preserve older patients' dignity and autonomy

    Giving older people and their carers adequate information for them to make informed choices about care further increases autonomy

    Insensitivity and disrespect

    Health services should aim to preserve dignity and autonomy and minimise distress …

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