Invited Perspective| Volume 29, ISSUE 10, P1000-1008, October 2021

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Role of Dignity in Mental Healthcare: Impact on Ageism and Human Rights of Older Persons


      • Dignity in older persons is a multidimensional construct comprising of self-respect, social acknowledgment, independence, and privacy.
      • Ageism adversely affects dignity and human rights of older persons.
      • Rights-based approach in geriatric mental healthcare needs to be grounded in the voices and participation of older persons.
      • The UN Convention on the rights of older persons provides an appropriate scaffolding for dignified mental healthcare and related policies in older persons.


      The global demographic shift toward an aging population is predicted to result in a significant burden of mental health conditions and psychosocial disability. There has been a greater awareness of ageism and its toxic effects creating a paradigm shift to include a human right, ethical, and social justice-based approach to augment the biomedical model of mental healthcare. The concept of dignity lies at the heart of human rights and must be a central concept integrated into public health and mental healthcare. Dignity denotes the self-respect and worthiness of an individual as well as social consideration of his/her identity. Dignity in older persons is multi-dimensional and includes several factors such as privacy, independence, inclusion, autonomy, etc. There are several determinants such as frailty, dependence, sensory, cognitive impairment and socioeconomic vulnerabilities, which tend to compromise dignity in the elderly and hence their fundamental rights. One such construct is that of ageism which comprises stereotypes, prejudice and discrimination based on age. Ageism and related forms of stigma impair dignified healthcare in older persons and deprive them of their rights. Mental health professionals are uniquely positioned to incorporate the strategies to promote dignity in their clinical care and research as well as advocate for related social/health policies based on a human rights approach. These intersections are discussed in this paper in light of the United Nations Convention on Rights of the Older Persons.

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      1. United Nations. Department of Economic and Social Affairs. World population ageing highlights. 2019. Available at: Accessed May 3, 2021

      2. World Health Organization. Mental health of older adults. 2017. Available at: Accessed May 3, 2021

        • Wykle ML
        • Musil CM
        Mental health of older persons: social and cultural factors.
        Generations. 1993; 17: 7-12
        • Cornwell EY
        • Waite LJ
        Social disconnectedness, perceived isolation, and health among older adults.
        J Health Soc Behav. 2009; 50: 31-48
        • Coyle CE
        • Dugan E.
        Social isolation, loneliness and health among older adults.
        J Aging Health. 2012; 24: 1346-1363
        • Kwag KH
        • Martin P
        • Russell D
        • et al.
        The impact of perceived stress, social support, and home-based physical activity on mental health among older adults.
        Int J Aging Hum Dev. 2011; 72: 137-154
        • Gallagher A
        • Li S
        • Wainwright P
        • et al.
        Dignity in the care of older people–a review of the theoretical and empirical literature.
        BMC Nursing. 2008; 7: 1-2
      3. Tadd W. Ethics, Law and Society. Vol. III. Edited by: Gunning J, Holm S. Ashgate: Surrey, 2007, pp. 73-92.

        • Royal College of Nursing
        Defending Dignity – Challenges and Opportunities for Nursing.
        RCN, London2008 (Available at) (Accessed May 3, 2021)
        • Nordenfelt L
        Dignity and the care of the elderly.
        Med Health Care Philos. 2003; 6: 103-110
        • Woolhead G
        • Tadd W
        • Boix-Ferrer JA
        • et al.
        "Tu" or "Vous?": A European qualitative study of dignity and communication with older people in health and social care settings.
        Patient Educ Couns. 2006; 61: 363-371
        • Calnan M
        • Badcott D
        • Woolhead G.
        Dignity under threat? A study of the experiences of older people in the United Kingdom.
        Int J Health Serv. 2006; 36: 355-375
        • Hall EO
        • Høy B.
        Re-establishing dignity: nurses' experiences of caring for older hospital patients.
        Scand J Caring Sci. 2012; 26: 287-294
        • Ariño-Blasco S
        • Tadd W
        • Boix-Ferrer J
        Dignity and older people: the voice of professionals.
        Quality Ageing Older Adults. 2005; 6: 30-36
        • Cairns D
        • Williams V
        • Victor C
        • et al.
        The meaning and importance of dignified care: findings from a survey of health and social care professionals.
        BMC Geriatr. 2013; 13: 1-6
        • Clancy A
        • Simonsen N
        • Lind J
        • et al.
        The meaning of dignity for older adults: a meta-synthesis.
        Nurs Ethics. 2020;
        • Mann J.
        Dignity and health: the UDHR’s revolutionary first article.
        Health Human Rights. 1998; 3: 30-38
      4. Wilkinson JA, Ferraro KF: Thirty years of ageism research, Ageism: Stereotyping and Prejudice Against Older Persons, edited by Todd D. Nelson, MIT Press, Cambridge, MA, 2002:339–358

        • Robb C
        • Chen H
        • Haley WE.
        Ageism in mental health and health care: a critical review.
        J Clin Geropsychol. 2002; 8: 1-2
        • Kelchner ES.
        Ageism's impact and effect on society: not just a concern for the old.
        J Gerontolog Soc Work. 2000; 32: 85-100
        • UN General Assembly
        Universal Declaration of Human Rights.
        1948: 217 (ParisA (III))
        • HelpAge International
        Out of the Shadows.
        HelpAge International, 2008
        • Biggs S
        • Haapala I.
        Elder mistreatment, ageism, and human rights.
        Int Psychogeriatr. 2013; 25: 1299
      5. World Medical Association. WMA Declaration of Helsinki—ethical principles for medical research involving human subjects. 1964. Available at: Accessed May 3, 2021

        • Murali V
        • Oyebode F.
        Poverty, social inequality and mental health.
        Adv Psychiatr Treatment. 2004; 10: 216-224
        • Vahia IV
        COVID-19, aging and mental health: lessons from the first six months.
        Am J Geriatr Psychiatr. 2020; 28: 691-694
        • Black K.
        • Dobbs D.
        Community-dwelling older adults’ perceptions of dignity: core meanings, challenges, supports and opportunities.
        Ageing Soc. 2014; 34: 1292-1313
        • Lyons A
        • Alba B
        • Heywood W
        • et al.
        Experiences of ageism and the mental health of older adults.
        Aging Mental Health. 2018; 22: 1456-1464
      6. Patients Association. We've been listening, have you been learning?. 2011. Available at:'ve%20been% 20listening,%20have%20you%20been%20learning.pdf. Accessed May 3, 2021

        • Morris J.
        Ensuring dignity in the care of older people.
        BMJ. 2012; 344: e533
      7. British Geriatrics Society. Do not forget the person. 2010. Available at: option=com_content&view= article&id=475:do-not-forget-the-person&catid=6:prindex& Itemid=99. Accessed May 3, 2021

        • Ounalli H
        • Mamo D
        • Testoni I
        • et al.
        Improving dignity of care in community-dwelling elderly patients with cognitive decline and their caregivers. The role of dignity therapy.
        Behav Sci. 2020; 10: 178
        • Jacobson N.
        Dignity violation in health care.
        Qual Health Res. 2009; 19: 1536-1547
        • Martinsson G
        • Fagerberg I
        • Lindholm C
        • et al.
        Struggling for existence—life situation experiences of older persons with mental disorders.
        Int J Qual Stud Health Well-being. 2012; 7: 18422
      8. Rights, S. O. P. S. Towards a UN Convention. In A Resource for Promoting dialogue on creating a new UN Convention on the Rights of Older Persons, Coalition to Strengthen the Rights of Older Persons, dostupno na: https://social. un. org/ageing-working-group/documents/Coalition% 20to% 20Strengthen% 20the (Vol. 20). Accessed May 3, 2021

      9. United Nations. General assembly. Resolution adopted by the General Assembly on 13 December 2006. 61/106. Convention on the Rights of Persons with Disabilities. 2006. Available at: Accessed May 3, 2021

        • Doron I
        • Apter I.
        The debate around the need for an international convention on the rights of older persons.
        Gerontologist. 2010; 50: 586-593
      10. Royal College of Psychiatrists. Royal College of Psychiatrists' position statement PS2/2009. Age discrimination in mental health services: making equality a reality. 2009. Available at: Accessed May 3, 2021

        • Kinnear D
        • Victor C
        • Williams V.
        What facilitates the delivery of dignified care to older people? A survey of health care professionals.
        BMC Res Notes. 2015; 8 (1-0)
        • Nadimpalli SB
        • James BD
        • Yu L
        • et al.
        The association between discrimination and depressive symptoms among older African Americans: the role of psychological and social factors.
        Exp Aging Res. 2015; 41: 1-24
        • Bridges J.
        • Wilkinson C.
        Achieving dignity for older people with dementia in hospital.
        Nurs Standard. 2011; 25: 42-47
      11. World Health Organization. UN decade of healthy ageing 2021-2030. Available at: Accessed May 3, 2021

      12. HelpAge International. UN Convention on the rights of older people. Available at: Accessed May 3, 2021

        • Tang KL
        • Lee JJ.
        Global social justice for older people: the case for an international convention on the rights of older people.
        Br J Soc Work. 2006; 36: 1135-1150
        • De Pauw M.
        Global Population Aging from a Human Rights Perspective: The Need for a UN Convention on the Rights of Older Persons.
        Global Europe–Basel Papers on Europe in a Global Perspective, 2017