Dignity, Risk, and Choice

Education, resources and practice considerations in older adult care

What is "Dignity of Risk"?

The right to take risks (and to potentially fail) when engaging in life experiences.

The term Dignity of Risk was first used in the context of people with intellectual disabilities in the 1970s. At that time, people with intellectual or developmental disabilities were often viewed as not capable of living independently or making decisions for themselves. This perspective often deprived this population of many typical life experiences that others take for granted (Perske, 1974).

Today, the Dignity of Risk acknowledges that life experiences carry the risk of failure and that we must support people in experiencing a spectrum of success and failure throughout their lives.

This guide serves to extend the Dignity of Risk into the care of older adults and offer points of reflection and consideration, which readers may find helpful in their own practices within the health care system, or in their experiences within their communities.

Check out these resources that further illustrate the concept:

Projects in Nova Scotia

In 2011, a quality assurance study was completed by a group within Capital Health in Halifax (now NSHA's Central Zone) examining the care needs of patients classified as subacute (Elbourne et al, 2013)An unexpected finding of this work was how frequently staff recommended 24-hour care for older patients who were deemed to be somehow at risk if they were to return home. The study authors questioned if attitudes towards risk were influencing these recommendations.

This led to taking a closer look at how health care providers interact with older adults in our health care system.  The research group was interested in answering questions like:

  • What language do health care providers use with older adults? With their partners in care and caregivers?
  • What values, assumptions, or cultural factors influence how health care providers enable (or create barriers for) older adults in their decision making and care planning as they age?

In a follow-up project, a multi-disciplinary group working in geriatrics explored concepts of risk and patient safety in the care of older adults. Investigators were curious about how risk-tolerant the geriatric inpatient units were and explored issues around this in a one-day participatory workshop titled, Is the Patient Safe to Go Home?

Between 2013 and 2015, six Is the Patient Safe to Go Home? workshops were delivered with over 250 participants including hospital and community health care staff in Halifax, Truro, and Saskatoon. These workshops were also held with academics and health care staff at a national gerontology conference and included older adults and caregivers as participants.

Elbourne, H. F., Hominick, K., Mallery, L., & Rockwood, K. (2013). Characteristics of patients described as sub-acute in an acute care hospital. Canadian Journal on Aging/La Revue canadienne du vieillissement, 32(2), 203-208.

Perske, R. (1974). The dignity of risk and the mentally retarded. National Association for Retarded Citizens. [Please note: this citation is used to provide historical context and as such the language at the time of publication is not reflective of current and respectful language].