There can be such a thing as human dignity in risk, and there can be a dehumanizing indignity in safety.
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Healthcare providers experience several challenges when implementing a dignity of risk approach in the care of older adults
Existing healthcare culture often views risk as something inherently negative—something to be avoided or eliminated rather than acknowledged and supported. This mindset can lead to overly restrictive practices that may unintentionally cause harm, especially for older adults living with frailty or dementia.
By recognizing and understanding these challenges, we can better support one another in improving outcomes for older adults and supporting the essential care partners involved in their lives.
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Ageism is the negative stereotypes (how we think), prejudices (how we feel) and discriminations (how we act) toward others or ourselves based on age.
World Health Organization, 2025
Ageism has negative effects on physical health and well-being, particularly if the older adult internalizes negative stereotypes and beliefs about aging. Ageism can lead to overprotective attitudes and behaviours towards older adults that remove independence and autonomy too soon or unnecessarily.
Shifting toward an approach that promotes autonomy, one that respects older adults' individual experiences with risk and prioritizes their preferences and values in care planning and interactions, requires a cultural shift in caregiving practices, emphasizing collaboration, dignity, and person-centered decision-making.
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Adults are entitled to receive respect for their dignity and autonomy, even in the context of frailty and disability.
Confusion and fear about legal responsibilities among healthcare providers (HCPs) can lead to conservative, defensive, and overly restrictive approaches to caring for frail older adults (Ibrahim & Davis, 2013).
However, HCPs are guided by standards of care and professional codes of ethics that emphasize:
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'Safety' language and approaches can create rigid thinking and care planning that restricts older adults. This approach focuses on deficits rather than strengths.
Shifting to an informed risk management approach offers more opportunities for ability-based care planning, while educating and coaching essential care partners to increase their sense of coping as a caregiver.
For example, supporting a hospitalized older adult living with moderate frailty (CFS 6) to use the bathroom independently rather than believing they need to stay in bed for their safety.
| Instead of | Consider |
| They're not safe. | What are the risks (and to what degree), and how can we reduce them? "Safe" is subjective. |
| Are they safe to go home? | What are the reasonable, foreseeable risks and how can we mitigate them? |
| We must keep them safe. | We can care plan around risks, while aiming to preserve autonomy/preferences. |
Risk and Risk Taking in Health and Social Welfare
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When working with older adults living with frailty, the "risk-free" option does not exist. There are often several competing day-to-day risks that emerge as frailty and/or dementia progress. Living with risk can be supported by adopting a risk-management approach to care planning, rather than an overemphasis on 'keeping safe.'
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The DoR adult participatory workshop aims to offer a supportive solution-based learning space for healthcare staff to become more aware of and develop skills in how the Dignity of Risk can be applied to the care of older adults living with frailty. This includes building confidence with proactive care planning conversations and coaching with essential care partners. Case studies offer the opportunity to apply Frailty and Dignity of Risk informed care planning in the context of a hospital admission and returning or remaining home with risk.
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Frailty and Dignity of Risk Informed Care in acute care Summary and resources coming soon…
