Sue Hall, Susan Longhurst and Irene Higginson

King's College London, Department of Palliative Care, Policy and Rehabilitation, London, UK

Address correspondence to: S. Hall. Tel: (+44) 207848 5578; Fax: (+44) 207848 5517. Email: sue.hall@kcl.ac.uk

Background: most older people living in nursing homes die there. An empirically based model of dignity has been developed, which forms the basis of a brief psychotherapy to help promote dignity and reduce distress at the end of life.

Objective: to explore the generalisability of the dignity model to older people in nursing homes.

Methods: qualitative interviews were used to explore views on maintaining dignity of 18 residents of nursing homes. A qualitative descriptive approach was used. The analysis was both deductive (arising from the dignity model) and inductive (arising from participants' views).

Results: the main categories of the dignity model were broadly supported: illness-related concerns, social aspects of the illness experience and dignity conserving repertoire. However, subthemes relating to death were not supported and two new themes emerged. Some residents saw their symptoms and loss of function as due to old age rather than illness. Although residents did not appear to experience distress due to thoughts of impending death, they were distressed by the multiple losses they had experienced.

Conclusions: these findings add to our understanding of the concerns of older people in care homes on maintaining dignity and suggest that dignity therapy may bolster their sense of dignity.

Keywords: aged, nursing homes, qualitative research, dignity, elderly