title: Systematic review: what interventions improve dignity for older patients in hospital?
abstract: OBJECTIVE
  To review the evidence for interventions to improve dignity for older patients in acute care.
  
  
  BACKGROUND
  High profile cases have highlighted failure to provide dignified care for older people in hospitals. There is good evidence on what older people consider is important for dignified care and abundant recommendations on improving dignity, but it is unclear which interventions are effective.
  
  
  METHODS
  Narrative systematic review.
  
  
  METHODS
  The Cochrane library, MEDLINE, EMBASE, CINAHL, BNI and HMIC electronic databases were searched for intervention studies of any design aiming to improve inpatients' dignity. The main population of interest was older patients, but the search included all patients. Studies that focused on 'dignity therapy' were excluded.
  
  
  RESULTS
  There were no intervention studies found in any country which aimed to improve patient dignity in hospitals which included evaluation of the effect. A narrative overview of papers that described implementing dignity interventions in practice but included no formal evaluation was, therefore, undertaken. Five papers were identified. Three themes were identified: knowing the person; partnership between older people and health care professionals; and, effective communication and clinical leadership. The effect on dignity of improving these is untested.
  
  
  CONCLUSIONS
  There are currently no studies that have tested interventions to improve the dignity of older people (nor anyone else) in hospitals. Further research using well designed trials of interventions is needed. There is also a need to develop and validate outcome measures for interventions to improve dignity.
  
  
  CONCLUSIONS
  At present nurses lack robust evidence on how to improve dignity. There is ample evidence on what undermines patients' dignity and there is a need to develop and test interventions designed to improve patient dignity.
authors.affiliation: Department of Postgraduate Research, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Zahran
authors.affiliation: Education Centre, Charing Cross Hospital, London, UK.
authors.forename: Marcelle
authors.initials: M
authors.lastname: Tauber
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
authors.forename: Holly Howe
authors.initials: HH
authors.lastname: Watson
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
authors.forename: Phoebe
authors.initials: P
authors.lastname: Coghlan
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: White
authors.affiliation: Imperial College Healthcare NHS Trust, Buckinghamshire New University, High Wycombe, UK.|Faculty Society & Health, Buckinghamshire New University, High Wycombe, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Procter
authors.affiliation: School of Advanced Health Care, Buckinghamshire New University, Uxbridge, UK.
authors.forename: Gulen
authors.initials: G
authors.lastname: Addis
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Norton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006299:Health Services for the Aged; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D009736:Nursing Process; D012297:Right to Die
keywords: acute care; dignity; interventions; older patients