Factors associated with older persons’ perceptions of dignity and well-being over a three-year period. A retrospective national study in residential care facilities

(2022) 22:515 Roos et al. BMC Geriatrics https://doi.org/10.1186/s12877-022-03205-1 Open Access RESEARCH Factors associated with older persons’ perceptions of dignity and well‑being over a three‑year period. A retrospective national study in residential care facilities Charlotte Roos1*, Moudud Alam2, Anna Swall1, Anne‑Marie Boström3,4,5 and Lena Marmstål Hammar1,3,6 Abstract Background: Dignity and well-being are central concepts in the care of older people, 65 years and older, world‑ wide. The person-centred practice framework identifies dignity and well-being as person-centred outcomes. Older persons living in residential care facilities, residents, have described that they sometimes lack a sense of dignity and well-being, and there is a need to understand which modifiable factors to target to improve this. The aim of this study was to examine the associations between perceptions of dignity and well-being and the independent variables of the attitudes of staff, the indoor-outdoor-mealtime environments, and individual factors for residents over a three-year period. Methods: A national retrospective longitudinal mixed cohort study was conducted in all residential care facilities within 290 municipalities in Sweden. All residents aged 65 years and older in 2016, 2017 and 2018 were invited to responded to a survey; including questions regarding self-rated health and mobility, the attitudes of staff, the indooroutdoor-mealtime environments, safety, and social activities. Data regarding age, sex and diagnosed dementia/pre‑ scribed medication for dementia were collected from two national databases. Descriptive statistics and ordinal logistic regression models were used to analyse the data. Results: A total of 13 763 (2016), 13 251 (2017) and 12 620 (2018) residents answered the survey. Most of them (69%) were women and the median age was 88 years. The odds for satisfaction with dignity did not differ over the three-year period, but the odds for satisfaction with well-being decreased over time. Residents who rated their health as good, who were not diagnosed with dementia/had no prescribed medication for dementia, who had not experi‑ enced disrespectful attitudes of staff and who found the indoor-outdoor-mealtime environments to be pleasant had higher odds of being satisfied with aspects of dignity and well-being over the three-year period. Conclusions: The person-centred practice framework, which targets the attitudes of staff and the care environment, can be used as a theoretical framework when designing improvement strategies to promote dignity and well-being. Registered nurses, due to their core competencies, focusing on person-centred care and quality improvement work, should be given an active role as facilitators in such improvement strategies. *Correspondence: 1 School of Health and Welfare, Dalarna University, Falun, Sweden Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Roos et al. BMC Geriatrics (2022) 22:515 Page 2 of 14 Keywords: Dignity, Long-term care, Older persons, Person-centred care, Person-centred practice framework, Residential care facilities, Well-being Background Dignity is a central concept in the care of older people worldwide [1]. To preserve dignity, respect must be paid to a person’s integrity and self-determination, i.e., autonomy [2, 3]. As older people live longer with both comorbidities and long-term disabilities [4], it commonly implies restricted autonomy [5]. Individualized care is described as an important aspect to promote dignity [6]. Older persons living in residential care facilities (RCFs) have, in experiencing self-determination and individualized care, described the importance of having choices regarding one’s care. In addition, the importance of having control over how to receive care, when to receive care, [6–9] what to eat, when to eat and where and with whom to eat [10] have been emphasized. However, staff in RCFs sometimes lack the ability to promote self-determination and individualized care [7, 9–11]. Furthermore, well-being is a central concept in the care of older people worldwide, and International Sustainable Development Goal Number Three highlights the promotion of wellbeing for humans of all ages [12]. Well-being is described as a subjective feeling of pleasure [13]. To experience well-being, older persons living in RCFs (residents) have described the importance of meaningful activities, i.e., activities that agree with an individual’s hobbies and lifestyle. Nevertheless, residents have reported a lack of such activities in RCFs [14, 15]. In Sweden, dignity and well-being are central concepts in the legislation regulating the care of older persons receiving home care services and those living in RCFs. The legislation regarding dignity and well-being is named the Swedish national fundamental values (SNFVs) of older persons [16, 17]. The SNFVs define that in order for residents to experience dignity, staff members must respect residents’ personal integrity, self-determination and participation. To experience dignity, it is further important that care is individualized and that staff members treat residents with a respectful attitude. To experience well-being, according to the definition in the SNFVs, residents must feel meaningfulness and safety. The Swedish National Board of Health and Welfare (NBHW) was assigned to facilitate the implementation of the SNFVs in all RCFs in Sweden when it was legislated [18]. One strategy used was the development of educational material to be used by staff members in RCFs [19]. Another strategy was that managers of the RCFs were invited to participate in a university course regarding how to support and facilitate the implementation of the SNFVs [20]. Every year, the Swedish NBHW conducts a survey of all residents aged 65 years and older. The survey aims to capture residents’ perceptions (...truncated)