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

BACKGROUND: Dignity and well-being are central concepts in the care of older people, 65 years and older, worldwide. 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 indoor-outdoor-mealtime environments, safety, and social activities. Data regarding age, sex and diagnosed dementia/prescribed 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 experienced 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.