In helping address an aging patient’s dignity needs, the Patient Dignity Inventory is only an initial step in taking patients from feelings of helplessness, shame, apathy, or anger to a place where they feel empowered to exercise their own agency and valued by the people around them. Once the PDI is used to identify the most critical issues bothering the patient, its time to start thinking about the best ways to address them. Some solutions involve fairly straightforward changes to patients’ daily routines that take their need for agency into account, like consistently asking them for their consent and enabling them to make small decisions where possible. However, more complex needs like the need to feel valued by the people around them can sometimes be addressed with Dignity Therapy, a series of in depth questions that help patients feel heard by giving them a forum to tell their story and help carers to understand their personality and experiences in depth.

“Tell me a little about your life history, particularly the parts that you either remember most, or think are the most important. When did you feel most alive?” 
This question serves as a good opener to Dignity Therapy, as it helps reveal right away what life experiences patients value the most, as well as what experiences brought them the most joy and fulfillment.

“Are there specific things that you would want your family to know about you, and are there particular things you would want them to remember?”
This is a question that can help start to bridge the gaps that can develop between the elderly and their families as they age. Particularly for parents, they may have missed opportunities earlier in life to get to know their children on a level beyond their roles as parent and child, which can leave both sides feeling awkward and uncomfortable when aging parents can no longer fulfill their previous roles as providers and caretakers. Facilitating a deeper understanding of an aging loved one’s core personality traits and hidden facets can help renew love and connection and provide valuable new conversation topics.

“What are the most important roles you have played in life (family roles, vocational roles, community service roles, etc.)? Why were they so important to you, and what do you think you accomplished in those roles?”
This question can serve multiple purposes within dignity therapy. Inviting reflection upon the achievements of a lifetime can help a previously-active older person combat feelings of uselessness or lack of accomplishment. It can also help a caregiver identify what family and community roles are important to patients, and possibly help them connect with activities and roles they can still participate in that could provide them some of that same feeling of achievement.

“What are your most important accomplishments, and what do you feel most proud of?”
This question continues to build off the previous one and continues to build a sense of pride and achievement in elders who are feeling as though they’ve failed to contribute because they are no longer actively providing the same skills they used to. Asking them to reflect on all they’ve achieved can re-contextualize their life in a big picture sense that can remind them of everything they’ve already done and help them believe they’ve earned their relaxation.

“Are there particular things that you feel still need to be said to your loved ones, or things that you would want to take the time to say once again?”
Frequently elders and their families have fallen into a rut in their interpersonal relationships that causes ongoing dissatisfaction that they don’t feel they know how to fix, and often leads to them bottling up positive feelings as well as negative ones. Giving a patient space to express emotions they’ve been keeping pushed down can help to start them on a path towards greater emotional expression and mental health.

“What are your hopes and dreams for your loved ones?”
The elderly have often reached a point where they’ve given up on making plans for the future by the time a long-term care provider begins working with them. Asking them about what they want for their loved ones can re-engage them with imagining the future and dreaming of their legacy. Focusing on what they want for other people can also help move them away from wallowing in self-pity and into a space of looking at what they can still do to help their loved ones achieve their dreams.

“What have you learned about life that you would want to pass along to others? What advice or words of guidance would you wish to pass along to your (son, daughter, husband, wife, parents, others)?”
An elder’s lifetime of experience is incredibly valuable, but in the course of day-to-day routine and the vast difference between the modern world and the circumstances in which they grew up, and elder’s wisdom and advice may be frequently overlooked as too antiquated to be useful. Drawing specific attention to the elder’s wisdom and guidance as part of dignity therapy can help to make space for their younger relatives to feel the weight and value of their loved one’s experience.

“Are there words or perhaps even instructions you would like to offer your family to help prepare them for the future?”
Many patients have begun to think about their eventual passing and what they want to happen after their death, but may not know how to make their wishes heard by their caretakers. Asking them this question will ideally enable patients to make their wishes known on any topic they feel strongly about, not just in regards to their death but also to leave a record of advice for future events they may not be likely to see in person such as weddings or graduations. Having a record of their elder’s own words after their death can also be an immense comfort to grieving families, but is a step that family members are unlikely to consider taking themselves out of discomfort with engaging with their loved one’s mortality.

“In creating this permanent record, are there other things that you would like included?”
At this point in the discussion, many other thoughts of importance may have occurred that are unique to the individual, so it can be good to leave space at the end to cover any other thoughts or feelings that a patient is having.

Dignity therapy comprises part of an ongoing discussion with patients about their needs and wants on a level beyond their purely physical needs. While a care provider may only go through this specific set of questions once with each patient, it help to establish a rapport on an ongoing basis, and lets patients feel that they can open new conversations with their care provider about their dignity needs as they arise. Dignity therapy is only one of a set of tools that can help address these problems, so I personally don’t use it with every patient, but it’s a useful question set to reflect on to determine what areas of a patient’s life are still under served. This leads me to the last part of my dignity care toolset, the Patient Dignity Question, which I will cover in the third and final blog post on this topic.