Nova Scotia Health’s Dignity of Risk Program leading change in caring for older adults living with frailty and dementia

Nova Scotia Health’s new Dignity of Risk Program, the first of its kind in Canada, will help older adults living with frailty and dementia maintain their independence.

The Dignity of Risk Program is overseen by Nova Scotia Health's Frailty and Elder Care Network. It aims to educate healthcare teams, patients, caregivers, families and other essential care partners about balancing a person’s right to take reasonable risks, such as walking, even if unsteady, that align with their preferences, dignity and values with support and strategies to manage those risks.

“This program is about respecting people’s right to live their lives, even when that involves some risk. It encourages understanding about how an older adult wants to live their life and working with them, their healthcare provider and other essential care partners, to manage risks so they can maintain autonomy as long as possible,” said Catherine-Anne Murray, Dignity of Risk Program team lead.

Carolyn Hortie of Dartmouth sees the importance of the Dignity of Risk education and awareness from both a personal and professional perspective. At 80 years old, Hortie volunteers full-time as the president of the Dartmouth Hospital Auxiliary. She heard about the Dignity of Risk training and arranged a session for Auxiliary members and their families.

“It was such an excellent presentation, and I hope that as many people as possible can hear this important message. People need to understand that it is fine to watch out for someone older, but don’t put them bubble wrap.” On a personal note, Hortie added, “I feel very independent, and I want to keep feeling this way. Attending this session gave me confidence that I wasn’t wrong in my way of thinking.”

Research shows that 90-95 per cent of older adults want to live in their own homes. On average, 37 per cent of older adults admitted to Nova Scotia hospitals do not return to the place they call home but rather may transition to long-term care after extensive stays in hospital. Longer stays in hospital can increase the risk of injury and harm for older adults (65+), including increased frailty and exposure to other illnesses that can potentially extend their hospital stay and contribute to loss of independence.

“Nova Scotia is projected to experience an 87 per cent increase in the number of people living with dementia from 2020 to 2050. This demographic shift makes it essential for our health care system — and our communities more broadly — to foster a culture that is more dementia-friendly,” said Sacha Nadeau, Director of Research and Advocacy, Alzheimer Society of Nova Scotia.

The Canadian Charter of Rights for People with Dementia emphasizes the rights of people with dementia to access support to live as independently as possible and to be engaged in their community. “Programs like Dignity of Risk help challenge the status quo, to facilitate opportunities for autonomy and meaningful activity at every stage of dementia,” said Nadeau.

Understanding the risks that come with frailty and dementia can help prepare patients, caregivers and other essential care partners to plan to mitigate risks, while maintaining as much dignity and independence as possible within the older adult’s daily life.

“The desire to ‘keep people safe’ can unintentionally limit older adults’ choices in how they live and can lead to removing independence too soon or unnecessarily. We are challenging and supporting people to think differently when working with older adults living with dementia and frailty”, said Murray.

“We are so pleased to be able to enhance awareness and understanding for patients, their families and healthcare providers to support more choice in how people live through our new Dignity of Risk Program,” said Dr. Kenneth Rockwood, QEII Health Sciences Centre Internist-Geriatrician and Clinician Scientist and Medical Director, Frailty and Elder Care Network.

For more information about the Dignity of Risk approach to care, visit Dignity of Risk | Nova Scotia Health.

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