Dignity of Risk

What is Dignity of Risk?

Dignity of risk is the right to live life in a way someone chooses, even with risk. It recognizes that daily life is uncertain and that taking normal risks can lead to positive outcomes in quality of life, health and well-being.

Why is the Dignity of Risk approach to care important to older adults?

Most older adults (65+) want to keep their independence and make their own (or be involved in) choices instead of being “kept safe.” When living with frailty or dementia, older adults should be supported to live in ways that reflect what matters most to them.

Barriers to Dignity of Risk

Our own worries can make us want to do things for older adults to help them avoid possible harms from risk-taking. Common barriers include:  

• Worry or fear that something bad will happen
• Ageism, or the belief that older adults cannot make their own choices
• Being overprotective, which can stop meaningful activities unnecessarily or too soon
• Focusing only on safety, such as preventing falls by preventing standing and walking, instead of balancing safety with quality of life or the possible harms of not walking

How can we support older adults living with frailty?

We can help older adults by:

• Asking what matters most to them
• Understanding why they make certain choices (often for a benefit)
• Focusing first on the good things that can happen from taking a risk
• Helping them find ways to lower possible harms while supporting positive risk-taking

What concerns tend to be most common?

Older adults living with frailty or dementia may face concerns such as:

• Risk for falls when up and walking
• Difficulty using appliances like a stove
• Difficulty taking medications properly
• Becoming disoriented on outings
• Challenges with personal care like bathing and toileting

These activities are often still meaningful to the person. It’s important not to assume the worst case scenario will happen. The level of possible harm will depend on the person’s health, frailty level, living or social situation, supports available and awareness of the concern.

Balancing safety with independence

How concerns are managed often depends on the comfort, experience and skills of caregivers and healthcare providers. When safety is a concern, the goal should be to adapt meaningful activities, not necessarily remove them right away. Discuss with older adults how activities can be modified so there is less potential for harm.

Examples include:

• Living at home: Work with caregivers and healthcare teams to identify concerns and lower possible harms, while still looking for ways to stay independent.
• Walking or going outside: Wear bright clothing, use a GPS device or go with a support person.
• Cooking: Install stove sensors or have someone check in after cooking.
• Moving around the home: Use a cane or walker, add grab bars, improve lighting and keep pathways clear of clutter. Strength and balance exercises will also help maintain independence with standing and walking. 

“There is a life for us, if we risk it.”

A person living with dementia, in “Nothing Ventured Nothing Gained: Risk Guidance for People with Dementia” Department of Health and Social Care. (2010). Nothing ventured, nothing gained: risk guidance for people with dementia. United Kingdom.