Safe Enough to Thrive: A Dignity of Risk Framework for Older Adult Mental Health Care

Abstract

Background Older adults with psychiatric disorders and/or neurocognitive impairment are often cared for in restrictive settings such as long-term care facilities and inpatient psychiatric hospitals. Risk-averse institutional cultures can lead to overly restrictive practices that prioritize safety at the expense of autonomy and dignity. Objective To develop a geropsychology-informed dignity of risk framework that helps clinicians and teams balance safety and autonomy in geriatric mental health care. Methods This conceptual paper integrates psychological, gerontological, and philosophical literature, including human rights perspectives, geropsychological work on fluctuating capacity and serious mental illness, and empirical studies of institutional risk cultures, coercion, and ageism. Results The resulting framework comprises five elements: (1) clarifying older adults’ values and goals; (2) assessing and supporting decision-making capacity; (3) distinguishing everyday life risk from high, non-negotiable risk; (4) explicitly weighing psychological benefits alongside physical risks; and (5) documenting “safe enough” risk-sharing plans in partnership with older adults, families, and staff.