[Protecting dignity: Reviewing the decision-supporting process for an isolated elderly individual living in a large housing complex]

Aim: To clarify the conditions under which dignity is maintained by reviewing the decision-supporting process for a case.

Methods: We conducted both a longitudinal epidemiological survey and action research in parallel in a large housing complex district in Tokyo, Japan, using the community-based participatory research framework. Through collaboration with community professionals, we supported an isolated elderly man who refused medical intervention for three years until his death. After his passing, we re-examined all of his records, conducted in-depth interviews with the community professionals, and held a conference to review the process of managing this individual.

Results: Concerning support for the decision-making, three conclusions were obtained from the data: 1) a decision is not always stated explicitly; 2) a decision should be supported by the team, because mind sometimes changes; and 3) supporting decision-making is a process in itself. For the maintenance of dignity in the medical setting, the following were kept in mind: medical context is not all that is important; supporters should wait for the right moment to intervene, and support should be provided to help the patient keep in touch with other people and the community.

Conclusions: While precisely defining dignity can be difficult, we explored the conditions under which dignity could be maintained by reviewing the decision-supporting process for a single case. Geriatricians may encounter difficult and complex cases such as this in the clinical setting, but guidelines cannot cover such diverse cases.