Dignity of Older Adults in Long-Term Care Facilities: A Systematic Review of Qualitative Evidence from Residents, Staff, and Relatives

Background/Objectives: With global population aging, long-term care (LTC) facilities play an essential role in supporting older adults. However, residents are vulnerable to dignity loss in these institutional settings. Understanding dignity from the perspectives of residents, staff, and relatives is critical for informing person-centered care and policy. This review aimed to synthesize qualitative evidence on dignity in LTC facilities across multiple stakeholders. Methods: Following the PRISMA guidelines, we systematically searched six databases (PubMed, Scopus, Web of Science, Wan Fang, VIP, and CNKI) for qualitative studies published in 2010–2023. Eligible studies explored experiences of dignity among older LTC residents, staff, or relatives. Methodological quality was appraised using the Critical Appraisal Skills Programme (CASP) checklist. Data were analysed through thematic synthesis, and findings were compared across stakeholder groups. Results: A total of 1948 records were identified, of which 27 qualitative studies met the inclusion criteria. Two themes emerged from residents’ perspectives: institutionalization and resilience in preserving dignity. From staff perspectives, three themes were identified: understaffing and workload pressures, general approaches to dignity care, and person-centered care. Relatives’ accounts highlighted two themes: uneasiness regarding indignity and ethical expectations in a caring culture. Integrating these perspectives, we propose a triangular model in which residents, staff, and relatives collaboratively sustain dignity. Conclusions: Older adults’ dignity in LTC is shaped by complex interactions among institutional conditions, caregiving practices, and family involvement. Enhancing dignity requires adequate staffing, structural support for person-centered care, and greater involvement of relatives in decision-making. The proposed triangular model offers a framework for guiding interventions, staff training, and policy reforms aimed at safeguarding dignity in LTC facilities.