Ignoring the Older Person’s Voice: Dignity, Ageism, and Epistemic Injustice in Geriatric Nursing Practice—A Nursing-Oriented Conceptual Review and Practice Framework

Background/Objectives: Older adults may experience healthcare encounters in which their voices are discounted, redirected through family members, or interpreted through age-related assumptions about cognitive decline. Although such problems are often discussed through dignity, communication, ageism, person-centred care, or shared decision-making, this conceptual review argues that they also involve epistemic harms: harms that occur when older adults are not recognized as credible knowers of their own bodies, needs, values, histories, and care priorities. Methods: This article develops a conceptual and critical analysis of Fricker’s account of testimonial and hermeneutical injustice, later critiques of epistemic injustice, and the nursing and gerontological literature on dignity, person-centred nursing, documentation, dementia care, and shared decision-making. Results: The analysis distinguishes ordinary communication failure, institutional restriction of interpretive space, testimonial injustice, and hermeneutical injustice. It identifies interacting interpersonal and institutional mechanisms through which older adults’ knowledge may be discounted or rendered invisible and develops five theoretically derived principles: credibility-oriented listening, narrative recognition, supported participation, relational decision-making, and epistemic documentation. For each principle, the framework identifies the epistemic failure addressed, its added value beyond general person-centred practice, and responsibilities at both individual and organizational levels. Conclusions: An epistemic-justice lens does not replace dignity, person-centred care, shared decision-making, or professional judgement. It adds a focused analysis of credibility, interpretive authority, knowledge visibility, and whose account shapes care. The proposed framework is a conceptual and normative contribution that requires empirical evaluation before its effects can be established.