A Dignified Dining Experience
Many seniors experiencing dementia lose interest in food and eating. This can be because of appetite loss, inability to use certain utensils, and;trouble with depth perception and seeing contrasts that make it difficult to recognize different foods. Person-centered care communities avoid bland, repetitive meals and make dining an engaging experience.
- Ensuring residents nutritional needs are met is a top priority, but seniors are more likely to eat foods theyre comfortable with from childhood, and weight loss can be dangerous for seniors with dementia. Liberal dining programs include traditional favorites like meatloaf, casseroles, and creamy soups alongside healthy dishes.
- Modified utensils and brightly colored plates encourage independence and help with food recognition.
- Multiple meal options throughout the day let seniors with dementia choose their own schedules without missing nutrition. For example, there may be two breakfasts one for early birds, and one for late risers.
- Some communities have different dining locations for residents who are independent and those who need more support.
Practice Recommendations For Person
Know the person living with dementia.
The individual living with dementia is more than a diagnosis. It is important to know the unique and complete person, including his/her values, beliefs, interests, abilities, likes and dislikesboth past and present. This information should inform every interaction and experience.
Recognize and accept the persons reality.
It is important to see the world from the perspective of the individual living with dementia. Doing so recognizes behavior as a form of communication, thereby promoting effective and empathetic communication that validates feelings and connects with the individual in his/her reality.
Identify and support ongoing opportunities for meaningful engagement.
Every experience and interaction can be seen as an opportunity for engagement. Engagement should be meaningful to, and purposeful for, the individual living with dementia. It should support interests and preferences, allow for choice and success, and recognize that even when the dementia is most severe, the person can experience joy, comfort, and meaning in life.
Create and maintain a supportive community for individuals, families, and staff.
A supportive community allows for comfort and creates opportunities for success. It is a community that values each person and respects individual differences, celebrates accomplishments and occasions, and provides access to and opportunities for autonomy, engagement, and shared experiences.
What Is Reminiscence Therapy
One thing that may be helpful to all cases, however, is reminiscence therapy introduced in this video by Jacqueline Ash, Lansdowne Hills activities coordinator.
Reminiscence therapy uses each clients own life story as mental stimulation. Therefore, if a client has enjoyed a career as a painter, this might include offering them an easel, canvas, brush and encouragement in a relaxed environment.
Because participating in the activities we love is a good way to activate memory, we see the benefits every day.
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Minimising Moments Of Friction With Person
Dementia care is delicate and complex,filled with nuances and challenges. We recognise it is not fuelled by the pursuit of a cure. It is care rooted in the fundamental idea that behind each challenge is a unique individual with an unmet emotional or physical need that requires understanding and assistance.
The responsive behaviours are among the most distressing and challenging outcomes of the condition. These responsive behaviours most commonly include apathy, depression, irritability, agitation or anxiety. The pressures on a care environment and individual carers to mitigate episodes of responsive behaviour, as well as the moments of friction they entail, can be significant. We believe that it is only by applying a person-centred approach when caring for someone living with dementia that quality of life can be maintained, episodes of responsive behaviour can be minimised and efficiency can be achieved¹
Supporting person-centred care
Stage 5: Overnight Care
We can no longer be safe or feel safe overnight when our ability to understand what is happening around us is gone, hence our ability to recognize risk. We now need someone during the night if we wake and for all but an hour or two during the daysomeone to lead us through tasks and find appropriate social and sensory stimulation for us. We still benefit from an hour or two alone to enjoy privacy and autonomy, but we have lost the ability to initiate activities to keep our brains active and engaged and sleep well.
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A Combined Biomedical And Psychological Approach
The biomedical approach helps care practitioners understand the type of dementia with which a person is diagnosed and any behavioural issues that may present ; a psychosocial approach helps in the tailoring of individual interventions . A combined approach can, therefore, help with effective symptom management, predicting disease progression and planning for care . When talking to people with dementia, understanding dementia as a disease and its symptomatology helps to develop a therapeutic relationship to support them throughout the care process .
High-quality dementia care depends on care practitioners having appropriate skills. The bio-psychosocial model can:
- Enhance positive carer attitudes;
- Increase carers sense of role competence and job satisfaction;
- Help carers devise personalised, appropriate interventions that meet individual needs .
What Is Dementia And What Causes Dementia
Dementia is a condition, not a disease. Dementia means memory loss and progressive cognitive impairment . It is not a disease, although it can be the result of a number of diseases such as Parkinsons, Alzheimers, alcoholism, and heart disease. People experiencing dementia are often unaware that they are impaired, and do not understand that they need;help.
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Treat People With Dignity Compassion And Respect
Patients often lose their independence when they enter care, which puts their dignity at risk. Person-centred care enables you to maintain that dignity by respecting their wishes and treating them with compassion and empathy.
To fulfil this principle, you must always keep in mind that patients have their own thoughts, feelings, opinions, beliefs, and values, and these dont suddenly become invalidated by their care needs. Respecting their personal qualities helps the patient feel validated and cared for much more wholly: both physically and emotionally.
Personal Preferences And Decision
Memory care communities of the past often had set wake-up and lights-out times, rigid meal structures, and other one-size-fits-all protocols. A person-centered approach focuses on maintaining residents personal preferences as much as possible. ;
- Residents can set their own sleep schedules, within reason. Night owls may be able to stay up late, with programming into the evening.
- Some seniors may prefer to shower, while others choose to take baths.
- Multiple meal options and snacks enable;residents to eat what they want, when they want it.
- A variety of religious services and spiritual support systems cater to different beliefs.
- Living spaces can be decorated with personal furniture, artwork, and memorabilia.
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Staff Development Role Play
Role plays where a facilitator plays the part of a person with dementia can help staff learn to individualise their approaches to care around specific tasks. In the following example, staff members experience how having more information about people improves communication.
Two participants act out their roles: a person with dementia and a staff member bathing the person.
- The staff member attempts to bath a person without information about their unique needs and preferences.
- The staff member then describes to other participants the process and problems encountered. Guided discussion follows.
- Before attempting to bath the person again, the staff member is given an information sheet listing the persons unique preferences and important life events.
- Now the staff member attempts to bath the person using personal information to engage and calm them.
- De-briefing allows participants to describe the ways they might use information about individuals to better interact with them.
Three Ways To Make It Work
If youre caring for someone with dementia you can ensure your care is more person centred by:
1. Giving a choice of food at mealtimes. Either ask what theyd like, or show pictures to help. Failing that, whenever possible, give them something theyve always enjoyed, and would choose to make themselves.
2. Little things mean a lot too much choice may be overwhelming but some are essential. For example, choosing which necklace, lipstick, watch or tie to wear, might seem insignificant, but it can make someone with dementia feel more in control of their own life.
3. Ask yourself: Am I seeing the world through their eyes? If the answer is yes youre using a person-centred approach and doing a great job.
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What Is Patient Centered Care And Why Is It Important
Patient-centered care has the potential to make care more tailored to the needs of patients with multi-morbidity. PCC can be defined as providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions .
Stage 6: Fulltime Care
When we have lost the ability to understand the world around us, or recognize the people in our lives, we are in the final stage of dementia. We have not lost ourselves, however, nor are we lost to our loved ones, if they become our memory keepers and storytellersif they tell us who they are, who we are, whom we love and who loves us with love rather than concern or sorrow. Because we cannot learn new things without rational thinking or memory skills, we do best with routine, consistency and a peaceful environment. However, we still need our loved ones and the sensory stimulation that is beautiful to us.
This is a summary of the stages of dementia I have watched my clients go through here at DAWN. They reflect changes in functioning rather than a progression of symptoms or pathology. When we watch for and respond to peoples changing ability to function and their emotional needs, customizing the level of care accordingly, they are more apt to accept care and less likely to put themselves at risk through resisting help.
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One Practical Method To Communicate Resident Preferences
Research conducted through Miami University in Ohio outlines a practical way to identify and communicate person-centered preferences. Researchers;developed a tool called Preferences for Every Day Living Inventory ; there is a version for those living in the community and for those living in a facility. The PELI helps identify and rank the importance of personal preferences.
Once we know what’s important to someone, the next challenge is to communicate these preferences to those around the individual who is receiving care. The recommendation from the PELI team is to use a five-by-seven laminated card to clearly communicate the preferences of the person, including some fundamental information about his or her background, family, personality, work, and the types of activities enjoyed. This card can then travel with the person, such as on their walker or wheelchair, enabling others around her to quickly know some key information about this person.;
Be certain to exclude HIPAA informationthat is, information that would violate the privacy and security of health information.;
This certainly isn’t the only way to communicate personal preferences, but it does provide a usable tool to help honor the individual choices of those being cared for.
Shifts In Organizational Culture
As noted, person-centered care exists within the larger movement of culture change, a broad-based effort to transform nursing homes from interpersonal health care institutions into true person-centered homes offering long-term care services . After much work in the early 1980s among various organizations and advocates, the Pioneer Network took the lead in fostering the culture-change movement within nursing homes. stated that culture change movements overarching goals are to individualize care for residents, making communities more homelike and less institutional. It promotes person-centered care through reorientation of the communitys cultureits values, attitudes, and normsalong with its supporting core systems . In addition, it strives to honor residents individual rights, offering them quality of life and quality of care in equal measure. Culture change also recognizes the importance of all staff members contributions to the pursuit of excellence .
Over the years, various models have been evaluated and research has demonstrated results. However, there is still much work to be done to identify outcomes and support the overall business model. stated that several aspects of the nursing home field, including its workforce, regulation, and reimbursement, limit the initiation of culture-change practices. Culture change requires dedicated leadership over a period of years, a stable workforce, the buy-in of nursing, and funds for environmental improvements .
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How Important Is Compassion In Healthcare
It is hard to imagine healthcare without a focus on compassion, but of course we are all aware of care situations that seem to lack compassion.
It is hard to imagine healthcare without a focus on compassion, but of course we are all aware of care situations that seem to lack compassion. ;However we shouldnt objectify compassion in a way that somehow privileges it over other values such as dignity, respect, kindness and love.
These principles are equally important to compassion and indeed all of them are necessary for care to be person-centred. ;However,;I get concerned these days when compassion seems to be used as a;catch-all for everything that is good care;;almost a replacement for other principles .
A person-centred approach has compassion at its core. ;It focuses on cultivating a culture of care that tries to create as much happiness as possible for everyone. ;Increased happiness results in increased well-being. ;A person-centred culture enhances;the well-being of everyone.
Best Practices For Residents Living In Long
- A growing body of evidence supports the idea that personhood and selfhood are not lost even in advanced dementia.
- Person-centered dementia care can significantly reduce behavioral disturbances, specifically aggression and agitation.
- Person-centered care can be mutually beneficial for staff and patients.
According to the Alzheimers Association, approximately 5.7 million Americans have Alzheimers dementia, and that number is expected to grow. The progressively debilitating nature of the disease causes patients to lose the ability to live independently, so many rely on long-term care services. In the United States, about 1.4 million residents live in long-term care facilities; 50.4% of them have been diagnosed with dementia.
To receive Medicare and Medicaid funding, long-term facilities must comply with federal regulations that require them to promote residents quality of life and to preserve their dignity and self-determination. This includes allowing residents the opportunity to participate in the development and implementation of a person-centered care plan.
Stage 4: Clinginess Or Clingy Dementia
We become clingy when we have lost our rational thinking and memory skills to the point that we can no longer interpret what is happening around us and we no longer feel secure. If we have learned that our homes are safe, we may still live alone, but we tend to follow our primary caregiver from room to room or need constant reassurance, for we are living in the three-second nowtrapped in the present without the past or future. Now we need help with even the simplest tasks and most people are strangers to us. Routine and consistency are critical, and knowing we are safe is essential to maintain our emotional well-being.
Three Facts Worth Knowing
1. The person-centred approach was developed in the UK by Professor Thomas Kitwood, a pioneer in the field of dementia care in the 1980s and has since received worldwide recognition and praise.
2. Person-centred care has been shown in studies to reduce agitation and aggression in people with dementia.
3. Another study of person-centred care showed it significantly reduced the number of people with dementia needing hospital treatment or anti-psychotic medication both of which can be the result of aggressive behaviour.
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Our Dementia Care Is Personal
Dementia is an umbrella term describing a variety of symptoms linking to the slowing of brain function. Alzheimers disease presents many of these symptoms, and different types of dementia are present in many other conditions.
As a result, the common understanding may not fit with a single individuals experience of it. Understanding how much this can vary per person is the starting point to good care. With the correct client-focused assessment, a bespoke care plan can be made that welcomes input from loved ones.
Our specialist dementia staff are trained to meet each resident exactly where they are in their experience, and take it from there.
What Is The Person
A person-centred approach to healthcare is a way of organizing and providing services that places;the person at;the centre of planning and decision-making; that is respectful of individual beliefs and values and that doesnt make assumptions about people before understanding their life context and what is important to them.
A person-centred approach is respectful of all;persons;;what;I mean here is that;person-centred care has a focus on the quality of;the care that patients/service-users/families/care partners and so on receive, and of course that is;the focus for evaluating the effectiveness of care;services.
However, a person-centred approach considers the effectiveness of person-centred care alongside the;importance of it happening in a person-centred culture,;that is, a culture that respects the needs of those who are providing;the care and their value as persons.
For too long;the focus has been on service users without the concomitant focus on staff; focusing on one at the expense of;the other is fundamentally flawed, as shown in cases like the Mid-Staffordshire Inquiry and others.
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Data Synthesis And Analysis
All data analyses and syntheses were performed using comprehensive meta-analysis software, Version 3.0. The standardized mean difference was calculated with 95% conference interval , as the included studies used different measures in scoring outcomes. Additional subgroup analysis was performed to study heterogeneity between the studies using the I2 value. The included studies were divided into four subgroups on the basis of the following:
The severity of dementia in the study participants was determined using the mean mini mental state examination score. The severe dementia group had an MMSE score 10, and the less severe dementia group had an MMSE >10.
The intervention type: staff training or culture change vs individualized activities.
The duration of the intervention: short term =10 days3 months; long term =>3 months.